Virilization

What is virilization?

Virilization (pronounced “vee-ruh-lai-ZAY-shun”) is a process in which a female develops male characteristics or when a newborn has signs of male hormone exposure at birth. It can happen if your adrenal glands make too much male hormone (androgen) or if you take anabolic steroids.

Virilization is a sought-after outcome for many people receiving gender affirmation care. If you desire characteristics that are more traditionally male, talk to your healthcare provider about voluntary virilization.

Virilization in females vs. males

A person who is genetically female can develop virilization at any age. In adult women and people assigned female at birth (AFAB):

• Their breasts become smaller.
• Their uterus shrinks.
• Their clitoris enlarges.
• Their periods become irregular.

Virilization is less obvious in people who are genetically male. If signs aren’t apparent at birth, they may become apparent during puberty. Many males who produce excess androgen also start puberty earlier than their peers. In adult men and people assigned male at birth (AMAB), excess adrenal hormones might suppress testicular function and lead to infertility.

What are the symptoms of virilization?

Symptoms vary from person to person and may include:

• Increased facial or body hair.
• Acne or oily skin.
• Irregular periods.
• Male pattern baldness.
• Smaller breast size.
• Enlarged clitoris.
• Deepening of the voice.
• Increased sex drive.

What causes virilization?

The main cause of virilization is overproduction of male hormones (androgens).

Health conditions that may result in excess androgens include:

• Congenital adrenal hyperplasia.
• Polycystic ovary syndrome (PCOS).
• Cushing syndrome.
• Adrenal gland tumors (like adrenal adenoma).
• Ovarian tumors.

Virilization can also occur if you take anabolic steroids to enhance physical performance (more common in sports like weightlifting).

How is virilization diagnosed?

A healthcare provider will do a physical examination and review your symptoms and medical history. To confirm a diagnosis, they may request a:

• Blood test to measure your androgen levels.
• Imaging tests, like an ultrasound, CT (computed tomography) scan or MRI (magnetic resonance imaging) to get a better look at your adrenal glands or ovaries.

How is virilization treated?

It depends on the cause. Treatments to reverse virilization include:

• Glucocorticoids. This is a type of steroid that can suppress male hormone production in your adrenal glands. Healthcare providers use this treatment when a genetic condition (like congenital adrenal hyperplasia) is the culprit.
• Adrenal gland removal (adrenalectomy). When an adrenal tumor causes virilization, treatment usually involves surgical removal of the affected adrenal gland. Most adrenal tumors are benign (noncancerous). Rarely, they can be malignant (cancerous).
• Oophorectomy (removal of ovaries). Surgery is the standard treatment for ovarian tumors that cause virilizing symptoms. Depending on your age and whether you plan to become pregnant in the future, your provider may recommend a unilateral salpingo-oophorectomy. During this procedure, they remove one ovary and one fallopian tube to preserve the possibility of pregnancy.

Can virilization be prevented?

You can’t prevent virilization if you have a genetic condition that causes your symptoms. But you can successfully manage your condition with treatment.

Women and people AFAB who take anabolic steroids have an increased risk of virilization. If you take these medications, follow your healthcare provider’s instructions to reduce your risk of unwanted symptoms.

Is virilization reversible?

Virilization is typically reversible with appropriate treatment. Your healthcare provider will come up with a personalized plan that fits your needs.

There is, however, one possible exception regarding anabolic steroids. Women and people AFAB who develop virilizing symptoms because of them may experience permanent vocal changes. But some women can raise the pitch of their voice again through treatment at a specialized voice center.

When should I see my healthcare provider?

You know your body better than anyone. Call a provider any time you notice something out of the ordinary. If you suddenly develop thicker body hair or other symptoms that aren’t typical for you, let a provider know. They can find out why and let you know whether they recommend treatment.

Hirsutism vs. virilization: What’s the difference?

Hirsutism is when a woman or person assigned female at birth (AFAB) develops increased body hair — most commonly on their face, chest, belly, back and inner thighs. People who have hirsutism experience less severe symptoms compared to those who have virilization.

Like virilization, hirsutism can happen when your adrenal gland makes too much androgen. But it’s also a symptom of several other conditions like polycystic ovary syndrome (PCOS) and Cushing syndrome.

What is an undervirilized male?

The term “undervirilized male” refers to a person who is genetically male but produces lower-than-typical levels of male hormone (androgen). This results in female characteristics.