BACKGROUND Previous studies have demonstrated changes in the lipidic profile following treatment with ketoconazole. However, the possible influence in patients with hyperandrogenism treated with this drug and its possible relation with the evolution of the hormonal pattern is unknown. RESULTS Thirty-seven women with no tumoral hyperandrogenism treated with ketoconazole for 9 months (400 mg/day) were studied during treatment and one month after suppression of the medication. The study included the evaluation of total cholesterol, HDL cholesterol, triglycerides, LDL cholesterol and hormonal determinations of estradiol, androstenedione, testosterone, dehydroepiandrosterone, sulphate and sex hormone binding globulin. RESULTS A rapid and significant decrease of LDL cholesterol and total cholesterol was observed (p < 0.01) which was reversible upon discontinuation of treatment. The HDL cholesterol levels and triglycerides did not modify. The final hormonal profile was more favorable with a significant reduction of testosterone and dehydroepiandrosterone sulphate (p < 0.01) and an increase in estradiol (p < 0.01). No statistical correlation was observed between the changes of sexual steroids and the changes in the lipidic pattern. CONCLUSIONS In patients with non tumoral hyperandrogenism treated with ketoconazole the modifications of the steroid hormone profile do not appear to be related with changes in lipidic metabolism.