Virilization

Introduction

• Description: Virilization refers to the loss of female sexual characteristics such as body contour and the acquisition of masculine qualities such as increased muscle mass, temporal balding, deepening of the voice, and clitoromegaly.

• Prevalence: Uncommon.

• Predominant Age: Reproductive age.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Idiopathic ovarian (polycystic ovary syndrome, hilus cell hyperplasia/tumor, arrhenoblastoma, adrenal rest), adrenal (congenital adrenal hyperplasia [10%–15% of women with hirsutism], Cushing’s disease, virilizing carcinoma or adenoma), drugs (minoxidil; androgens, including danazol, phenytoin, diazoxide, valproate), pregnancy (androgen excess of pregnancy, luteoma, or hyperreactio luteinalis). In premenopausal women, polycystic ovarian syndrome is the most common cause; in postmenopausal women, it is usually associated with ovarian hyperthecosis or an androgen-secreting tumor.

• Risk Factors: None known.

Signs and Symptoms

• Amenorrhea (common but not universal)

• Temporal or frontal balding

• Deepening of the voice

• Clitoral enlargement

• Vaginal dryness

• Increased muscle mass

• Male-pattern hair growth

Diagnostic Approach