What Causes High Testosterone in Women?

When women have high testosterone, the primary hormone in people assigned male at birth, it is medically known as hyperandrogenism. Underlying health conditions, medication side effects, or lifestyle influences can lead to high testosterone.

Symptoms of high testosterone in women include excess hair growth on the face or body, acne, mood swings, weight gain, infertility, and mental health changes.

There are many reasons why women may have high testosterone, including certain conditions and medications.

1. Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a hormone disorder that affects the ovaries, small glands on both sides of the uterus (womb) that produce eggs and release hormones. PCOS causes multiple cysts (fluid-filled sacs) on the ovaries, affecting how they work. PCOS is the most common cause of high testosterone in women, affecting about 10% worldwide.

Symptoms of PCOS may include irregular periods, weight changes, acne, hirsutism (extra hair), and infertility (difficulties getting pregnant).

2. Insulin Resistance

Insulin resistance happens when your body doesn’t respond to insulin, a hormone that lowers glucose, a type of sugar the body uses for energy. The body responds by making extra insulin, which can trigger the ovaries to create more testosterone.

Insulin resistance commonly shares a link to PCOS and raises the risk of type 2 diabetes, high cholesterol, high blood pressure, and heart disease.

3. Medications

Some medications and supplements can cause high testosterone in women. These include:

• Anabolic steroids: A steroid that helps treat hormone imbalances in men; sometimes misused by people, including women, to help build muscle
• Depakote (valproic acid): An antiseizure medication
• Danocrine (danazol): A synthetic steroid that treats the excess production of female hormones
• Dehydroepiandrosterone (DHEA): A hormonal supplement
• Femara (letrozole): A hormone blocker that treats infertility and certain types of cancer

4. Adrenal Gland Disorders

The adrenal glands are small organs on top of each kidney. They produce hormones that regulate blood pressure, energy, and the stress response.

Adrenal tumors or congenital adrenal hyperplasia (CAH), a group of hereditary adrenal gland disorders, can cause these glands to make too many androgens (male hormones), leading to high testosterone. 

5. Cushing Syndrome

Cushing syndrome occurs when the body makes too much cortisol (the stress hormone), disrupting hormone balance. It can be caused by adrenal tumors, long-term steroid use, or conditions affecting the pituitary gland (a gland in your brain that controls hormone production).

Besides hormone imbalances, people with Cushing syndrome may experience easy bruising, fatigue, weight gain, depression, and low libido (sex drive).

6. Tumors

Although rare, certain tumors can cause high testosterone levels in women. Examples include adrenal, ovarian, and pituitary tumors.

Common symptoms of high testosterone levels in women include:

• Acne, especially along the jawline and chin
• Balding, thinning, or receding scalp hair
• Hirsutism (excess, thicker, or darker hair on the face, chest, and back)
• Irregular periods or missed periods
• Weight gain, typically around the midsection

Depending on the underlying cause, symptoms may also include:

• Anxiety or depression
• Bigger clitoris (the sensitive organ above the vagina)
• Deeper voice
• Infertility
• Mood swings
• Vaginal bleeding after menopause

Several types of healthcare providers can diagnose high testosterone in women, such as:

• A primary care provider
• An endocrinologist, a doctor who specializes in diagnosing and treating conditions related to the endocrine system (the glands and organs that make hormones).
• A gynecologist, a doctor who specializes in female reproductive health.

These providers determine your condition by reviewing your symptoms and medical history, performing a physical exam, and ordering diagnostic tests. During the physical exam, they’ll check for signs such as excess facial or body hair and skin changes. They’ll likely perform a pelvic exam to check for any changes to your reproductive system.

They may also order the following diagnostic tests.

Blood Tests

Your healthcare provider may order blood tests that measure the following:

• Cortisol: To check adrenal function
• Estrogen: To measure hormonal balance and ovarian function
• Follicle-stimulating hormone (FSH): To measure ovarian function
• Luteinizing hormone (LH): To check ovarian function
• Glucose: To measure blood sugar
• Hemoglobin A1C: To measure your average blood sugar over three months 
• Lipids: To measure cholesterol and triglyceride levels
• Pregnancy test: To check for pregnancy in premenopausal people
• Testosterone: To measure total and free testosterone levels in the blood
• Thyroid-stimulating hormone (TSH): To measure thyroid function

In some cases, endocrinology (hormone) or fertility specialists may order more advanced blood tests, like:

