From the Guidelines
Elevated testosterone in adult females is most commonly caused by Polycystic Ovary Syndrome (PCOS), affecting 10-13% of women, as well as other conditions such as congenital adrenal hyperplasia, ovarian and adrenal tumors, and certain medications. According to the most recent study 1, PCOS is a common endocrine disorder affecting women throughout their lifespan, with a prevalence of approximately 10-13% globally. The study also highlights that biochemical hyperandrogenism is a hallmark and diagnostic feature of PCOS, and that total testosterone (TT) and free testosterone (FT) are the most accurate androgen measurements for assessing biochemical hyperandrogenism in PCOS diagnosis.
Other causes of hyperandrogenism in adult females include:
- Congenital adrenal hyperplasia, a genetic disorder affecting adrenal gland function, which can increase testosterone production 1
- Ovarian and adrenal tumors, though rare, can secrete excessive testosterone 1
- Certain medications like anabolic steroids, testosterone supplements, and some fertility treatments can raise testosterone levels 1
- Cushing's syndrome, caused by excessive cortisol, may also increase testosterone production 1
- Insulin resistance and obesity contribute to elevated testosterone as fat tissue converts other hormones to testosterone 1
- Thyroid disorders, particularly hypothyroidism, can disrupt hormone balance 1
Diagnosis of hyperandrogenism typically involves blood tests measuring hormone levels, such as TT and FT, as well as ultrasound imaging, and sometimes MRI or CT scans 1. The most recent study 1 recommends using TT and FT as the first-line laboratory tests to assess biochemical hyperandrogenism in the diagnosis of PCOS, and suggests that laboratories should utilize liquid chromatography with tandem mass spectrometry (LC-MS/MS) for androgen measurement given its high accuracy. Treatment depends on the underlying cause and may include lifestyle changes, hormonal contraceptives, anti-androgen medications like spironolactone, metformin for insulin resistance, or surgery for tumors 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Causes of Hyperandrogenism in Adult Females
The causes of hyperandrogenism in adult females can be attributed to various factors, including:
- Ovarian hyperthecosis, a condition characterized by the presence of nests of luteinized theca cells in the ovarian stroma, leading to persistent testosterone release 2
- Polycystic ovary syndrome (PCOS), a hormonal disorder that can cause hyperandrogenism, often accompanied by symptoms such as hirsutism, acne, and oligomenorrhea 3, 4
- Androgen-secreting tumors of ovarian or adrenal origin, which can lead to severe signs of hyperandrogenism, including virilization 3, 5, 4, 6
- Congenital adrenal hyperplasia, a genetic disorder that can cause hyperandrogenism, particularly in women with non-classical forms of the condition 3, 5, 4
- Cushing's disease, a rare endocrine disorder caused by an ACTH-producing pituitary adenoma, which can lead to hyperandrogenism 3, 5
- Hyperprolactinemia, a condition characterized by elevated prolactin levels, which can contribute to hyperandrogenism 3
- Iatrogenic hyperandrogenism, which can occur due to exogenous androgen administration or other medical treatments 5
Diagnostic Considerations
Diagnosing the underlying cause of hyperandrogenism in adult females requires a comprehensive approach, including:
- Laboratory tests to assess serum testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate, androstenedione, and inhibin B levels 5
- Imaging studies, such as ultrasound or computed tomography scans, to evaluate ovarian or adrenal morphology 4, 6
- Clinical evaluation of symptoms, including the severity and duration of hyperandrogenism, as well as the presence of accompanying signs such as hirsutism, acne, or virilization 3, 5, 6
Treatment Options
Treatment for hyperandrogenism in adult females depends on the underlying cause and may involve:
- Surgical intervention, such as laparoscopic bilateral salpingo-oophorectomy or tumor resection, for androgen-secreting ovarian tumors 2, 4, 6
- Pharmacotherapy, including anti-androgen medications, gonadotropin-releasing hormone agonists, or metformin, to manage symptoms and reduce androgen production 2, 5, 4