Suffering From Hair Thinning. Blood Test Showed Elevated Levels Of Testosterone. Medications

Posted on Wed, 5 Jun 2013

Question: i went to a dermotolgist for thinning hair he did blood work and said my testosterone levels were elevated, go to gyn, was sent for ct scan of abdomen/pelvis, Impression:small low density bilateral adnexal lesion in pelvis most likely ovarian cyst also the right ovary apears to be mildly enlarged in overall size found 1.5 cyst on left ovary and 1.3 cyst on right. no free fluid is seen. Next was sent for ultrasound both ways, impression: uterus to be top normal in size, endometrium is not markedly thickened but is 7mm , I am 58 post menopausal also.right ovary is top normal in size and does contain 2.1cm somewhat hpoechoic solid mass no significant cyst is seen no significant free fluid, this is on right ovary possibility of hemmorrhagic, neoplastic or fibrotic lesion is considered although not present on XXXXXXX 2012 ultrasound. repeat ultrasound in 8 weeks for any change simle 1.1cm on left ovary. I have had a biospy of uterus, endometrium, both o.k but he did a pap and said 1 tiny cell showed displaysia,not worried. My question is should I wait 8 weeks for another ultrasound, do you feel this has anything to do with testosterone level, woulad the tiny displasia have anything to do with ovary i have had that before but not for 4-5 years. I am very nervous, not sleeping, so afraid of ovarian cancer. XXXXXXX 2012, only had simple cyst on left ovary, could something bad come in that short of time. I really feel o.k., except nerves are shot.

Answered by Dr. Dr. ARIF N K (31 minutes later)

Hello,

Thanks for your query.

I can understand your concerns; I will surely clear all your doubts. Let me come to the present scenario:

1) You are postmenopausal, but according to me 7mm is THICKENED, anything above 5mm is abnormal, as you said the biopsy is normal.
2) Solid ovarian mass of any size in post menopausal lady is again abnormal.
I can help you much better if you can send me your reports by mail, but I can reply to your question in detail only after 6 hrs from now (6AM Indian std time).
Kindly reply the following questions as well:
1) Do you any time had postmenopausal spotting or bleeding?
2) Do you have abnormal/foul smelling vaginal discharge?
3) Do you have any other medical problems like Diabetes/ HTN/ Thyroid problem?
4) Do you have gastric/ bladder/ bowel symptoms frequently?
5) When did you last got pelvic examination?

Waiting for your response,
Dr Arif

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Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. ARIF N K (56 minutes later)

I am sorry but I am not very good with computers, so I dont know how to send test results, to answer questions, I have had no spotting or bleeding, no foul or abnormal discharge, no problems with bladder or bowels , no frequent urination and moving bowels every day o.k. I was not due for my yearly exam till end of july, and like I said had a ulrasound last XXXXXXX 4 th 2012, and had no cyst on right ovary, just simple cyst on left. I read the tests results right from paper exactually as stated, should I wait 8 weeks like was told to by radiologist on ultrasound results or move forward. thank you

Answered by Dr. Dr. ARIF N K (7 hours later)

Hello,

Thanks for answering the questions.

You can take someone's help to scan the report and upload it here using the "Upload" feature available on this page. Alternatively you can mail it to YYYY@YYYY with a subject line "Attn: Dr. Arif Khan".

Nevertheless I will try to analyse from your history and give you my opinion. Hypoechoic solid mass in ovary in postmenopausal age is not normal. Though the size is small, one cannot differentiate benign vs malignant nature of a mass only based on the size. Few other features such as presence of septations, multilocularity, solid areas, bilaterality and fluid in abdomen need to be noted to differentiate them. Consider none of the other findings are there in this case, I strongly suggest you to do a CA-19 9, CA-125 tumour marker blood investigation.
My personal opinion is if the tumour markers are normal, you need not worry. You can wait for 8 weeks and get a repeat scan done.

Though your endometrial thickness is on higher side, we can note the changes in the follow up scan as well.

The aforementioned symptoms (which are absent currently) are concerning features. If at any point of time you develop postmenopausal bleeding or spotting symptoms, I think you should get a repeat endometrial biopsy.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.

Regards,
Dr. Arif

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. ARIF N K (9 hours later)

Thank you for your help, I did not see any mention of septations, multiocularity, and the reort said no significant fluid seen, when you say bilaterality, you don't mean if left cyst had 1.1 simple cyst on it that does not count? The only thing mentioned was nonspecific 2.1cm diameter solid lesion on right ovary. My doctor did not mention getting ca 125 blood test, I will have to question that, I had a ultrasound, last XXXXXXX 2012, and nothing was on right ovary, just simole cyst on left ovary. I have been under a lot of stress since loss of my son, so I am not coping well with anything, I do not want to do anything that could jeopardize my health for my families sake, they have been threw enough, also I do not have diabetes, or thyroid, I forgot to mention that last time , do you mind me asking why that would make a difference, or are you looking at a reason for testosterone levels and hair thinning? Also my doctor said the displaysia which was only tiny in cervix was not associated with ovarys, I had that 4-5 years ago he said just coincidence. thank You

Answered by Dr. Dr. ARIF N K (1 hour later)

Thank you XXXXXX for followup question...

I believe those features were not seen. Bilateral doesn't include small cysts which is not significant at all. Yes simple cysts do not count. I urge you to be relaxed and not to take stress. Life has its ups and downs.

facial hair growth. Now the main task is to find out where it is getting produced. Usual origin in your age group is Androgen producing ovarian tumour, adrenal tumour.

Dysplasia could go away on its own or, rarely cervical neoplasia. As you mentioned its mild, so no need to worry presently.
If you liked my answer, kindly rate my answers and write your valuable review.

Dr Arif
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. ARIF N K (1 hour later)

my ct-scan showed the adrenal gland was normal, I do not have any hydroagenism symptoms like excess hair growth anywhere, only thinning hair, My doctor does not think it is associated nor does the endocrinologist, I did have another testosterone blood test, have not got results yet. I just do not know from test results if I should wait 8 weeks or proceed forward and get ovarys removed, based on ct- scan and ultrasound reports what is your opinion, wait or take immediate action? What is your opinion that the lesion was not ther XXXXXXX 2012, and now is , can something bad come that quickly? Thank You

Answered by Dr. Dr. ARIF N K (33 minutes later)

Hello,

Not all ovarian tumours are malignant; it could be benign also. Therefore not all ovarian tumour need to be removed. Removal of ovaries is suggested only when pelvic and radiological findings are suspicious.

Based on your history and the ultrasound features provided, I do not feel you are dealing with a malignant concern. However without an opportunity to physically examine you, I would not be able to assist you. Therefore I suggest you get yourself examined by a good gynecologist, don't wait for 8 weeks. Follow up with a qualified gynecologist will keep you at best health as far as ovaries and pelvic organs are concerned.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.
If all your queries are answered, please write your review after closing the discussion.

Wish you good health.

Regards,
Dr Arif

PS: If you wish to write to me in future, you can consult me again directly through my profile
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Above answer was peer-reviewed by : Dr. Prasad