High testosterone in women can present as acne, unwanted hair growth on the face (known as hirsutism), hair loss on the head, abdominal weight gain, and irregular periods.
Testosterone is often thought of as a “male sex hormone” because it is essential to the development of male growth1—regulating sex drive, muscle mass, sexual function, and fat distribution. However, testosterone also exists in women, playing an important role in supporting a healthy sexual desire, better energy, immune function, and ovary function, among other roles.
In women during the reproductive years, the two sources of androgen production (the type of hormone testosterone is) are the adrenal glands and ovaries.
While women need some testosterone, high testosterone in women is a concern for a variety of reasons, such as its connection to PCOS, adrenal issues, and other health conditions, as well as its potential to cause symptoms like irregular menstrual cycles, acne, and fertility challenges. For women with high T, these symptoms can impact their physical appearance, emotional well-being, and overall quality of life.
As a frequent topic of discussion on my Instagram page, it’s clear that many women are seeking answers about how to diagnose and treat high testosterone. In this article, I will walk you through recognizing elevated testosterone in women, identifying its potential causes, and exploring steps to address it. You'll learn how evidence based options like a balanced diet, exercise, and supplementation can help bring testosterone levels into a normal range, supporting fertility and overall reproductive health.
It’s important to keep in mind as we dive into this topic that testosterone in women is actually natural and healthy, as it is for all bodies. But like all hormones (and most things in life) too much of a good thing can be problematic.
Signs of High Testosterone in Women
Hyperandrogenism describes the excess production of androgens2, which can include testosterone. However, in women, excess testosterone levels can suppress ovulation and lead to symptoms, including irregular periods and infertility, among others.
Signs of high testosterone in a woman3 can include:
- Irregular menstrual cycles
- Fertility challenges
- Hair loss on the scalp
- Excess body hair (especially on the upper lip, chin, chest and abdomen)
- Acne
- Oily skin
- Increased body odor
- Sleep disturbances
- Irritability and aggression
- Decreased breast size
- Increased muscle mass
- Deepening of the voice
Connection Between High Testosterone and Hirsutism
Excessive testosterone can lead to hirsutism, which is the medical term for excessive growth of thick, dark hair. If you notice excess hair on your back, face, chest, or abdomen, this is a strong sign that you're experiencing an imbalance of androgen hormones and potentially high testosterone.
Not only is sprouting hair all over something you might find to be embarrassing, but it can potentially be a sign of an underlying medical condition, meaning it should be taken seriously.
Testing Testosterone Levels in Women
Maintaining total testosterone levels within the normal range, as shown in the graph below, can help ensure testosterone is working for your body without causing unwanted symptoms. A simple blood test administered by your doctor can tell you how much testosterone your body is making and whether it's considered a normal amount.
As a hormone, testosterone levels can fluctuate throughout the day. The best time to get tested is in the morning when testosterone levels are at their highest.
What Causes High Testosterone in Women?
Several different mechanisms lead to high testosterone in women. Certain hormonal disorders and medical conditions4 that affect the ovaries, insulin levels, or the adrenal glands are usually the cause. These can include conditions such as:
1. Polycystic Ovary Syndrome (PCOS)
One of the most common causes of high testosterone5 levels in women is PCOS. This is a hormonal condition that can affect as many as 1 in 10 women (or up to 10% of the female population in the U.S.6).
If you have PCOS, you may notice excess body hair or infrequent periods7, which are among the most common symptoms of PCOS. This condition can lead to certain complications, such as infertility, cardiovascular disease, diabetes, and obesity, due to its connection to inflammation and insulin resistance.
Research has shown that even beyond our reproductive years, PCOS can affect women in menopause.
2. Congenital Adrenal Hyperplasia (CAH)
This condition directly affects the adrenal glands, which produce hormones, including testosterone. When someone has CAH, the adrenal glands overproduce testosterone, leading to severe acne and what is classified in medicine as “behavioral and physical masculinization,” which is the tissue's response to androgens.
This specific medical condition can be tested for, however, physical and behavioral traits must also be present to receive a diagnosis of CAH. On the other hand, if you experience these symptoms, it does not necessarily mean you have CAH for certain, as on their own, symptoms like severe acne are not enough to determine that someone has elevated androgens.
3. High Insulin & Blood Sugar Levels
Blood sugar dysregulation and insulin resistance are the crux of many hormone imbalances, including high testosterone.
High insulin levels can lead to increased testosterone production in women through several mechanisms. Insulin resistance, often seen in conditions like PCOS, results in elevated circulating insulin, which stimulates the ovaries to produce more testosterone8.
While many body tissues will begin ignoring insulin signals when they remain elevated for a long period of time, the ovaries are among the few organs that will continue to remain sensitive to insulin and produce more testosterone, even when levels are higher than normal.
