Endocrine Evaluation of Hyperandrogenism in Women

Hyperandrogenism in women encompasses a spectrum of clinical manifestations including hirsutism, acne, androgenetic alopecia, menstrual dysfunction, and virilization. Although polyendocrine metabolic ovarian syndrome accounts for the majority of cases, a systematic endocrine evaluation is essential to identify less common but clinically significant etiologies including androgen-secreting tumors, ovarian hyperthecosis, congenital adrenal hyperplasia, and cortisol excess. Total testosterone liquid chromatography-tandem mass spectrometry measurement in women has refined thresholds for further evaluation across the reproductive lifespan leading to appropriate diagnosis. This article synthesizes current evidence and expert guidance on clinical assessment, biochemical testing, and diagnostic strategies for hyperandrogenism.