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High Testosterone in Women: Signs, Causes, and Treatment

Testosterone is predominantly recognized as a male hormone, but it is also produced in the ovaries and female adrenal glands in small quantities. There is now increased speculation about testosterone levels in women due to recent media coverage on track star Caster Semenya, who was barred from competing due to her naturally high levels of testosterone. In her case, as with many other women, there was an underlying condition that required further examination.

A woman with high testosterone symptoms

Women normally secrete significantly lower levels of testosterone than men. Normal levels for a woman range from 15–70 nanograms per deciliter (ng/dL), whereas it typically ranges from 280–1,100 ng/dL for men. Hormone levels in the body vary from day-to-day and also throughout the course of the day.

Woman’s Age (years) Normal testosterone level (ng/dL)
10–11 < 7–44
12–16 < 7–75
17–18 20–75
19+ 8–60

Small amounts of testosterone are usually released into a woman’s bloodstream from the ovaries and adrenal glands. Testosterone helps a woman maintain bone mass, generate new blood cells, maintain libido, and regulate moods. The combined effect of testosterone and estrogen assists with the growth, repair, and maintenance of a woman’s reproductive tissues.

In most cases, high testosterone levels in women are usually due to an underlying medical condition such as polycystic ovary syndrome (PCOS) or congenital adrenal hyperplasia.

In some cases, a group of conditions labeled intersex could be the cause, wherein the person has chromosomal, hormonal, or physiological sex variations that don’t fit into the typical definition of male or female. In very extreme cases, high testosterone levels in women could be an indication of a more severe medical condition where tumors may be present on the ovaries or the adrenal glands.

High testosterone symptoms in women include:

  • Acne
  • Excess facial, chest, back, or other body hair
  • Thinning hair
  • Irregular periods
  • Mood swings
  • Enlarged clitoris
  • Increased muscle mass
  • Reduction in breast size
  • Loss of sex drive
  • Deepening of voice

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In severe cases, high testosterone levels in women can lead to obesity and infertility.

There are various conditions that cause fluctuations in a woman’s hormone levels. Some of the leading causes of high testosterone levels in women are polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia (CAH), thyroid problems, and insulin resistance.

PCOS is one of the causes of high testosterone levels in women

PCOS is an endocrine condition that affects 1 in 10 women worldwide. PCOS interferes with menstrual cycles and makes it difficult to get pregnant.

These are some common symptoms of PCOS:

  • Excess or thinning body hair
  • Enlarged ovaries (which develop follicles, but don’t release eggs regularly)
  • Menstrual irregularity, infrequency, or longevity 
  • Obesity
  • Acne
  • Apple-shaped body

PCOS can also lead to numerous infertility challenges, increased risk of heart disease, sleep apnea, and Type 2 diabetes.

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The underlying cause of PCOS isn’t definitively known, but most women with PCOS have symptoms similar to other high testosterone symptoms. Genetics and excess insulin also appear to be contributing factors to PCOS. In addition, PCOS is associated with low levels of HDL (ie. ''good'' cholesterol), insulin resistance, heightened triglycerides, high LDL (ie. ''bad'' cholesterol), obesity, and high blood pressure. Fortunately, there are a variety of remedies to treat ovarian cysts.

Hirsutism in women is defined by the growth of unwanted hair. The symptoms of hirsutism include male-patterned hair growth that is usually dark and coarse on the chest, back or face.

In cases of exceptionally high testosterone in women, symptoms may also include:

  • Reduced breast size
  • Balding
  • Enlarged clitoris
  • Acne
  • Bulky muscles
  • Deepening of voice

CAH is a collective group of inherited disorders associated with the adrenal glands, which produce the hormones cortisol and aldosterone. These hormones help regulate the body’s metabolism and blood pressure. The adrenal glands also secrete the male sex hormones DHEA and testosterone.

Women with CAH lack an enzyme needed to help regulate the secretion of these hormones, so they produce too little cortisol and too much testosterone. CAH can be mild (non-classic CAH) or severe (classic CAH).