Insulin resistance lowers the levels of sex hormone-binding globulin (SHBG), a protein that usually binds to testosterone and keeps it inactive. When SHBG levels drop, more active testosterone is available in the body.
Additionally, high insulin levels can prompt the adrenal glands to produce more androgens, including testosterone. By addressing insulin resistance through lifestyle changes, diet, and medication, these hormonal imbalances can be managed, helping to reduce elevated testosterone levels.
Related Article: 5 Blood Sugar Balancing Strategies for PCOS
How to Lower Testosterone in Women
High testosterone in women can be targeted in a number of ways. This includes lifestyle changes like eating an anti-inflammatory diet, lifestyle practices, and taking targeted supplements, as well as the use of hormone medications that can help manage high androgen levels.
How To Treat High Testosterone In Women Naturally
Simple diet and lifestyle changes can often have significant effects on your overall hormone and testosterone levels. For example, increasing the levels of fat and protein in your meals, while reducing sugar intake and getting enough exercise and sleep can help optimize your blood sugar, reduce inflammation, and get your hormones back on track. Here's more about how to naturally lower testosterone in women:
1. Eat a Hormone-Balancing Diet
Eating a hormone-balancing diet can often help relieve symptoms of high testosterone, as well as PMS, hormonal headaches, menstrual cramps, mood swings and more. Focus on a diet rich in whole foods, including fruits, vegetables, lean proteins, and healthy fats.
The best type of diet for helping to lower high androgens and also addressing issues like PCOS include:
- An ideal goal of six to nine servings of vegetables a day (especially leafy greens and cruciferous types like broccoli), which will help you reach the target of at least 25 grams of fiber per day.
- Fresh fruits, such as berries
- Healthy fats including fatty fish like salmon and sardines, nuts, seeds, avocado and avocado oil, coconut oil, olive oil, and ghee
- Grass-fed meat and pasture-raised poultry
Reducing foods that can potentially worsen inflammation and increase androgens, such as sugary foods, refined grains, dairy products, alcohol, and refined vegetable oils found in packaged and processed foods can also help testosterone levels normalize.
For help getting started, download your FREE Hormone Starter Kit with 7-Day Meal Plan & Recipe Guide Book.
2. Get Regular Exercise
Engage in a combination of cardiovascular exercise and strength training, such as for about 30 minutes per day. Regular physical activity helps balance hormones, improve insulin sensitivity, and manage weight, all of which can influence testosterone levels.
Read more on how to exercise with your cycle.
3. Manage Stress
Practice stress-reducing techniques such as meditation, yoga, or deep breathing exercises. Chronic stress can increase cortisol levels, which may exacerbate hormonal imbalances including high testosterone.
4. Prioritize Getting Adequate Sleep
Ensure you get 7-9 hours of quality sleep each night. Proper sleep helps regulate hormone production and balance, which can mitigate symptoms of high testosterone.
If you struggle with sleep, consider these sleep practices to help you get a more restful sleep.
5. Maintain a Healthy Weight
Excess body fat, particularly abdominal fat, can contribute to insulin resistance and elevated testosterone levels and is associated with a higher risk for PCOS.
Aiming for a healthy weight through nutrition and exercise is the foundation. In some cases, medical interventions through medication may be necessary.
Supplements to Help Lower Testosterone in Females
In addition to improving your diet, certain herbs such as Saw Palmetto and Vitex or chasteberry can be helpful. Nutrients like vitamin D, DIM, Zinc, N-acetyl cysteine (NAC), and myo-inositol have been shown to help optimize testosterone levels.
There are five key supplements from Dr. Brighten Essentials that many women with elevated testosterone have found helpful: Balance, Adrenal Support, Saw Palmetto Plus, Myo Inositol Plus and N-Acetyl Cysteine. Together they have synergistic benefits and include the key nutrients that can help improve testosterone.
Diindolylmethane (DIM)
DIM is a natural androgen receptor antagonist9, which opposes the actions of testosterone. It also supports estrogen metabolism by promoting the conversion of estrogen into its less active forms, which can indirectly help balance testosterone levels. This balance can mitigate symptoms related to excess testosterone, such as mood swings and excessive hair growth.
DIM is a nutrient derived from cruciferous vegetables like broccoli. Aim to eat cabbage, kale, cauliflower, Brussel sprouts, and other cruciferous vegetables three to four times weekly, which will naturally boost your intake, while also considering DIM in supplement form.
The Balance Women's Hormone Support formula contains DIM in addition to Vitex, and calcium d-glucarate which together help support estrogen and testosterone metabolism. Vitex (or Chaste Tree) supports hormonal balance by influencing the pituitary gland to regulate the release of luteinizing hormone (LH), which can help lower testosterone levels10. This can support your body in naturally improving symptoms like irregular periods and acne that are associated with high testosterone.
