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Evaluation and management of postmenopausal hyperandrogenism

Janet E Hall, MD
Section Editors
William F Crowley, Jr, MD
Robert L Barbieri, MD
Deputy Editor
Kathryn A Martin, MD


The presentation of new onset hyperandrogenism is extremely rare in postmenopausal women. In premenopausal women, the most common cause of androgen excess is polycystic ovary syndrome (PCOS). In contrast, when hyperandrogenism develops de novo or progresses in postmenopausal women, it is usually associated with other causes, such as ovarian hyperthecosis or an androgen-secreting tumor.

The etiology, clinical presentation, diagnosis, and management of postmenopausal hyperandrogenism are reviewed here. Detailed information on the severe causes of postmenopausal hyperandrogenism and the evaluation of hyperandrogenism in premenopausal women are reviewed separately. (See "Ovarian hyperthecosis" and "Sex cord-stromal tumors of the ovary: Sertoli-stromal cell tumors" and "Clinical presentation and evaluation of adrenocortical tumors" and "Evaluation of premenopausal women with hirsutism".)


Endogenous androgens are produced by the adrenal glands and the ovaries in both pre- and postmenopausal women [1]. With aging, there is a dramatic decrease in adrenal androgens, principally dehydroepiandrosterone (DHEA) and its sulfate (DHEAS), from their peak in early adulthood [2-4]. Changes in ovarian androgen secretion as a function of age and menopause are far less dramatic, with longitudinal studies centered on the final menstrual period showing that total testosterone levels decrease only slightly, with a somewhat greater decrease in sex hormone-binding globulin (SHBG) [2,5]. (See "Overview of androgen deficiency and therapy in women", section on 'Androgen production'.)

Normal androgen levels in postmenopausal women vary depending on the type of assay done and the laboratory in which they are done, but they are generally within or near the following ranges [6-9]:

Total testosterone – 20 to 70 ng/dL (0.5 to 2.8 nmol/L)

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Literature review current through: Nov 2017. | This topic last updated: Jan 03, 2017.
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