Plasma Testosterone in Idiopathic Hirsutism, and the Changes Produced by Adrenal and Ovarian Stimulation and Suppression

Plasma testosterone values in the basal state were within normal range (0.03–0.20 μg/100 ml) in 40 women with idiopathic hirsutism. Corticotropin stimulation tests were done in 8 patients; in 7, plasma testosterone increased significantly, and 1 patient tested at 4-hr intervals after 1 injection of ACTH gel showed maximal increase at 4 hr. Stimulation tests resulted in elevation of plasma testosterone in 3 of 4 nonhirsute female control subjects. Dexamethasone suppression tests resulted in significant reduction in plasma testosterone in 5 of 9 patients. HCG was given to 10 patients. No response in plasma testosterone was seen in the first 24 hr after 1500 U was given to 2 patients on 3 successive days, or after 12,000 U to 1 patient on 2 successive days, the adrenals being suppressed in all 3. A single injection of 24,000 U given to 1 patient while adrenal suppression was maintained resulted in a significant rise only after 72 hr. A single injection of 12,000 U was given, without adrenal suppression, to 3 women; a marked increase in plasma testosterone, delayed until 96 hr after injection, occurred in 1; increase occurred within 24 hr and was sustained for 96 hr in 1; and the third showed only slight increase by 72 hr. HCG stimulation preceded by a course of FSH in 3 patients resulted in a significant change at 72 hr. In only 1 of the 3 patients given FSH did plasma testosterone rise before injection of HCG. Estrogen-progestogen preparations reduced the plasma testosterone in 2 of 3 patients in whom serial estimations were performed. The failure of ovarian stimulation to produce a ready response in plasma testosterone levels tends to deny the ovaries an important role in testosterone production