testosterone in women

[mandy1442]

hello. i am 32 years old and my doctor found out in sept.2008 (1 year after my 2nd boy was born) that my testosterone level is highly elevated. current lab test did show again it is still elevated (level was 95, range is: 20-70). i am also hypothyroid and take Levothyroxine 50mcg since dec.2008. my current lab level of TSH was 1.45, all other also normal. my female hormones are in range too. all my other blood test CBC CMP etc. were normal too, some to the lower side, but still in range. have irregular periods since always, lucky to have 2 boys. had always some cysts on my ovaries which always caused pain or not and went away on their own. but was hard to even get pregnant. this year my periods come every few months and some of them for 2 weeks slow, inbetween 1 was 1 week very heavy with clots, than my last one from sept.4 til sept.27 2009 slow flow. is it PCOS? also have breast pain, will have a mammogram next week because have high history of cancer (incl.breast) in my family (fathers side). and always tired, in pain (body aches, acne a lot!!!!!!!!!!!!!!! and more body and facial hair, weight gain which didnt change even with taking levothyroxine!, also headaches, swollen lymphnodes everywhere, had big painful swelling over right knee that i sometimes could walk or almost not, comes in flares, sometimes both legs, no energy, etc.)  need any advise! thanks so much.

[Elaine Brown, MD]

HI!
Your story certainly sounds a lot like PCOS!  The other possibility is congenital adrenal hyperplasia.  If you want to sort the two out, a 17 hydroxyprogesterone level would be a good test.  Also, DHEAS is another good test.  Many women with PCOS also have an elevated prolactin level, and since you have thyroid issues, I would certainly want to check your level if you were my patient.
One of the best medications for treating PCOS is oral contraceptives--these cause the body to produce a protein called sex hormone binding globulin which binds up and inactivates excess testosterone.  Another good medication is Spironolactone--this must be used with the birth control pill (it can cause birth defects) and works by blocking the action of testosterone.  This combination of medications will get rid of most of your symptoms ( irregular periods, hair growth, acne, ovarian cysts). But obviously are not going to help you get pregnant if you are going for a girl!
You might want to see a good endocrinologist in addition to your gynecologist.
Good luck!
Dr B

[mandy1442]

hi dr.brown. thanks so much for your answer.
my prolactin level is in range the nurse from my doctor told me so, also my RF and the ANA too. but i was reading my other test again and will give you some numbers, maybe you can tell me is it good or not good, the tests were done in a time i didnt have so much pain or symptoms. today my symptomes are really worse. maybe i shall test my blood every month? i also will have a ultrasound for abdomen and pelvic, this will be on nov16, mammogr. next week or so. i still have since almost 3 months very strong tailbone pain.sometimes really deep down sometimes higher. hear that can be from fibroids or something like that? i had my last period  sept.4-27.2009, just 2 days with ultra light spotting on oct15+16. thats it. what do you think? hope the ultrasound will give me some answers.
here are my levels:
TSH 1.45
T3 Uptake 31%
T4 (Thyroxine) Total, 10.3 mcg/dL
Free T4 Index (T7) 3.2
Hemoglobin in CBC Test: 13.5
LDL: 66
HDL: 59
Cholest.Total: 135
Triglyc.: 51
CMP - Glucose (fasting): 87
Urea Nitrogen: 8
FSH: 4.5 (in what phase may i be when i dont get my periods?)
LH: 9.5 mIu/mL
Progesterone Total: 1.2 ng/mL (which I think is low)
Estradiol: 63 pg/mL
Testosterone: 95 ng/dL

I sound like a man, i look like a man (back hair and facial hair, lots of hair on legs since always)
we dont want kids anymore. have enough.

what about cushings syndrom (syndrome)? my hands and feet feel often so swollen and hot but they are not swollen. and i broke some glasses etc because i couldnt grap, had knee swelling for over 9 months, breast tenderness with swellings on ribbone both breast and under armpits...

or even with this test results in peri-menopause?

HELP