What is the role of lab studies in the evaluation of androgen excess?

Updated: Apr 07, 2020
  • Author: Mohamed Yahya Abdel-Rahman, MD, MSc; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Laboratory evaluation should be part of the workup for every woman who seeks treatment for signs or symptoms of androgen excess, such as hirsutism. Although the most common cause of androgen excess in women is PCOS, some women with only mild hirsutism are found to have an androgen-secreting neoplasm, for which early diagnosis and treatment can be life saving. Furthermore, delay in diagnosis and appropriate treatment of non-life-threatening conditions can result in irreversible virilization. Fortunately, the basic laboratory evaluation for hirsutism is relatively inexpensive.

Some organizations recommend laboratory evaluation (and imaging studies) only for women with moderate or severe hirsutism (mFG >15). [66] Exceptions are made for Asian women, hirsutism of sudden onset, and the presence of other symptoms suggesting underlying pathology. However, for the reasons mentioned above, a basic laboratory evaluation can be justified in all women seeking treatment for hirsutism. [67, 21] A 2012 position statement from the Androgen Excess and Polycystic Ovary Syndrome Society recommends basic hormonal evaluations for every woman who presents with hirsutism. [68]

Laboratory tests can be divided into (1) basic screening tests and (2) diagnostic tests indicated for signs and symptoms suggestive of specific pathology. [21] The following screening tests should be performed in all women presenting with signs of increased androgens.

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