Investigation of Hirsutism: Testosterone is Not Enough

Carter, G D; Holland, S.; Alaghband-Zadeh, J.; Rayman, Gerry; Dorrington-Ward, P; Wise, P. H.

doi:10.1177/000456328302000502

Cited by 118 publications

(56 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recently Carter et al 5 showed that a free androgen index (total testosterone/SHBG) gave a better discrimination between clinically hirsute and non-hirsute patients than either of these measurements alone. However it has yet to be shown whether an empirical index or a derived free-androgen value is as efficient as measuring the actual free testosterone concentration in establishing abnormal androgen status in hirsute women.…”

Section: Discussionmentioning

confidence: 99%

Plasma Free Testosterone—is An Index Sufficient?

1985

View full text Add to dashboard Cite

SUMMARY.Only about 50% of women who are clinically hirsute have a raised total plasma testosterone concentration; in those cases where the total testosterone is normal the free testosterone may, in fact, be raised. Since the measurement of free testosterone is tedious, workers have used an androgen index or a calculated free testosterone concentration from the measurements of total testosterone and sex-hormone-binding globulin. We have examined the correlation between measured free testosterone, a derived free testosterone and an androgen index in hirsute women, normally menstruating women and non-hirsute women on oral contraceptive therapy. These three measures of the free testosterone concentration in blood gave similar results in all cases.It is well documented that only about half the cases of female hirsutism are associated with raised plasma total testosterone values. I, 2 The testosterone circulating in blood is mostly bound to either sex-hormone-binding globulin (SHBG) or albumin, with only about 1% unbound in female plasma.l As it has been suggested that only the unbound or free portion is available to target tissues it seems more appropriate to measure the free testosterone concentration for a more comprehensive evaluation of endocrine status. Unfortunately the methods for its determination are complex, tedious and unsuited for routine analyses.After computing a formula for the relationship between plasma free testosterone and SHBG Anderson et al. 4were able to calculate a derived free testosterone concentration from the measurements of total testosterone and SHBG concentration. Recently Carter et al. 5 showed that a free androgen index (total testosterone/SHBG) gave a better discrimination between clinically hirsute and non-hirsute patients than either of these measurements alone. However it has yet to be shown whether an empirical index or a derived free-androgen value is as efficient as measuring the actual free testosterone concentration in establishing abnormal androgen status in hirsute women.We have measured total testosterone concentration (T); free testosterone concentration (mIT); SHBG-binding capacity (as nmollL Correspondence: Dr M J Wheeler. dihydrotestosterone bound); T/SHBG ratio; and a derived free-testosterone concentration (dIT) in hirsute women, non-hirsute normallymenstruating women, and women taking oral contraceptive therapy. Patients and methodsSerum samples were collected from 18 nonhirsute normally-menstruating women (mean age 28·4 years, range 21--41; Group N), 21 non-hirsute women taking oral contraceptive therapy (mean age 24·8 years, range 18-35; Group P), and 50 hirsute female patients (mean age 28·7 years, range 20·39; Group H).Plasma T was measured by the radioimmunoassay method of Wheeler and Luther" after an initial ether extraction, and SHBG-binding capacity was measured as the amount of 14C_ dihydrotestosterone bound by a modification of the method of Rosner.7 These assays had a within-assay precision of 4·7% and 5·0% and a between-assay precision of 7·7% and 9·0%, r...

show abstract

Section: Discussionmentioning

confidence: 99%

Plasma Free Testosterone—is An Index Sufficient?