• 17-Hydroxyprogesterone: Helps diagnose or rule out congenital adrenal hyperplasia
• Adrenocorticotropic hormone (ACTH): Checks adrenal and pituitary function
• Anti-Müllerian hormone (AMH): Helps confirm if you have PCOS
• Dehydroepiandrosterone sulfate (DHEA-S): Measures adrenal hormone production
• Sex hormone-binding globulin (SHBG): Helps diagnose metabolic disorders

Imaging Tests

Imaging studies may include:

• Ultrasound: This uses sound waves to create pictures of the ovaries, helping check their size and look for cysts or tumors.
• Computed tomography (CT) scan: This uses images taken from different angles to create detailed pictures inside the body. It can spot adrenal and ovarian tumors.
• Magnetic resonance imaging (MRI) scan: This uses magnets and radio waves to create images of organs and tissues. It helps spot adrenal, ovarian, or pituitary tumors.

Managing high testosterone levels involves both lifestyle changes and medical treatments that target the underlying cause.

Lifestyle Changes

Eating a balanced diet can help regulate your hormones. For example, cutting back on sugary drinks and processed foods helps reduce insulin resistance.

Eating more of the following nutrients keeps your blood sugar steady and helps balance hormones:

• Fiber (green leafy vegetables)
• Protein
• Healthy fats (coconut oil, fish, nuts, olive oil)

Your provider may also suggest the following supplements to help reduce symptoms of PCOS: 

• Calcium
• Ovasitol, Pregnitude (myo-inositol, d-chiro-inositol)
• Prebiotics or probiotics
• Vitamin D

Staying active and managing stress can also help balance hormones. Strength training and activities like walking, swimming, or biking reduce fat and improve how your body uses insulin. Yoga, meditation, and breathing exercises help lower cortisol.

Hair Removal or Hair Growth Treatments

If high testosterone has caused you to grow more hair on your face or body and you want to get rid of it, waxing and threading are temporary hair removal options. Laser hair removal and electrolysis, a permanent type of hair removal that uses electric currents, offer longer-lasting solutions.

If high testosterone has caused hair loss on your scalp, Rogaine (minoxidil) can help regrow hair by improving blood flow to the scalp.

Hormone-Regulating Medications

Providers may prescribe the following types of medications to control hormone levels and reduce symptoms:

• Antiandrogen medications: Medications like Aldactone (spironolactone) block testosterone’s effects on the skin and hair.
• Clomid (clomiphene citrate): This fertility treatment can stimulate ovulation.
• GLP-1 agonists for weight loss and insulin sensitivity: Medications like Victoza (liraglutide) and Ozempic (semaglutide) promote weight loss and improve insulin function.
• Glucophage (metformin): This treats insulin resistance and regulates blood sugar.
• Statins: Medications like Lipitor (atorvastatin) lower cholesterol.
• Thiazolidinediones (TZDs): Medications like Actos (pioglitazone) improve insulin resistance and lower androgen levels.

Voice Therapy

If you experience voice changes, a speech therapist can help you manage this. This support is especially beneficial if the changes are troubling or make communication difficult. If testosterone levels cause lasting voice changes, therapy will focus on helping you adapt to your new voice rather than attempting to reverse the changes.

Surgery

Healthcare providers sometimes recommend surgery if tumors or severe conditions are causing high testosterone. They may suggest:

• Fertility-sparing surgery: Specialty surgical techniques that remove tumors or cysts while helping people keep the ability to have children
• Ovary removal: Bilateral oophorectomy (removal of both ovaries) for PCOS symptoms that are severe, or when other treatments don’t help
• Tumor removal: The surgical removal of adrenal, ovarian, or pituitary tumors

Living with high testosterone can affect emotional, mental, and physical health. Acne, facial hair, or infertility can lead to frustration, embarrassment, sadness, or stress. Irregular or absent periods may also cause the endometrium (lining of the uterus) to thicken, increasing the risk of endometrial (uterine) cancer. 

Regular checkups with a healthcare provider can help them monitor your hormone levels and adjust treatment as needed. Mental health counseling and support groups can offer valuable emotional and mental support.

High testosterone in women can lead to changes like extra facial hair, acne, irregular periods, and weight gain. These changes can happen for different reasons, most commonly due to PCOS.

To determine the cause of your high testosterone levels, a healthcare provider will likely do a physical exam and blood tests. They may also do an imaging scan.

Treatment options may include hair removal techniques, lifestyle changes, medications, or surgery. Managing high testosterone can improve your symptoms and help lower the risk of complications.