Virilization secondary to topical testosterone

Topical testosterone is recognized as a standard treatment for vulvar lichen sclerosus et atrophicus. Systemic androgenic side effects of this medication are widely believed to be uncommon and mild. A case is reported of severe hirsutism with other signs of virilization and markedly elevated serum testosterone levels secondary to use of topical testosterone propionate for vulvar lichen sclerosus et atrophicus. Caution is necessary in the use of topical testosterone, with close monitoring for signs of virilization. Alternative treatments for this condition, such as intralesional corticosteroids or topical progesterone, are recommended to avoid the risk of androgenic side effects.