From the Guidelines
Treatment for elevated testosterone in women should prioritize combined oral contraceptives and anti-androgen medications, such as spironolactone, to manage symptoms and address the underlying cause, as supported by the most recent evidence from 2019 1.
Introduction to Treatment Options
The primary goal of treatment is to reduce testosterone levels, manage symptoms such as hirsutism and acne, and improve quality of life.
- Combined oral contraceptives containing ethinyl estradiol with progestins like drospirenone or cyproterone acetate are first-line treatments for women with polycystic ovary syndrome (PCOS) 1.
- Spironolactone (50-200 mg daily) is often added for its anti-androgenic effects, particularly for treating hirsutism and acne, with a reported improvement in 17 of 20 (85%) patients in one study 1.
Additional Treatment Considerations
- Metformin (500-2000 mg daily) may be prescribed, especially for women with insulin resistance, as it improves insulin sensitivity and indirectly lowers testosterone, with significant improvement in 18 of 25 patients (72%) in a 24-week uncontrolled, prospective study 1.
- For women with more severe hirsutism, finasteride (2.5-5 mg daily) or flutamide may be considered, though these require careful monitoring, with anecdotal evidence supporting their use in 4 reports 1.
Lifestyle Modifications and Monitoring
- Lifestyle modifications including weight loss through diet and exercise are crucial components of treatment, as even modest weight reduction can significantly improve hormonal profiles.
- Regular monitoring of hormone levels, liver function, and metabolic parameters is essential during treatment, with individualized approaches based on symptoms, fertility desires, and the specific cause of testosterone elevation.
From the FDA Drug Label
Desogestrel, in combination with ethinyl estradiol, does not counteract the estrogen-induced increase in SHBG, resulting in lower serum levels of free testosterone (96 to 99) The FDA-approved drug label for ethinyl estradiol 2 suggests that it can be used to treat conditions related to hormonal imbalance.
- Ethinyl estradiol can increase sex hormone-binding globulin (SHBG), which can lead to a decrease in free testosterone levels.
- This makes ethinyl estradiol a potential treatment option for elevated testosterone in women. However, it is essential to consult a healthcare professional for proper diagnosis and treatment, as ethinyl estradiol may have varying effects on different individuals.
From the Research
Treatment Options for Elevated Testosterone in Women
- Combined oral contraceptives (COCs) containing drospirenone have been shown to be effective in reducing testosterone levels and improving hirsutism symptoms in women 3, 4.
- A prospective randomized trial comparing low-dose ethinyl estradiol and drospirenone 24/4 COC vs. ethinyl estradiol and drospirenone 21/7 COC found that both regimens significantly decreased total and free testosterone levels and improved hirsutism scores 3.
- Another study found that a drospirenone-containing COC had better outcomes in terms of persistent regular cycles, antiandrogenic effect, fall in BMI and BP, better lipid profile, and favorable glycemic and hormonal profile compared to a desogestrel-containing COC in women with polycystic ovary syndrome (PCOS) 4.
Measurement and Diagnosis
- Serum testosterone measurements have significant limitations in the female population, and measurements themselves are not always informative in patient diagnosis, treatment, or prognosis 5.
- The Endocrine Society Clinical Practice guideline recommends against making a diagnosis of androgen deficiency in women at present due to the lack of a well-defined clinical syndrome and normative data on total or free testosterone levels across the lifespan 6.
Therapeutic Use of Testosterone
- The International Society for the Study of Women's Sexual Health Clinical Practice Guideline recommends the use of systemic transdermal testosterone for women with hypoactive sexual desire disorder (HSDD) not primarily related to modifiable factors or comorbidities 7.
- The guideline suggests that a total testosterone level should not be used to diagnose HSDD, but as a baseline for monitoring, and that patients should be assessed for signs of androgen excess and total testosterone levels monitored to maintain concentrations in the physiologic premenopausal range 7.