Serum levels of sex hormones in vulvar lichen sclerosus, and the effect of topical testosterone.

Lichen sclerosus is a chronic cutaneous disorder of unknown cause that most commonly occurs on the vulva in postmenopausal women. Earlier investigations suggested that the affected tissue is reversibly atrophic and that it has normal metabolic potential. The present study was designed to determine whether levels of sex steroid hormones in serum are altered in this disease and how they are affected by topical testosterone, a recognized form of therapy. As compared with normal values for age, serum levels of dihydrotestosterone, free testosterone, and androstenedione were significantly decreased in patients with untreated vulvar lichen sclerosus. Dihydrotestosterone and testosterone levels rose and exceeded normal values after therapy. These results suggest that abnormal enzymatic activity (5 alpha-reductase) may be responsible for this disease and indicate a need for similar studies of the disorder in other locations.