Ovarian Leydig Cell Hyperplasia as a Rare Cause of Hair Loss in a Postmenopausal Female Patient: A Case Report and Diagnostic Approach Toward Postmenopausal Hyperandrogenism

An 84-year-old postmenopausal woman with androgenetic alopecia and a significantly elevated serum testosterone level (19 nmol/l) was diagnosed with benign bilateral Leydig cell hyperplasia, a rare cause of hyperandrogenism after menopause. Despite normal imaging of the adrenals and ovaries, a laparoscopic bilateral salpingo-oophorectomy was performed after other causes were excluded, revealing the Leydig cell hyperplasia upon histopathological examination. The patient's serum testosterone normalized (0.5 nmol/l) one week post-surgery, indicating that Leydig cell hyperplasia can be a hidden cause of hyperandrogenism in postmenopausal women and may require surgical intervention for diagnosis and treatment.