Treatment for Elevated Testosterone Levels Post Menopause
Spironolactone is the recommended first-line treatment for elevated testosterone levels in postmenopausal women, with doses typically starting at 25-100 mg daily. 1
Evaluation and Diagnosis
Before initiating treatment, a thorough evaluation is necessary to determine the cause of elevated testosterone:
- Rule out androgen-producing tumors of the adrenal glands or ovaries, which are rare but serious causes of postmenopausal hyperandrogenism 2
- Measure serum testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate, androstenedione, and inhibin B 2
- Consider magnetic resonance imaging of adrenal glands or ovaries if an etiological source of androgen hypersecretion is suspected 2
- Evaluate for worsening of pre-existing conditions such as polycystic ovary syndrome, congenital adrenal hyperplasia, ovarian hyperthecosis, or Cushing syndrome 2
Treatment Options
First-line Treatment:
- Spironolactone: Start with 25-100 mg daily, administered in either single or divided doses 1
- Titrate dose at two-week intervals based on clinical response and testosterone levels
- Doses greater than 100 mg/day generally do not provide additional benefit
- Monitor for potential side effects including hyperkalemia, especially in patients with reduced renal function
Additional Treatment Options:
GnRH agonists/antagonists: Consider for women who are either unfit for surgery or in whom the source of elevated testosterone is unidentified 2
Surgical intervention: May be necessary if an androgen-producing tumor is identified 2
Monitoring and Follow-up
- Regular monitoring of testosterone levels to assess treatment efficacy 2
- Monitor for clinical improvement of hyperandrogenic symptoms (hirsutism, acne, alopecia) 2
- Assess for potential cardiovascular and metabolic complications, as elevated testosterone can lead to hypercholesterolemia, insulin resistance, and hypertension 2
Special Considerations
Health Implications of Elevated Testosterone
Elevated testosterone in postmenopausal women is associated with:
- Hirsutism and other manifestations of hyperandrogenism such as acne and alopecia 2
- Metabolic consequences including hypercholesterolemia, insulin resistance, and hypertension 2
- Potential negative impact on cardiovascular health 2
Testosterone Therapy Considerations
While this question addresses treating elevated testosterone, it's worth noting that testosterone therapy is sometimes prescribed for postmenopausal women with hypoactive sexual desire disorder:
- Testosterone therapy should not be used in women with elevated testosterone levels 3, 4
- Testosterone therapy is only appropriate for women with documented low testosterone causing sexual dysfunction 4, 5
- When prescribed for hypoactive sexual desire disorder, transdermal patches and topical gels are preferred formulations 4, 6
Pitfalls to Avoid
- Failing to rule out androgen-producing tumors before initiating treatment 2
- Not monitoring for metabolic and cardiovascular complications of hyperandrogenism 2
- Using testosterone therapy in women who already have elevated testosterone levels 4, 5
- Overlooking the potential benefits of spironolactone as an anti-androgenic medication 1