Zinc & Saw Palmetto
Zinc plays a crucial role in regulating hormone production, including testosterone, by modulating the activity of various enzymes11 involved in hormone synthesis. Adequate zinc levels can help balance testosterone levels and improve symptoms associated with hormonal imbalances, such as acne.
Saw Palmetto helps the body maintain healthy levels of potent androgens that lead to hair loss and acne by inhibiting the enzyme 5-alpha reductase12.
See the Saw Palmetto Plus I recommend here.
For more help treating acne with effective supplements, check out this article: The 10 Best Vitamins and Supplements for Hormonal Acne
N-Acetyl Cysteine
N-Acetyl Cysteine (or NAC) is an important amino acid for optimizing weight, improving hair, and creating clear skin. NAC has antioxidant properties that help reduce oxidative stress and inflammation, which can improve insulin sensitivity, potentially lower testosterone levels, and improve markers of PCOS13. It also supports overall hormonal balance and metabolic health.
Learn more about NAC supplements here.
Myoinositol
Myoinositol is a well studied nutrient that has been shown to improve insulin14 and testosterone levels, especially in those with PCOS. It may also help improve levels of inflammation15 in the body.
It is one of the best studied supplements for those with high androgens, which is why we included it in our Myo Inositol Plus formula to support those struggling with high androgens.
And, if you have PCOS and are looking for help managing symptoms with supplements, refer to this article: 10 Best Supplements For PCOS
Medication Treatment for High Testosterone in Females
Insert image treatment for high testosterone in females
While many cases of high testosterone in women will respond to nutrition and lifestyle changes, in some cases, medications may be necessary to manage symptoms.
1. Metformin
This medicine is used to treat type 2 diabetes and is commonly prescribed to women with PCOS. It can help lower high testosterone by decreasing blood sugar levels and helping the body better regulate insulin. When the body is more sensitive to insulin and blood sugar is better managed, hormone levels more easily return to the normal range.
2. Glucocorticoids
These are a type of steroid hormone that helps reduce inflammation in the body and may be used in cases of congenital adrenal hyperplasia. Glucocorticoids naturally exist within the body to help your cells use sugar and fat. However, in cases of high testosterone, additional glucocorticoids are needed to support normal responses to inflammation and the use of glucose (or sugar).
3. Spironolactone
This is a diuretic that helps regulate water and salt levels in the body. It is often used to reduce excessive facial hair growth. It does this by slowing down the production of androgen sex hormones, including testosterone. You can read more about Spironolactone here.
4. Oral contraceptives
Certain birth control pills are an effective treatment for blocking testosterone. According to the American Academy of Family Physicians16, birth control that uses low levels of norgestimate, gestodene, and desogestrel are best for managing high testosterone in women.
Bear in mind that this treatment can come with its own side effects, such as decreased libido and mood, which you should discuss with your health provider.
Read more: Treating PCOS Symptoms With The Pill
Key Takeaways on High Testosterone In Women
- High testosterone symptoms in women can includes irregular menstrual cycles, fertility issues, scalp hair loss, excess body hair, acne, and mood changes. These symptoms reflect an imbalance in hormone levels, impacting women's health and quality of life.
- Conditions like PCOS, Congenital Adrenal Hyperplasia (CAH), and insulin resistance can all contribute to high T in women.
- Elevated insulin levels can exacerbate high testosterone by decreasing SHBG levels and stimulating androgen production in the ovaries and adrenal glands.
- If you suspect you have high T, discuss your medical history with your doctor and test your hormone levels.
- Strategies to manage high testosterone include diet modifications, exercise, stress management, and sleep optimization. Medications might include Metformin, Glucocorticoids, Spironolactone, and low-androgenic oral contraceptives.
- A number of supplements can also help restore hormonal balance, including saw palmetto, Vitex, DIM, N-acetyl cysteine, and myo-inositol.
References
- https://www.health.harvard.edu/staying-healthy/testosterone--what-it-does-and-doesnt-do#:~:text=Testosterone%20is%20the%20major%20sex,production%20of%20testosterone%20in%20men. ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8548673/ ↩︎
- https://onlinelibrary.wiley.com/doi/10.1111/cen.14710 ↩︎
- https://onlinelibrary.wiley.com/doi/10.1111/cen.14710 ↩︎
- https://pubmed.ncbi.nlm.nih.gov/38579789/ ↩︎
- https://www.endocrine.org/patient-engagement/endocrine-library/pcos ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9541126/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9665922/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9962283/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9923052/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206839/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9340349/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573309/ ↩︎
- https://www.ncbi.nlm.nih.gov/pubmed/18335328 ↩︎
- https://www.ncbi.nlm.nih.gov/pubmed/19499845 ↩︎
- https://www.aafp.org/afp/2003/0615/p2565.html ↩︎
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