Approach to Investigation of Hyperandrogenism in a Postmenopausal Woman

November 2022 in “ The Journal of Clinical Endocrinology and Metabolism ”

Angelica Lindén Hirschberg

hyperandrogenism androgenic alopecia androgen polycystic ovary syndrome PCOS ovarian hyperthecosis androgen-secreting tumors adrenal tumors nonclassic congenital adrenal hyperplasia Cushing's syndrome serum testosterone antiandrogen therapy hysterectomy bilateral salpingo-ophorectomy clitoromegaly

Studysummary This review discusses the causes and recommended clinical investigations for postmenopausal hyperandrogenism, highlighting the role of androgen excess in symptoms like hirsutism and its association with metabolic disorders.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

Postmenopausal hyperandrogenism is a condition characterized by excess androgen, leading to symptoms such as increased hair growth, acne, androgenic alopecia, and virilization. It can also be associated with metabolic disorders like abdominal obesity, insulin resistance, and type 2 diabetes. The most common cause is polycystic ovary syndrome (PCOS), but it can also be caused by ovarian hyperthecosis, androgen-secreting ovarian or adrenal tumors, nonclassic congenital adrenal hyperplasia, and Cushing's syndrome. Diagnosis involves determining serum testosterone levels, with levels >5 nmol/L requiring investigation for a potential tumor. Imaging techniques are used to locate the source of androgen excess. Treatment includes surgical removal of an adrenal tumor or bilateral oophorectomy for curative treatment, or antiandrogen therapy for mild to moderate symptoms. A case study of a 66-year-old woman with suspected androgen-dependent hair loss showed that after undergoing hysterectomy and bilateral salpingo-ophorectomy, her testosterone levels normalized and most symptoms subsided, though androgenic alopecia and clitoromegaly remained.

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