High testosterone in a woman is an elevated androgen level that can cause acne, excess facial or body hair, scalp hair thinning, irregular or absent periods, and difficulty ovulating. Very high or rapidly rising levels can cause virilization, including a deeper voice, clitoral enlargement, increased muscle mass, or male-pattern baldness.
Testosterone is an androgen that women naturally produce in smaller amounts. A result is considered high when it exceeds the female reference range used by that laboratory. The interpretation also depends on symptoms and the level of free testosterone, the biologically active portion of testosterone.
The main effects involve hair growth, skin, scalp hair, menstruation, ovulation and virilization.
Common Effects of High Testosterone
| Effect | What it may look like |
|---|---|
| Excess hair growth | Coarser hair on the chin, upper lip, chest, abdomen, back or thighs |
| Acne and oily skin | Persistent or adult-onset acne on the face, chest or back |
| Scalp hair loss | Thinning at the hairline or crown, sometimes called female-pattern hair loss |
| Menstrual changes | Irregular, infrequent or absent periods |
| Ovulation problems | Difficulty becoming pregnant because ovulation is less predictable |
| Virilization | A deeper voice, increased muscle mass, clitoral enlargement, reduced breast tissue or rapid male-pattern balding |
Not every woman with high testosterone develops every symptom. Some women have noticeable androgen-related symptoms even when total testosterone is within the laboratory range. Free testosterone may be elevated, or the hair follicles may be more sensitive to androgens.
Can High Testosterone Affect Periods and Fertility?
Yes. High androgen levels can interfere with ovulation. Periods may become irregular or stop, and conception may become more difficult.
High testosterone does not automatically mean infertility. Many women with polycystic ovary syndrome, or PCOS, can become pregnant with appropriate treatment.
Long gaps between periods can also cause the uterine lining to become excessively thick. In women with PCOS, prolonged irregular menstruation is associated with a higher risk of endometrial hyperplasia and endometrial cancer.
What Causes High Testosterone in Women?
Polycystic Ovary Syndrome
PCOS is a common cause of androgen excess. It may involve irregular ovulation, higher androgen levels, acne, excess facial or body hair, insulin resistance and difficulty becoming pregnant.
A woman can have PCOS without having every typical symptom. An ovarian ultrasound is not required in every case.
Testosterone, Anabolic Steroids or Supplements
Testosterone therapy, anabolic steroids and some androgen-containing products can raise testosterone or cause androgen-related symptoms.
Tell a healthcare professional about prescription hormones, bodybuilding products, supplements and topical products used by a partner or another household member.
Adrenal or Ovarian Conditions
Less common causes include nonclassic congenital adrenal hyperplasia, Cushing syndrome, ovarian conditions that produce excess androgens and adrenal disorders.
An androgen-producing ovarian or adrenal tumor is uncommon. It needs prompt investigation when symptoms appear suddenly or progress quickly.
When Does High Testosterone Need Prompt Medical Evaluation?
Arrange a prompt medical assessment if you develop any of these symptoms, especially over a few weeks or months:
- Rapidly increasing facial or body hair
- A sudden deeper voice
- New frontal hairline recession or severe scalp hair loss
- Clitoral enlargement
- A sudden loss of periods
- Rapidly increasing muscle mass
- New symptoms after menopause
- A markedly abnormal testosterone result
Rapid virilization is more concerning for a significant androgen-producing condition than the gradual acne, hair growth or menstrual changes often associated with PCOS.
How Do Doctors Investigate High Testosterone?
Evaluation commonly includes:
- Total testosterone, sometimes repeated with a reliable assay.
- Free testosterone or SHBG testing when total testosterone does not explain the symptoms.
- DHEAS, which can help assess whether excess androgens are coming from the adrenal glands.
- 17-hydroxyprogesterone when congenital adrenal hyperplasia is possible.
- Tests for related conditions, including thyroid, prolactin, glucose and cholesterol testing.
- Pelvic or adrenal imaging when testosterone is markedly elevated or virilization is present.
A single high result does not identify the cause. Testosterone levels vary by laboratory method, age, menstrual status, medications and the amount of SHBG in the blood.
How Is High Testosterone Treated?
Treatment depends on the cause and whether pregnancy is desired. Depending on the diagnosis, a clinician may recommend hormonal contraception to regulate cycles and reduce androgen effects, antiandrogen medication for troublesome hair growth, treatment for insulin resistance or fertility medication to support ovulation.
Antiandrogens require medical supervision because some can harm a developing pregnancy.
Androgen-producing tumors generally require specialist treatment, often including surgery. Treating the underlying cause may improve acne, periods and excess hair, although voice deepening or established hair loss may not fully reverse.