Obesity and Androgens in Women.

Androgen excess is often associated with obesity states, at any age of life, because of changes in the pattern of secretion or metabolism of androgens and in their actions at the level of target tissues, particularly the adipose tissue. Androgen excess plays an important role in favouring the expansion of visceral fat, which characterize so-called visceral obesity. Moreover, there is evidence that the combination of androgen excess and obesity may favour the development of metabolic disorders, such as the metabolic syndrome and type 2 diabetes. In obese adolescent girls, androgen excess may also suggest the potential development of the polycystic ovary syndrome (PCOS). A new hypothesis, based on long-term lifestyle intervention programs or bariatric surgery, supports the concept that a "PCOS secondary to obesity" may exist, as confirmed by the complete resolution of all features defining PCOS after considerable weight loss. Obesity can also develop after long-term exposure to chronic stress, which is characterized by increased activity of the hypothalamic-pituitary-adrenal axis and the sympathetic system combined with higher than normal androgen production rates in women. This increasingly observed condition, often underestimated, should be considered more carefully, not only in mature women but also in girls during adolescence. The presence of a hyperandrogenic state can also be detected in menopausal women, as a consequence of the rearrangement of the sex hormone balance which, in turn, may play some role in determining the development of both visceral adiposity and even obesity and, consequently, metabolic disorders. Undoubtedly, the recognition of the potential negative effects of androgen excess in obese women may open new therapeutic perspectives aimed at achieving a sustained weight loss and its maintenance for as long as possible.