Postmenopausal Virilization After Spousal Use of Topical Androgens

The document reports a case of a 63-year-old postmenopausal woman who experienced virilization symptoms such as vocal changes, male pattern hair loss, and clitoromegaly due to unintentional transdermal absorption of testosterone from her husband's use of topical androgen (Androgel). The couple was aware of the risk of transfer and took precautions, but the transfer occurred through a shared washcloth. The woman's symptoms and elevated testosterone levels began to regress after her husband stopped using the gel and further declined when he resumed use with additional precautions to prevent transfer. This case emphasizes the importance of considering exogenous androgen exposure in the differential diagnosis of virilization and the need for physicians to inform patients about the risk of transdermal transmission to partners when prescribing topical androgens. The patient's androgen levels were monitored over time, with total testosterone levels initially at 329 ng/dL and decreasing to 50 ng/dL after the cessation of her husband's Androgel use. The case underlines that virilization from exogenous androgens, although rare, can occur in adults and should be considered when more common causes are excluded.