From the Guidelines
A testosterone level of 423 pg/ml in a woman's saliva is significantly elevated and warrants immediate medical evaluation by an endocrinologist or gynecologist to rule out conditions such as polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia, adrenal or ovarian tumors, or certain medications. The elevated testosterone could indicate hyperandrogenism, which is a clinical hallmark of PCOS, a complex syndrome with metabolic, reproductive, and psychological characteristics, as discussed in the study by 1. Symptoms associated with high testosterone in women may include irregular menstrual cycles, acne, excessive hair growth (hirsutism), male-pattern baldness, deepening voice, and changes in body composition.
According to the study by 1, the diagnostic accuracy of androgen measurement in PCOS is crucial, and total testosterone (TT) and free testosterone (FT) are recommended as the first-line laboratory tests to assess biochemical hyperandrogenism in the diagnosis of PCOS. The study by 1 also supports the use of TT and FT as the first-line laboratory tests, and suggests that liquid chromatography with tandem mass spectrometry (LC-MS/MS) is the most accurate method for measuring androgens.
Treatment depends on the underlying cause but might include oral contraceptives to suppress testosterone production, anti-androgen medications like spironolactone (50-200 mg daily), or specific treatments for identified conditions, as discussed in the study by 1. Lifestyle modifications such as maintaining a healthy weight through diet and exercise can also help manage symptoms. It's essential to confirm this result with blood testing, as saliva testing for hormones can sometimes be less reliable than serum measurements, and a comprehensive hormone panel would provide better diagnostic information.
The study by 1 provides the most recent and highest quality evidence, and its findings should be prioritized in the diagnosis and management of PCOS. Therefore, the patient should undergo further evaluation, including blood tests to confirm the elevated testosterone level and to rule out other potential causes, and should be referred to an endocrinologist or gynecologist for further management.
From the Research
Testosterone Levels in Women
- The normal testosterone level in women can vary, but a level of 423 in saliva is not directly comparable to serum levels due to differences in measurement methods 2.
- Salivary testosterone levels have been proposed as a possible substitute for serum testing, but studies have shown that there is no strong correlation between salivary and serum testosterone levels in postmenopausal women 2.
- In women with polycystic ovary syndrome (PCOS) or other hyperandrogenic disorders, testosterone levels can be elevated, leading to symptoms such as hirsutism and menstrual irregularity 3, 4, 5.
Hyperandrogenism in Women
- Hyperandrogenism in women is associated with an increased risk of cardiovascular disease and metabolic syndrome, particularly in premenopausal women 4.
- The diagnosis of hyperandrogenic disorders, such as PCOS or congenital adrenal hyperplasia, requires a thorough medical history, physical examination, and measurement of basal hormone levels and dynamic tests 5.
- Women with poorly controlled congenital adrenal hyperplasia are at increased risk of developing PCOS, highlighting the importance of routine screening and monitoring of hormonal control 6.
Measurement of Testosterone Levels
- The current gold standard for measuring biologically active testosterone is serum free testosterone by equilibrium dialysis, but alternative methods such as salivary testing are being explored 2.
- Salivary testosterone levels may not be a reliable indicator of testosterone levels in women, and further research is needed to determine the validity of this method 2.