Start your free visit for ED treatment. Learn more

Jan 31, 2022
5 min read

High testosterone in women: causes, symptoms, and treatment

 

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

High testosterone in women may bring to mind female bodybuilders with bulging muscles. In reality, that picture doesn’t match most women who have high testosterone levels. 

Many women with too much testosterone experience unwanted symptoms like excess hair and infertility, to name a few. Let’s look at how testosterone affects women, why some may have higher levels than others, and possible treatments. 

ADVERTISEMENT

Get proactive about your body

Modern Fertility’s suite of products helps support you with your reproductive health—all from the comfort of your home.

Learn more

What is testosterone?

Most people think of testosterone as the primary male sex hormone (also known as an androgen). Men have approximately 20–25 times higher testosterone levels than women, though this hormone is important for females, too (Fabbri, 2016). 

Specialized cells in the ovaries called theca cells manufacture testosterone in women. Testosterone is essential for its own sake, but it also gets converted to estrogen, the primary “female” hormone (Barbieri, 2021-a). 

Testosterone exists in men and women as either free testosterone or protein-bound testosterone; the combination of these two makes up your total testosterone concentration. 

In men, about 40% of testosterone bind to a protein called sex hormone-binding globulin (SHBG), which carries hormones through the bloodstream. The remaining 60% is readily available for use. In women, more than 80% of testosterone binds to SHBG, resulting in less free testosterone circulating in the body (Fabbri, 2016).

Why do women need testosterone?

Testosterone is a vital part of a woman’s health and well-being. It plays a key role in the following functions (Tyagi, 2017):

It’s important to remember that balance is critical—too much or too little testosterone can cause problems. For example, medical conditions like polycystic ovarian syndrome (PCOS) can increase testosterone levels, leading to other unwanted side effects (Rasquin, 2021).

Symptoms of high testosterone in women

When women have too much testosterone, it throws the ratio of female to male hormones out of balance. If levels of testosterone get too high, women may experience the following PCOS symptoms (Hall, 2021):

Some studies suggest that high testosterone levels may increase the risk of developing high cholesterol and heart disease (Udoff, 2020).

Causes of high testosterone levels in women

Elevated testosterone, also known as hyperandrogenism, may be due to several medical conditions, including the ones below (Hall, 2021; Barbieri, 2021-b). 

Polycystic ovary syndrome (PCOS)

PCOS is a common cause of high testosterone that affects roughly 5–15% of women aged 15–49 in the United States. It’s a complex medical condition that can wreak havoc on a woman’s body (Rasquin, 2021). 

It’s a hormonal imbalance that causes symptoms like irregular periods, obesity, excess hair growth, insulin resistance, and small fluid-filled follicles (sacs) on the ovaries. It’s also one of the most common causes of infertility. 

Having PCOS increases a woman’s risk of developing diabetes, high blood pressure, high cholesterol, heart disease, and stroke. The causes of PCOS aren’t well understood but are likely related to genetic and lifestyle factors (Rasquin, 2021).  

Congenital adrenal hyperplasia (CAH) 

CAH is a group of genetic disorders that affect the adrenal glands, which sit on top of your kidneys. Your adrenal glands produce hormones that help regulate your metabolism, immune system, and more. 

Women with CAH make too many androgens and have symptoms similar to PCOS. These include increased facial and body hair, irregular menstrual cycles, and infertility. This condition is usually diagnosed with special blood tests and is more common in higher-risk groups like Mediterranean, Hispanic, and Ashkenazi Jewish women (Nieman, 2019). 

Other causes

In the past, women who experienced abnormal hair growth but had regular periods, healthy androgen levels, and no other underlying issues were diagnosed with idiopathic hirsutism. In other words, hair growth due to unknown causes. 

However, the definitions of idiopathic hirsutism and PCOS have changed over the years and it’s likely that many women with this condition may actually have had PCOS (Barbieri, 2021-c). 

One study showed that women with idiopathic hirsutism had testosterone levels in a higher than normal range. Researchers also found these women had genetic changes that may have caused them to produce more testosterone in their skin, leading to more hair growth (Taheri, 2015). 

Cushing syndrome is another potential cause of high testosterone in women. With this condition, your adrenal glands secrete more hormones (like androgens and cortisol) than normal. Similarly, adrenal or ovarian tumors that secrete too many androgens will boost testosterone levels (Barbieri, 2021c). 
Lastly, hormone treatments or drugs like anabolic steroids, testosterone replacement therapy, or DHEA supplementation can cause higher than normal testosterone levels (Barbieri, 2021-c).

