Virilization

Virilization may be caused by:

• Excess testosterone production
• Use of anabolic steroids (used for performance-enhancement or other purposes)

In newborn boys or girls, the condition may be caused by:

• Certain medicines taken by the mother during pregnancy
• Congenital adrenal hyperplasia in the baby or the mother
• Other medical conditions in the mother (such as tumors of the ovaries or adrenal glands that release male hormones)

In girls who are going through puberty, the condition may be caused by:

• Polycystic ovary syndrome
• Certain medicines, or anabolic steroids
• Congenital adrenal hyperplasia
• Tumors of the ovaries, or adrenal glands that release male hormones (androgens)

In adult women, the condition may be caused by:

• Certain medicines, or anabolic steroids
• Tumors of the ovaries or adrenal glands that release male hormones

Signs of virilization in a female often depend on the level of testosterone in the body.

Low level (common):

• Thick, dark facial hair in the beard or mustache area
• Increase in body hair
• Oily skin or acne
• Irregular menstrual periods

Moderate level (uncommon):

• Male-pattern baldness
• Loss of female fat distribution
• Decreased breast size

High level (rare):

• Enlargement of the clitoris
• Deepening of the voice
• Male muscle pattern

Tests may include:

• Blood tests to detect excess testosterone or other androgen hormones in females
• CT scan, MRI, or ultrasound to check for tumors of the ovaries and adrenal glands

If virilization is caused by exposure to androgens (male hormones) in female adults, many of the symptoms go away when the hormones are stopped. However, deepening of the voice is a permanent effect of exposure to androgens.

Bulun SE, Babayev E. Physiology and pathology of the female reproductive axis. In: Melmed S, Auchus RJ, Goldfine AB, Rosen CJ, Kopp PA, eds. Williams Textbook of Endocrinology. 15th ed. Philadelphia, PA: Elsevier; 2025:chap 15.

Pitteloud, N, Papadakis GE, Jacobs AN. Physiology and disorders of puberty. In: Melmed S, Auchus RJ, Goldfine AB, Rosen CJ, Kopp PA, eds. Williams Textbook of Endocrinology. 15th ed. Philadelphia, PA: Elsevier; 2025:chap 23.

White PC. Sexual development. In: Goldman L, Cooney KA, eds. Goldman Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 214.

Updated by: Linda J. Vorvick, MD, Clinical Professor Emeritus, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.