Elevated serum testosterone, hirsutism, and virilism associated with combined androgen-estrogen hormone replacement therapy.

Nine postmenopausal women with symptoms and signs of androgen excess due to long-term use of an injectable androgen-estrogen combination were studied retrospectively. Cosmetically disturbing hirsutism was the major complaint in eight subjects. Other symptoms included hot flushes, decreased libido, mood changes, depression, and postmenopausal bleeding in the one patient with an intact uterus. Seven women had clitorimegaly; the clitoral index ranged from 45-120 mm2 (normal up to 35). Serum total testosterone levels were elevated in eight women, ranging from 5.7-14.9 nmol/L (normal up to 2.43). The androgen-estrogen combination was discontinued and oral or transdermal estrogen replacement was instituted. In five women followed serially for 16-24 months, elevated testosterone levels required 12-20 months to return to the normal premenopausal range.