From the Guidelines
Elevated testosterone in a 76-year-old female is a concerning finding that warrants prompt evaluation for potential ovarian or adrenal pathology, with a focus on ruling out androgen-secreting tumors through imaging studies and comprehensive laboratory workup. The patient's advanced age and potential for significant morbidity and mortality associated with untreated androgen excess necessitate a thorough investigation. Possible causes of elevated testosterone in this age group include ovarian or adrenal tumors, although polycystic ovary syndrome (PCOS) is less likely due to the patient's age 1. Other potential causes, such as congenital adrenal hyperplasia, Cushing's syndrome, or certain medications like anabolic steroids or danazol, should also be considered.
Key clinical concerns associated with elevated testosterone in elderly women include:
- Virilization symptoms, such as hirsutism, deepening voice, clitoromegaly, male-pattern baldness, and increased muscle mass
- Increased cardiovascular risk
- Insulin resistance and potential for developing type 2 diabetes
- Potential for malignancy, particularly if an androgen-secreting tumor is present
Given the potential for significant morbidity and mortality, a comprehensive laboratory workup, including total testosterone (TT), calculated free testosterone (cFT), and other androgen measures, should be performed to confirm the diagnosis and guide further evaluation 1. Imaging studies, such as transvaginal ultrasound and adrenal CT scan, should also be conducted to rule out ovarian or adrenal tumors. Treatment will depend on the underlying cause, but may involve surgical intervention for tumors or medication management for non-neoplastic causes. In all cases, prompt evaluation and treatment are essential to mitigate potential morbidity and mortality associated with elevated testosterone in elderly women.
From the Research
Causes of Elevated Testosterone in a 76-year-old Female
- Elevated testosterone in a 76-year-old female can be caused by various factors, including androgen-secreting adrenal cortical adenoma, ovarian hyperthecosis, or androgen-secreting ovarian tumour 2
- Other rare causes of elevated testosterone include marked elevation of sex hormone-binding globulin (SHBG) due to medication with estrogenic effects, hyperthyroidism, or liver disease 2
- Polycystic ovarian syndrome (PCOS) is also a common endocrine disorder in women of reproductive age, characterized by hyperandrogenism, chronic anovulation, and insulin resistance 3, 4, 5, 6
Clinical Concerns
- Elevated testosterone levels can lead to clinical symptoms such as hirsutism, seborrhoeic acne, and irregular menstrual cycles 2, 3, 4, 5, 6
- Insulin resistance and metabolic syndrome are also common in women with PCOS, increasing the risk of developing cardiovascular diseases and type 2 diabetes 3, 4, 5
- The diagnosis of elevated testosterone should be interpreted with care, especially in patients with clear clinical symptoms of hyperandrogenism but normal testosterone levels 2
- Treatment options for hyperandrogenism in PCOS include metformin, anti-androgens such as spironolactone, and lifestyle modifications 3, 4, 5, 6
Diagnostic Approach
- Total testosterone assay is recommended as the first-line approach for investigating hyperandrogenism 2
- Dehydroepiandrosterone sulfate (DHEAS) assay should be performed if testosterone levels are twice the upper limit of normal 2
- Further evaluation, including imaging studies and hormonal assays, may be necessary to determine the underlying cause of elevated testosterone 2