Can testosterone cause vulvar sebaceous cysts?

Testosterone Does Not Cause Vulvar Sebaceous Cysts

There is no evidence supporting that testosterone causes vulvar sebaceous cysts, and topical testosterone is no longer recommended for vulvar conditions due to ineffectiveness and risk of virilization. 1

Understanding Sebaceous Cysts and Vulvar Conditions

Sebaceous cysts are benign, encapsulated subepidermal nodules filled with keratin material that typically occur in areas with body hair 2. While sebaceous glands are abundant on the vulva, sebaceous cysts in this region are not directly linked to testosterone use in the available evidence.

Factors associated with sebaceous gland conditions:

• Advanced age
• Exposure to UV radiation
• Immunosuppression
• Hormonal changes (regulated by insulin levels, TSH, and cortisol) 3

Historical Use of Testosterone for Vulvar Conditions

Topical testosterone was historically used for vulvar conditions, particularly lichen sclerosus (LS), but current guidelines strongly recommend against this practice:

• British Association of Dermatologists guidelines explicitly state there is no supportive evidence for topical testosterone use in vulvar conditions 1
• Older studies suggested some benefit from topical testosterone in vulvar dystrophy, but more recent research has demonstrated that:
  • It is not as effective as clobetasol propionate
  • It is no more effective than an emollient
  • In maintenance therapy after topical corticosteroid, it performed worse than an emollient control 1

Risks of Topical Testosterone

When topical testosterone was used for vulvar conditions, significant side effects were documented:

• Severe hirsutism with other signs of virilization
• Markedly elevated serum testosterone levels 4
• Significant worsening of symptoms in patients with lichen sclerosus after switching from clobetasol propionate to testosterone 5
• Expensive treatment with risk of virilization with overuse 1

Current Treatment Recommendations for Vulvar Conditions

For vulvar conditions like lichen sclerosus, current guidelines recommend:

1. First-line treatment: Ultrapotent topical corticosteroids (clobetasol propionate 0.05%)

   • Documented to be safe and effective
   • Provides significant improvement in symptoms 1

2. Maintenance therapy:

   • Continue topical corticosteroids as needed
   • Regular emollients/moisturizers are useful for symptom control 5

Sebaceous Gland Conditions of the Vulva

For sebaceous gland conditions of the vulva, such as sebaceous hyperplasia:

• Isotretinoin therapy may be considered
• Dermatology consultation is recommended for proper management 3
• Surgical excision may be necessary for symptomatic sebaceous cysts 2

Important Caveats

• Vulvar sebaceous conditions can be diagnostically challenging due to their polymorphous clinical presentation 3
• Interdisciplinary care between gynecology and dermatology is often needed
• Any persistent or changing vulvar lesions should be evaluated for potential malignancy, as sebaceous carcinoma of the vulva, while rare, can occur 6

For patients with vulvar sebaceous cysts, proper diagnosis through biopsy may be necessary to rule out malignancy, and treatment should focus on addressing the cysts directly rather than hormonal manipulation.