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Role of endogenous estrogen in the hirsutism paradigm.

The study of women with androgen excess as a biologic experiment in nature may improve our understanding of hormonal determinants of cardiovascular risk. These women, who have androgen and estrogen excess, also have altered apolipoprotein metabolism, which correlates with insulin resistance. They often have android obesity, which appears to aggravate their metabolic alterations. Insulin resistance seems to have more of an influence on altered apolipoprotein metabolism than does endogenous ovarian androgen or estrogen, at least in hirsute women who are obese. It is hypothesized that adrenal dehydroepiandrosterone sulfate may modify the effects of insulin resistance, as reflected in androgen and apolipoprotein lipid metabolism. These hormonal interactive influences, which require further investigation, may hold clues to why men and women differ in the time of onset of the multifactorial problem of coronary vascular disease.