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Idiopathic
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No known cause
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Exposure to exogenous estrogens
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• Dermal and hair preparations (e.g. lavender and tea tree oils)
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• Milk and meat of cows treated with estrogens
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Illness
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• Liver disease (e.g. cirrhosis)
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• Renal failure
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• Thyrotoxicosis
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• Malnutrition
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Neoplasia
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• Adrenal
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• Testicular
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Congenital adrenal hyperplasia
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• (Late-onset) 21-hydroxylase deficiency (21-OHD)
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• 11-beta-hydroxylase deficiency
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• Overexpression of aromatase
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Other hormonal aberrations
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• Androgen deficiency (e.g. congenital adrenal hyperplasia)
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• Androgen insensitivity
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• Extraglandular aromatization of androstenedione (e.g. aromatase excess syndrome (AES), obesity)
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Medication
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• Anti-androgens (e.g. bicalutamide, flutamide, finasteride, spironolactone)
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• Antimicrobials (e.g. antiretrovirals, isoniazid, ketoconazole, metronidazole, penicillamine)
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• Antineoplastic and immunomodulators (e.g. alkylating agents, bleomycin, cisplatin, cyclosporine, methotrexate, vincristine)
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• Gastrointestinal agents (e.g. cimetidine, metoclopramide, omeprazole, ranitidine)
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• Cardiovascular (e.g. amiodarone, amlodipine, angiotensin-converting enzyme inhibitors, calcium channel blockers, digitoxin, fibrates, reserpine, spironolactone, statins)
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• Hormones (e.g. androgens, chorionic gonadotropin, estrogens, GnRH agonist, GH)
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• Neurologic/psychiatric (e.g. haloperidol, methylphenidate, opioids, risperidone, TCAs)
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• Drugs of abuse (e.g. alcohol, amphetamines, heroin, marijuana, methadone)
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