The symptoms of CAH are similar to other conditions with high testosterone levels in women:

  • Deepening of voice
  • Enlarged clitoris
  • Acne
  • Early appearance of pubic hair
  • Excess facial and bodily hair
  • Irregular and infrequent periods
  • Stunted growth in adulthood, but rapid growth during childhood

The thyroid gland is involved in a wide range of bodily functions, such as metabolism and the production and concentration of hormones in the body. Studies have confirmed the indirect link between hypothyroidism (an underactive thyroid condition) and testosterone levels. Hypothyroidism can cause a decline in the production of sex hormone-binding globulin (SHBG), which is integral for balancing the sex hormones in a person’s blood. If SHBG levels fall too low, testosterone levels may increase, and associated symptoms follow.

Insulin resistance occurs when the body fails to recognize the insulin hormone, which subsequently increases blood sugar levels. Insulin then remains unutilized in the bloodstream and this promotes the production of testosterone in a woman’s ovaries.

High testosterone levels in women may be diagnosed by blood tests. A doctor may suspect that you have high testosterone levels after a physical examination. 

Physical examination

During a physical examination, your doctor will examine you based on your symptoms, such as body hair, facial hair, and acne.

You doctor may also ask you a series of questions in relation to your menstrual cycle, libido, and mood changes. If your doctor suspects PCOS, he/she may visually and manually examine your pelvic area to identify any abnormalities. 

Blood test

If your symptoms are indicative of high testosterone levels, your doctor may take a blood sample to test your hormone levels. Normally, this test is done in the morning when testosterone levels are usually high. They may also test your glucose and cholesterol levels. These tests may be vital to your health condition if you have PCOS or if your menstruation has stopped due to excessive athletic training or anorexia nervosa.

Ultrasound

Your doctor may further recommend an ultrasound to check your ovaries and uterus if they suspect PCOS.

Before starting any regime to lower testosterone, a woman should first consult her doctor. The treatment recommended is usually dependent on the underlying cause of the high testosterone levels. Typically, a doctor will recommend lifestyle changes, including dietary changes, for more sustained results. They may also recommend medication or treatment to control symptoms, such as unwanted hair or acne. 

Medication

Medical treatments usually depend on the cause of the excess testosterone production, and may include surgery, oral contraceptives, or a combination of anti-androgens or other hormonal therapy.

High testosterone in women can usually be treated with the following:

  • Eflornithine, a cream applied to the skin that reduces the facial hair growth
  • Glucocorticosteroids, a steroid hormone that reduces inflammation
  • Metformin, medication for Type 2 diabetes
  • Progestin, a hormone that may regulate menstruation and improve fertility
  • Spironolactone, a diuretic that regulates water and salt levels and slows down excessive hair growth

Oral contraceptives are sometimes also prescribed to treat and help block the production of excess testosterone. The best oral contraceptives for high testosterone and hirsutism are those with low doses of norgestimate, desogestrel, and gestodene.

Oral contraceptives may not be ideal for women trying to get pregnant, so be sure to share your reproductive plans with your doctor so they can determine an appropriate course of treatment.

Lifestyle changes

A woman with high testosterone levels

There are lifestyle changes which have proven to dramatically improve the quality of life for women suffering from high testosterone, rather than simply manage their symptoms.

Achieving a healthy weight and maintaining it may assist with the management of your hormonal imbalance symptoms. Losing even 5 to 10 percent of your body weight can reduce testosterone levels, improve PCOS symptoms, and even help prevent complications associated with infertility.

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High testosterone levels in women may cause a range of symptoms from excessive facial hair to infertility challenges. Most, if not all, symptoms are usually a result of an underlying medical condition. Generally, treatment of the underlying disorder can reduce the symptoms associated with the disorder and improve overall quality of life.

If you think that you may be experiencing high testosterone symptoms, you should consult your doctor to determine the cause and to start appropriate treatment for your condition.

https://www.webmd.com/women/guide/normal-testosterone-and-estrogen-levels-in-women

https://www.healthline.com/health/high-testosterone-in-women

https://www.medicalnewstoday.com/articles/321292.php

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743370/

https://www.aruplab.com/news/06-04-19-/women-high-testosterone

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