Androgen Excess Treatment & Management

Updated: Mar 14, 2018
  • Author: Mohamed Yahya Abdel-Rahman, MD, MSc; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Treatment

Medical Care

Women with mild hirsutism can be treated safely and effectively by most primary care providers after serious etiologies have been excluded. Those with more significant symptoms or life-threatening disease should be referred to specialists. Women with emotional distress regardless of the degree of symptoms often benefit from referral for psychological support.

Women with significant acne or hirsutism that does not respond to standard therapy are often best treated in conjunction with a dermatologist and sometimes a medical or reproductive endocrinologist. Women with signs of virilization should be evaluated by a medical endocrinologist. Likewise, women with significant adrenal disease require the expertise of a medical endocrinologist and possibly a surgeon specializing in adrenal tumors.

Women with PCOS should be comanaged with an obstetrician-gynecologist or reproductive endocrinologist, particularly if infertility is a factor. Those with ovarian tumors should be evaluated and treated by an obstetrician-gynecologist or a gynecologic oncologist.

Many women are familiar with different hair removal methods like shaving, waxing, and using depilatory creams. They are all easy, safe, and inexpensive; however, mild skin irritation either due to local trauma or chemical reaction may occur. [80] Women using these methods can be reassured that these methods do not exacerbate hair growth, but they will not lower the androgen levels if they are elevated. Combining one of these local measures with systemic treatment might help achieve rapid response and better patient satisfaction.

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Surgical Care

Surgical removal is the standard therapy for ovarian and adrenal tumors that result in androgen excess. Surgery for PCOS is less commonly performed today, since adhesions routinely occur after both wedge resection and ovarian drilling. However, infertile women with PCOS who are resistant to clomiphene citrate are sometimes treated with laparoscopic ovarian drilling to avoid the risks and expenses associated with ovulation induction with gonadotropins or IVF. [81]

A retrospective study by Christ and Falcone found that in women with PCOS, bariatric surgery significantly reduced androgen levels, leading to a substantial drop in the percentage of women who met the criteria for hyperandrogenism. [82]

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Consultations

Women with mild hirsutism can be treated safely and effectively by most primary care providers after serious etiologies have been excluded. Those with more significant symptoms or life-threatening disease should be referred to specialists. Women with emotional distress regardless of the degree of symptoms often benefit from referral for psychological support.

Women with significant acne or hirsutism that does not respond to standard therapy are often best treated in conjunction with a dermatologist and sometimes a medical or reproductive endocrinologist. Women with signs of virilization should be evaluated by a medical endocrinologist. Likewise, women with significant adrenal disease require the expertise of a medical endocrinologist and possibly a surgeon specializing in adrenal tumors.

Women with PCOS are should be comanaged with an obstetrician-gynecologist or reproductive endocrinologist, particularly if infertility is a factor. Those with ovarian tumors should be evaluated and treated by an obstetrician-gynecologist or a gynecologic oncologist.

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Diet

In women who are obese, a modification of life style and weight loss are pivotal. Suppression of hair growth is unlikely without weight loss. [26] A loss of 5-10% of body weight for obese women with PCOS in a 6-month period is enough to greatly improve hirsutism in most women. [83]

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Activity

Regular exercise and behavioral modification programs are essential for acute and long-term weight management. Different exercise regimens have been advocated from 30 minutes 3 times a week, to 10 minutes multiple times a day, to 1 hour of exercise most days of the week. The best program is one that the patient will actually follow. [84]

Restricting calories should accompany increased energy expenditure. When applying calorie restriction and exercise to a group of women with PCOS, one study found an average weight loss of 15 lb, a 92% ovulation rate, and a 33-45% spontaneous pregnancy rate. [85]

Unfortunately, lifestyle modification and weight loss programs require prolonged patient motivation and are therefore difficult to achieve beyond the research setting. Advice alone is typically ineffective at promoting sustained weight loss.

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