Evidence of biochemical hyperandrogenism in women: The limitations of serum testosterone quantitation

Abstract

Hyperandrogenism in women is a common clinical scenario and is characterised by menstrual disturbance, hirsutism and infertility. Accurate measurement of serum testosterone is often used in these patients to diagnose polycystic ovary syndrome (PCOS) and to prompt further investigation in patients with suspected androgen-secreting tumours. Immunoassay methods are commonly used for serum testosterone quantitation, although the ‘gold standard’ reference method is mass spectrometry (MS), which is only available at certain tertiary centres. In this retrospective observational study, 57 female patients were investigated for possible hyperandrogenism. Biochemical testing for testosterone using an immunoassay was compared to an MS method. Correlation between the immunoassay and MS method was worse at lower testosterone concentrations, however overall, gave a reasonably strong correlation coefficient of 0.73. This study highlights the ongoing controversy over the most reliable test for hyperandrogenism in clinical practice. It is vital that clinicians are aware of the limitations of these methods and the clinical repercussions.

Keywords::

• Hyperandrogenism polycystic ovarian syndrome
• testosterone

Acknowledgements

We acknowledge with gratitude the efforts of Ann Ainsworth and Sally Kilsbie in helping to locate patients’ clinical notes for data collection.

Ethical approval

The study was approved by the audit committee of our department and the local ethic committee was aware of the study. Formal ethical approval was not deemed necessary as the study was primarily a service evaluation and audit.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.