From the Guidelines
Yes, it is recommended to stop oral contraceptives before testing testosterone levels for PCOS evaluation. Ideally, patients should discontinue combined oral contraceptives for at least 2-4 weeks prior to testing, as these medications can suppress testosterone production and alter sex hormone binding globulin (SHBG) levels, potentially masking the hormonal abnormalities characteristic of PCOS 1. When testing for PCOS, clinicians typically measure total testosterone, free testosterone, and SHBG, along with other hormones like LH, FSH, prolactin, and TSH to rule out other conditions.
Key Considerations
- The timing of the test is also important - it should ideally be performed in the early follicular phase of the menstrual cycle (days 3-5) for the most accurate results.
- If a patient cannot discontinue contraceptives due to medical necessity, this should be clearly noted when interpreting results, as the values may not accurately reflect the patient's baseline hormonal status.
- After testing is complete and if PCOS is diagnosed, oral contraceptives may actually be part of the treatment plan for managing symptoms.
Diagnostic Approach
- The detection of hyperandrogenism in women with PCOS can be accomplished clinically through assessment of hirsutism, acne or androgenic alopecia, or via biochemical testing of circulating androgen concentrations 1.
- Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is considered the reference standard for assessing steroids including androgens, but its use is limited by technical complexity and accessibility 1.
- Immunoassay methods are widely available, but the results of total testosterone (TT) and calculated free androgen index (FAI) can be influenced by fluctuations in SHBG levels, which are affected by age, weight, and medication use 1.
From the Research
Testing for Testosterone in Female Patients with PCOS
When evaluating a female patient for Polycystic Ovary Syndrome (PCOS) by testing their testosterone levels, it is essential to consider the potential impact of oral contraception on the results.
- The use of oral contraceptives can affect testosterone levels, as they often contain estrogen and progestin, which can influence hormone production 2, 3.
- Studies have shown that oral contraceptives can decrease testosterone levels in women with PCOS, with some treatments normalizing elevated testosterone levels within a few weeks to months 2, 3.
- However, the effect of oral contraceptives on testosterone levels can vary depending on the type and dosage of the contraceptive, as well as individual patient factors 4.
- To accurately assess testosterone levels, it may be necessary for patients to stop taking oral contraceptives for a certain period before testing, although the optimal duration for this is not clearly established in the provided studies.
- It is crucial to weigh the potential benefits of oral contraceptives in managing PCOS symptoms against the need for accurate testosterone level testing, and to consider alternative diagnostic approaches or adjustments to treatment regimens as needed 5, 6.