1985

View full text Add to dashboard Cite

show abstract

“…Free androgen index (FAI) was determined as follows: FAIZtestosterone (nmol/l)!100/SHBG (nmol/l) (17). The homeostasis model assessment of IR (HOMA-IR) index was calculated as follows: HOMA-IRZfasting insulin (mIU/ml)!fasting glucose (mg/dl)/405 (18).…”

Section: Methodsmentioning

confidence: 99%

Association between menstrual cycle irregularities and endocrine and metabolic characteristics of the polycystic ovary syndrome

Panidis

Τζιόμαλος

Chatzis

et al. 2013

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: Insulin resistance (IR) is frequent in polycystic ovary syndrome (PCOS) and contributes to the increased risk for type 2 diabetes mellitus and cardiovascular disease of this population. Several markers of IR are used but most are expensive or have limited sensitivity and specificity. Preliminary data suggest that the menstrual cycle pattern correlates with IR in PCOS but existing studies are small. We aimed to assess the relationship between the type of menstrual cycle irregularities and IR in PCOS. Design: Prospective study. Methods: We studied 1285 women with PCOS, divided according to the menstrual cycle pattern. Results: Patients with isolated secondary amenorrhea and those with secondary amenorrhea alternating with regular menstrual cycles were more insulin resistant than patients with regular cycles (Group D). Patients with isolated oligomenorrhea were also more insulin resistant than Group D. However, patients with oligomenorrhea alternating with regular cycles, secondary amenorrhea, or polymenorrhea had comparable levels of markers of IR with Group D. Moreover, patients with oligomenorrhea alternating with regular cycles were less insulin resistant than patients with secondary amenorrhea alternating with regular cycles. Finally, patients with isolated polymenorrhea and those with polymenorrhea alternating with regular cycles had comparable levels of markers of IR with Group D. Conclusions: Amenorrhea is associated with more pronounced IR in PCOS, and oligomenorrhea portends a less excessive risk for IR than amenorrhea whereas polymenorrhea appears to be even more benign metabolically. Therefore, the type of menstrual cycle abnormality appears to represent a useful tool for identifying a more adverse metabolic profile in PCOS.

show abstract

“…Free androgen index (FAI) was determined as follows: FAIZtestosterone (nmol/l)! 100/SHBG (nmol/l) (20). The homeostasis model assessment of IR (HOMA-IR) index was calculated as follows: HOMA-IRZfasting insulin (mIU/l)!glucose (mg/dl)/405 (21).…”

Section: Methodsmentioning

confidence: 99%

The clinical significance and primary determinants of hirsutism in patients with polycystic ovary syndrome

Panidis

Τζιόμαλος

Papadakis

et al. 2013

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: Hirsutism is frequently present in patients with polycystic ovary syndrome (PCOS) and is a major sign of hyperandrogenism. However, other disorders frequently present in PCOS, particularly abdominal obesity and insulin resistance (IR), have also been implicated in the development of hirsutism in this population but relevant data are limited. We aimed to define the determinants of the presence of hirsutism in PCOS. Design: Observational study. Methods: We studied 1297 patients with PCOS (age 24.3G5.8 years, BMI 26.8G6.9 kg/m 2 ). Hirsutism was defined as a modified Ferriman-Gallwey score R8. Results: Women with hirsutism were younger, had greater BMI, and had higher levels of circulating androgens than women without hirsutism; markers of IR did not differ between the two groups after adjustment for age and BMI. The prevalence of hirsutism progressively declined with age, was lower in normal-weight women than in overweight and obese women, and was comparably prevalent in the hyperandrogenemic phenotypes of PCOS. In binary logistic regression analysis, independent predictors of the presence of hirsutism were younger age, larger waist circumference (W), and higher serum testosterone levels. In stepwise linear regression analysis, the Ferriman-Gallwey score independently correlated with age, W, free androgen index, and serum D 4 -androstenedione and DHEAS levels. Conclusions: Besides hyperandrogenemia, abdominal obesity, and young age are independently associated with the presence of hirsutism. In contrast, the relationship between IR and hirsutism appears to be mediated by the more severe obesity of insulin-resistant patients with PCOS.

show abstract

Investigation of Hirsutism: Testosterone is Not Enough

Cited by 118 publications

References 7 publications

Plasma Free Testosterone—is An Index Sufficient?

Plasma Free Testosterone—is An Index Sufficient?

Association between menstrual cycle irregularities and endocrine and metabolic characteristics of the polycystic ovary syndrome

The clinical significance and primary determinants of hirsutism in patients with polycystic ovary syndrome

Contact Info

Product

Resources

About