From the Guidelines
A patient with hyperandrogenism should consult an endocrinologist, who specializes in hormone-related disorders, as they are specifically trained to diagnose and treat conditions involving hormonal imbalances, including elevated testosterone levels. According to the most recent study on evaluating the diagnostic accuracy of androgen measurement in polycystic ovary syndrome 1, hyperandrogenism is a key diagnostic criterion for PCOS, and accurately diagnosing biochemical hyperandrogenism presents considerable challenges. Endocrinologists are equipped to conduct a thorough evaluation, including blood tests to measure hormone levels, imaging studies like ultrasounds, and a detailed medical history.
In some cases, particularly when hyperandrogenism is related to polycystic ovary syndrome (PCOS), a reproductive endocrinologist or gynecologist with expertise in hormonal disorders may also be appropriate. The specialist will typically use liquid chromatography-tandem mass spectrometry (LC-MS/MS) as the reference standard for assessing steroids, including androgens, to accurately diagnose biochemical hyperandrogenism.
Treatment approaches vary depending on the underlying cause and may include medications such as spironolactone, which blocks testosterone effects; oral contraceptives to regulate hormones; metformin to improve insulin sensitivity; or specific treatments for underlying conditions like congenital adrenal hyperplasia or adrenal tumors. Consulting the right specialist is crucial because hyperandrogenism can have various causes ranging from PCOS to adrenal disorders, pituitary abnormalities, or certain medications, each requiring different treatment approaches.
Key considerations in the diagnosis and treatment of hyperandrogenism include:
- Accurate measurement of androgen levels using LC-MS/MS
- Evaluation of clinical and biochemical hyperandrogenism
- Assessment of ovulatory dysfunction and polycystic ovary morphology
- Consideration of underlying causes, such as PCOS, adrenal disorders, or pituitary abnormalities
- Individualized treatment approaches based on the underlying cause and patient needs.
From the Research
Specialist for High Testosterone
To manage high testosterone levels, also known as hyperandrogenism, patients should consult an endocrinologist 2, 3, 4.
- An endocrinologist is a specialist who deals with the diagnosis and treatment of disorders related to hormones, including those that cause high testosterone levels.
- They can investigate the underlying cause of hyperandrogenism, which may include non-classical congenital adrenal hyperplasia (NCCAH), polycystic ovary syndrome (PCOS), or other conditions 2, 3, 4.
- The endocrinologist will perform diagnostic tests, such as the Synacthen test and molecular testing, to confirm the diagnosis and develop a treatment plan 2.
- Treatment may involve hydrocortisone supplementation, oral contraceptives, and/or antiandrogens to decrease androgen levels and alleviate symptoms such as hirsutism and acne 2, 5.
When to Consult a Specialist
Patients with symptoms of hyperandrogenism, such as:
- Hirsutism (excessive hair growth)
- Acne
- Androgenic alopecia (male-pattern baldness)
- Irregular menstrual cycles
- Subfertility
should consult an endocrinologist for proper evaluation and treatment 2, 3, 4.