Elevated Testosterone Secondary to Leydig Cell Hyperplasia in Bilateral Ovaries

A 64-year-old postmenopausal woman presented with hirsutism, generalized hair loss, terminal hairs on her face and chest, and acne after stopping hormone replacement therapy. Her testosterone levels were significantly elevated at 119 ng/dL, which is above the normal range of 2-45 ng/dL. Other hormonal levels were within normal limits. Imaging studies, including transvaginal ultrasound, CT, and MRI, did not reveal any significant adrenal or ovarian masses. However, after persistent symptoms and consistently high testosterone levels, reaching up to 170 ng/dL, the patient underwent a bilateral salpingo-oophorectomy. Postoperative testosterone levels dropped to 18 ng/dL and remained normal, with her symptoms resolving over the following months. Surgical pathology revealed Leydig cell hyperplasia in both ovaries, identifying it as the rare cause of her elevated testosterone levels and hyperandrogenism symptoms.