Medroxyprogesterone acetate for the evaluation of hypertestosteronism in hirsute women

Twenty-three women with moderately elevated plasma testosterone levels (77 to 240 ng/dl) received 10 mg of medroxyprogesterone acetate (MPA) orally, three times daily, for 3 months or more. The testosterone levels were reduced to normal (less than 70 ng/dl) in 21 patients, suppressed partially in 1 patient, and unchanged in 1 patient. The removal of an ovarian teratoma normalized the testosterone level in the patient whose levels had failed to suppress with MPA. On therapy, the mean plasma testosterone concentration decreased 60%, apparent free testosterone decreased 31%, and dihydrotesterone decreased 34% (P less than 0.001, P = 0.05, and P = 0.01, respectively). A small decrease in the testosterone-binding capacity did not reach statistical significance. Experience with this simple trial suggests that extensive diagnostic testing may not be required in women with hirsutism and moderately elevated testosterone levels.