Approach to Investigation of Hyperandrogenism in a Postmenopausal Woman

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.