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Endogenous Hyperandrogenism in Women and Its Influence on Exercise Capacity and Athletic Performance: A Narrative
Karolina Galas1, Paulina Lewandowska1
1Department of Internal Medicine, Medical University of Warsaw, Warsaw, POL.
Cureus
|July 13, 2026
Summary
High natural androgen levels in women may enhance exercise ability, particularly in those with differences of sex development (DSDs). However, results for polycystic ovary syndrome (PCOS) and congenital adrenal hyperplasia (CAH) are inconsistent, requiring further research.
Area of Science:
- Endocrinology and Sports Medicine
- Physiology of Exercise
- Women's Health
Background:
- Endogenous hyperandrogenism in women, seen in PCOS, CAH, and DSDs, is increasingly relevant to sports medicine and athletic regulations.
- While exogenous androgens benefit athletes, the effects of naturally elevated endogenous androgen levels on female exercise capacity are less understood.
- Androgens like testosterone may influence bone formation, muscle hypertrophy, red blood cell production, and oxygen delivery, potentially offering athletic advantages.
Purpose of the Study:
- To review existing literature on the association between endogenous hyperandrogenism and exercise capabilities in women.
- To evaluate the methodologic quality of studies examining high natural androgen levels and their impact on muscle strength, aerobic capacity, and hematologic parameters.
- To assess potential physiological advantages conferred by endogenous hyperandrogenism in female athletes.
Main Methods:
- Comprehensive literature search of PubMed/MEDLINE and Google Scholar.
- Manual screening of reference lists from identified articles.
- Inclusion of peer-reviewed articles examining endogenous androgens and exercise in women.
Main Results:
- Current evidence suggests that excessive endogenous androgen levels are linked to greater lean body mass, higher hemoglobin concentrations, and improved aerobic capacity compared to women with normal androgen levels.
- The strongest consensus for these benefits was observed in women with differences of sex development (DSDs).
- Data from women with polycystic ovary syndrome (PCOS) and congenital adrenal hyperplasia (CAH) showed inconsistent findings.
Conclusions:
- A potential physiological advantage from endogenous hyperandrogenism may exist in select groups of women, particularly those with DSDs.
- The extent of this advantage varies significantly depending on the specific hyperandrogenic condition (DSDs, PCOS, CAH).
- Further research with well-designed studies is necessary to clarify these relationships and inform clinical practice and regulatory policies.
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