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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 media coverage of 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.

The female body normally secretes significantly lower levels of testosterone than the male body. Normal female levels range from 15–70 nanograms per deciliter (ng/dL), whereas male levels typically range from 280–1,100 ng/dL. 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

In the female body, small amounts of testosterone are usually released into the bloodstream from the ovaries and adrenal glands. Testosterone helps a person maintain bone mass, generate new blood cells, maintain libido, and regulate mood. The combined effect of testosterone and estrogen assists with the growth, repair, and maintenance of female reproductive tissues.

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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, an intersex condition could be the cause, wherein the person has chromosomal, hormonal, or physiological sex variations that don’t fit into the typical, binary definition of male or female. In 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

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

There are various conditions that cause fluctuations in female 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 an endocrine condition that affects 1 in 10 people with ovaries worldwide. PCOS interferes with the menstrual cycle and makes it difficult to get pregnant.

These are some common symptoms of PCOS:

  • Excess facial or 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.

The underlying cause of PCOS isn’t definitively known, but most people 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 (''good'' cholesterol), insulin resistance, heightened triglycerides, high LDL (''bad'' cholesterol), obesity, and cardiovascular disease. Fortunately, there are a variety of remedies to treat ovarian cysts.

Female hirsutism is defined as the growth of excessive facial and body hair. The symptoms of hirsutism include male-patterned hair growth that is usually dark and coarse on the chest, back, or face.

High testosterone in women can sometimes go beyond simple hirsutism and cause other symptoms to develop in a process called virilization. Signs of virilization include:

  • Reduced breast size
  • Excessive hair loss
  • Enlarged clitoris
  • Acne
  • Bulky muscles
  • Deepening of voice

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

With CAH, an enzyme needed to help regulate the secretion of these hormones is lacking, causing too little cortisol and too much testosterone to be produced. CAH can be mild (non-classic CAH) or severe (classic CAH).

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

  • Deepening of voice
  • Enlarged clitoris
  • Acne
  • Early appearance of pubic hair
  • Excess facial and body 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 an 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, which promotes the production of testosterone in the ovaries.

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

Physical examination

During a physical examination, your health care provider will examine you based on your symptoms, such as body hair, facial hair, excessive hair loss, and acne.

Your health care provider may also ask you a series of questions in relation to your menstrual cycle, libido, and mood changes. If your doctor suspects PCOS, they may perform a pelvic ultrasound examination to identify any abnormalities. 

Blood test

If your symptoms are indicative of high testosterone levels, your health care provider 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 if you have PCOS or if your menstruation has stopped due to excessive athletic training or anorexia nervosa.

Ultrasound

Your health care provider may further recommend an ultrasound to check your ovaries and uterus if they suspect PCOS. If a person is suspected of having an adrenal pathology, they need to be evaluated with either computerized tomography (CT) or MRI.

Before starting any regime to lower testosterone, it’s important to first consult a health care provider. What treatment they recommend usually depends on what’s causing the high testosterone. Typically, a health care provider 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 are usually prescribed to treat 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 specific prescribed hormone medications.

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 people who are trying to get pregnant, so be sure to share your reproductive plans with your health care provider so they can determine an appropriate course of treatment.

Lifestyle changes

There are lifestyle changes which have been proven to dramatically improve the quality of life of people experiencing high testosterone.

Achieving a healthy weight and maintaining it may assist with the management of hormonal imbalance symptoms. If a health care provider recommends it, losing 5–10 percent of your body weight can reduce testosterone levels, improve PCOS symptoms, and even help prevent complications associated with infertility.

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

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

Saran, Sanjay, et al. “Effect of Hypothyroidism on Female Reproductive Hormones.” Indian Journal of Endocrinology and Metabolism, Medknow Publications & Media Pvt Ltd, 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4743370/.

“Hyperandrogenism.” Hyperandrogenism | DermNet NZ, dermnetnz.org/topics/hyperandrogenism/.

“Test ID: TTFB Testosterone, Total, Bioavailable, and Free, Serum.” TTFB - Overview: Testosterone, Total, Bioavailable, and Free, Serum, www.mayocliniclabs.com/test-catalog/Overview/83686.

“Test ID: TTFB - Testosterone, Total, Bioavailable, and Free, Serum.” MayoClinicLabs, www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/83686.

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