Androgen excess: Investigations and management

    Daria Lizneva, Larisa Gavrilova-Jordan, Walidah Walker, Ricardo Azziz
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    TLDR The conclusion is that managing androgen excess requires long-term treatment, including hormonal contraceptives and androgen blockers, with follow-up after six months.
    The document from 2016 provides an overview of the evaluation and management of androgen excess (AE), a condition often associated with polycystic ovary syndrome (PCOS) that can lead to hirsutism, acne, and female pattern hair loss (FPHL). It emphasizes the importance of using the modified Ferriman-Gallwey method to score hair growth and the need for high-quality assays to measure biochemical hyperandrogenism, including total and free testosterone levels. Management strategies include hormonal contraceptives and androgen blockade, with treatments varying in response time—acne often improves quickly, hirsutism takes 6 to 8 months, and FPHL may take 12 to 18 months to respond. The document also discusses various treatments for hirsutism, such as hormonal contraceptive combinations, antiandrogens, insulin sensitizers, and cosmetic approaches, noting that combined treatments are often more effective than monotherapy. For acne and FPHL, it mentions the effectiveness of hormonal contraceptives with antiandrogenic progestins, topical agents, and 2% topical minoxidil, respectively. Laser therapy and intense pulsed light (IPL) are highlighted as effective hair removal techniques. The document underscores that medical therapies for AE are often lifelong, with follow-up recommended at least six months after initiating treatment.
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