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Question of the Month

Q:  Is there treatment for a high level of testosterone in women? What causes a high level of testosterone? Can you please tell me what medication I can use?

High levels of testosterone in women can definitely be treated. In my experience though, many women with this problem are never diagnosed or, if they are, little is done about it.

The first step is to determine whether the extra testosterone is coming from the ovary or adrenal glands or both. Special testing can determine this. Then the cause of the abnormality needs to be found. Most common is polycystic ovary syndrome (PCOS) which affects over 5% of women. I'll have an article about this on my website very soon. When the problem is in the adrenal, it may be simply that the gland makes slightly more testosterone than it should for unknown reasons. Or there may be a condition known as late onset or non-classical congenital adrenal hyperplasia. In this case there is a deficiency of an enzyme which causes the adrenal to make the wrong proportion of hormones. Diagnosing this requires somewhat elaborate testing.

But to get to treatment: When testosterone comes from the ovary, the level can be lowered by oral contraceptives and sometimes by insulin-sensitizing medications originally developed for diabetes. If from the adrenal, by low doses of dexamethasone which is a form of cortisone.

Other medications can block the effects of testosterone such as spironolactone. These are all discussed in the article on unwanted hair.

If the level of testosterone is very high -- 150 ng/dL or higher, then a tumor needs to be ruled out. These are very rare but can occur. To get the right treatment, it is best to consult a physician experienced in treating excess testosterone in women.

Hope this is helpful.

Sincerely,
Geoffrey Redmond, MD


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