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Adolescent hyperandrogenism demands puberty-specific diagnostics and integrated, evidence-based care to balance hormonal, metabolic, and mental health outcomes.
Adolescent hyperandrogenism, often linked to polycystic ovary syndrome (PCOS), androgen-secreting tumors, and non-classic congenital adrenal hyperplasia presents major diagnostic challenges due to its overlap with normal puberty. Hence, this narrative review assessed diagnostic accuracy and treatment efficacy, underscoring the need for puberty-specific criteria and integrated, multidisciplinary care.
Researchers examined evidence from PubMed, Scopus, Web of Science, EMBASE, and Cochrane (2000–2025), prioritizing the 2023 PCOS guidelines, randomized trials, and large cohort studies (n ≥ 50). Non–peer-reviewed sources were excluded. Data from 122 studies were analyzed to evaluate safety, and quality-of-life outcomes.
Diagnostic Frameworks Still Lack Adolescent-Specific Precision
The study highlighted significant shortcomings in current diagnostic approaches. Age-specific biochemical cutoffs for testosterone, dehydroepiandrosterone sulfate (DHEA-S), and 17-hydroxyprogesterone remain poorly defined in adolescents, leading to inconsistent diagnoses.
Similarly, imaging criteria—particularly ovarian ultrasound findings—are often unreliable in teenagers due to rapid pubertal ovarian changes. The authors note that applying adult imaging thresholds may lead to overdiagnosis or unnecessary anxiety.
Therapeutic Landscape: Beyond Combined Oral Contraceptives
Combined oral contraceptives (COCs) continue to serve as first-line therapy for menstrual regulation and androgen suppression. However, emerging data underscore pivotal considerations:
Mental Health: A Major Yet Overlooked Component
One of the most striking findings is the high prevalence of psychological comorbidities. Anxiety and depression affect 38–45% of adolescents with hyperandrogenism, yet mental health screening is inconsistently integrated into routine care.
Experts emphasize that a purely hormonal approach is insufficient. A multidisciplinary model incorporating dermatology, gynecology, endocrinology, and psychology is fundamental to improve long-term outcomes.
Critical Gaps Highlighted for Future Research
The authors call for urgent research addressing three major gaps:
A Roadmap for Individualized Care
As adolescent hyperandrogenism continues to rise, the review stresses the requisition for evidence-based, patient-centered care pathways. Establishing age-appropriate reference standards, exploring safer therapeutic options, and embedding psychological support into routine practice will be key to improving health trajectories.
World Journal of Pediatrics
Adolescent hyperandrogenism: diagnostic challenges and therapeutic approaches
Marcio J. Concepción-Zavaleta et al.
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