Treatment options

If you suspect you have high levels of testosterone, seek medical advice from a healthcare professional. They’ll go over your medical history, perform a physical exam, and conduct blood tests to determine if your hormone levels are abnormal. They may check any or all of the following:

  • Total and free testosterone levels
  • Luteinizing hormone (LH)
  • Follicle-stimulating hormone (FSH)
  • Perform a DHEA sulfate test
  • Conduct ultrasound imaging of ovaries and adrenal glands 

If your provider uncovers a cause of high testosterone like Cushing syndrome or a tumor, there are treatments that can balance out your hormone levels. However, many people will need medications to help including (Barbieri, 2021-b):

  • Oral contraceptive pills: Birth control pills treat high testosterone by increasing estrogen and progesterone levels while lowering androgens. 
  • Spironolactone: Also known as a “water pill,” spironolactone is an anti-androgen drug that decreases testosterone production. 
  • Combination therapy: This involves using both birth control and spironolactone to treat a testosterone imbalance.

The bottom line

Testosterone is essential for the health and wellness of all people. The balance of female to male hormones is vital, so it makes sense that problems can arise when testosterone levels are imbalanced. Talk to a healthcare provider who can work with you to come up with the right plan.

References

  1. Barbieri, R. L. (2021-a). Steroid hormone metabolism in polycystic ovary syndrome. UpToDate. Retrieved from https://www.uptodate.com/contents/steroid-hormone-metabolism-in-polycystic-ovary-syndrome
  2. Barbieri, R. L. & Ehrmann, D. A. (2021-b). Evaluation of premenopausal women with hirsutism. UpToDate. Retrieved from https://www.uptodate.com/contents/evaluation-of-premenopausal-women-with-hirsutism
  3. Barbieri, R. L. & Ehrmann, D. A. (2021-c). Pathophysiology and causes of hirsutism. UpToDate. Retrieved from https://www.uptodate.com/contents/pathophysiology-and-causes-of-hirsutism
  4. Centers for Disease Control and Prevention (CDC). (2020). PCOS (Polycystic Ovary Syndrome) and diabetes. Retrieved from https://www.cdc.gov/diabetes/basics/pcos.html
  5. Clark, R. V., Wald, J. A., Swerdloff, R. S., et al. (2019). Large divergence in testosterone concentrations between men and women: Frame of reference for elite athletes in sex-specific competition in sports, a narrative review. Clinical Endocrinology, 90(1),15–22. doi:10.1111/cen.13840. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30136295/
  6. Fabbri, E., An, Y., Gonzalez-Freire, M., et al. (2016). Bioavailable testosterone linearly declines over a wide age spectrum in men and women from the baltimore longitudinal study of aging. The Journals Of Gerontology Series A: Biological Sciences And Medical Sciences, 71(9), 1202-1209. doi:10.1093/gerona/glw021. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26921861/ 
  7. Hall, J. E. (2021). Evaluation and management of postmenopausal hyperandrogenism. UpToDate. Retrieved from https://www.uptodate.com/contents/evaluation-and-management-of-postmenopausal-hyperandrogenism
  8. Nieman, L. K. & Merke, D. P. (2019). Diagnosis and treatment of nonclassic (late-onset) congenital adrenal hyperplasia due to 21-hydroxylase deficiency. UpToDate. Retrieved from https://www.uptodate.com/contents/diagnosis-and-treatment-of-nonclassic-late-onset-congenital-adrenal-hyperplasia-due-to-21-hydroxylase-deficiency
  9. Rasquin Leon, L. I. & Mayrin, J. V. (2021). Polycystic Ovarian Disease. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459251/
  10. Taheri, S., Zararsiz, G., Karaburgu, S., et al. (2015). Is idiopathic hirsutism (IH) really idiopathic? mRNA expressions of skin steroidogenic enzymes in women with IH. European Journal of Endocrinology, 173(4), 447-454. doi:10.1530/EJE-15-0460. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26194504
  11. Tyagi, V., Scordo, M., Yoon, R. S., et al. (2017). Revisiting the role of testosterone: Are we missing something? Reviews in Urology, 19(1), 16–24. doi:10.3909/riu0716. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28522926/
  12. Udoff, L. C. (2020). Overview of androgen deficiency and therapy in women. UpToDate. Retrieved from https://www.uptodate.com/contents/overview-of-androgen-deficiency-and-therapy-in-women