High Testosterone in Women: Causes, Symptoms, and Treatment

By Your Health Magazine Health Information Team

High testosterone in women can cause excess facial or body hair, acne, scalp hair thinning, irregular periods, and fertility problems. Polycystic ovary syndrome (PCOS) is the most common cause, but medications and less common ovarian or adrenal disorders can also raise testosterone. A blood result alone cannot identify the cause; it must be interpreted with symptoms, medical history, other laboratory tests, and sometimes imaging.

What Does High Testosterone Mean in Women?

Women naturally produce testosterone and other androgens in the ovaries and adrenal glands. These hormones support bone and muscle health, sexual function, and normal reproductive processes. Problems may develop when androgen production increases or when more testosterone circulates in its active, unbound form.

The medical term for excessive androgen activity is hyperandrogenism. Some women have elevated laboratory values without obvious symptoms, while others have symptoms even when their results fall within a laboratory’s reference range. Hair follicles and skin can differ in their sensitivity to androgens.

Common Symptoms of High Female Testosterone

Symptoms may appear gradually, particularly with PCOS. Possible signs include:

Coarse, dark hair on the chin, upper lip, chest, abdomen, back, or inner thighs
Persistent or severe acne and oily skin
Thinning scalp hair, especially around the crown or temples
Irregular, infrequent, or absent menstrual periods
Difficulty ovulating or becoming pregnant
Darkened, thickened patches of skin, which may accompany insulin resistance

More pronounced androgen effects, sometimes called virilization, can include a deepening voice, rapidly increasing muscle mass, enlargement of the clitoris, or quickly progressing facial and body hair. These changes require prompt medical evaluation, particularly when they develop over a few months or first appear after menopause.

What Causes High Testosterone in Women?

Possible cause	Typical clues
Polycystic ovary syndrome	Gradual acne or excess hair growth, irregular periods, difficulty ovulating, and sometimes insulin resistance
Medications or supplements	Use of testosterone, anabolic steroids, DHEA, or certain other medicines
Congenital adrenal hyperplasia	An inherited adrenal condition that may become apparent during childhood, adolescence, or adulthood
Ovarian hyperthecosis	Excess ovarian androgen production, most often considered in women around or after menopause
Ovarian or adrenal tumor	Rare, but more concerning when testosterone is markedly elevated or symptoms progress quickly
Cushing syndrome or another endocrine disorder	Additional findings may include easy bruising, muscle weakness, substantial body-composition changes, or other hormone abnormalities

PCOS is often considered when high testosterone occurs with irregular ovulation or periods. However, having high testosterone does not automatically mean a person has PCOS, and ovarian cysts are not required in every case. Learn more from the MedlinePlus overview of polycystic ovary syndrome.

How High Testosterone Is Evaluated

A clinician will usually ask when symptoms began, how quickly they are changing, whether menstrual cycles are regular, and whether pregnancy is possible. The evaluation may include a skin and hair examination, blood pressure measurement, and a review of medications, supplements, and family history.

Common tests include:

Total testosterone: Measures both protein-bound and unbound testosterone.
Free testosterone: Estimates or measures the smaller amount not attached to proteins.
Sex hormone-binding globulin: Helps clinicians understand how much testosterone may be biologically available.
DHEA-S: An adrenal androgen that may help determine whether excess hormones are coming from the adrenal glands.
17-hydroxyprogesterone: May be used to screen for nonclassic congenital adrenal hyperplasia.
Additional tests: Pregnancy testing, thyroid studies, prolactin, blood sugar, cholesterol, or cortisol testing may be appropriate based on symptoms.

Testosterone is often checked in the morning. Results must be compared with the laboratory’s reference range because testing methods and normal ranges vary. The MedlinePlus guide to testosterone level testing explains the differences between total, free, and bioavailable testosterone.

Tell the clinician about every prescription, over-the-counter product, and supplement you use. If you take estrogen, note the exact formulation and strength; this guide to understanding estradiol patch dosage provides additional context for discussing hormone therapy with your provider. Do not stop hormone therapy or other medications before testing unless instructed to do so.

A pelvic ultrasound or adrenal imaging may be ordered when symptoms progress rapidly, hormone levels are markedly abnormal, or the examination suggests an ovarian or adrenal condition. An ultrasound finding alone does not diagnose PCOS.

How Is High Testosterone Treated?

Treatment depends on the underlying cause, the symptoms that matter most to the patient, pregnancy plans, and other health considerations. The goal may be to restore more regular menstrual cycles, protect the uterine lining, improve acne or unwanted hair, address fertility concerns, or treat a specific ovarian or adrenal disorder.

PCOS management: Regular physical activity, balanced nutrition, and weight management may improve insulin resistance and hormone patterns when medically appropriate. Hormonal contraceptives may be prescribed to regulate periods and reduce acne or new unwanted hair growth.
Antiandrogen treatment: A clinician may prescribe a medicine such as spironolactone for acne or hirsutism. Effective contraception is generally necessary when pregnancy is possible because antiandrogens may harm fetal development.
Metabolic treatment: Metformin may be used for selected patients with PCOS, insulin resistance, prediabetes, or diabetes. It is not primarily a cosmetic hair-removal treatment.
Hair and skin care: Shaving, waxing, electrolysis, laser hair reduction, topical treatments, and standard acne therapies can address symptoms while the hormonal cause is being managed.
Medication-related elevations: A clinician may recommend changing an exposure or prescription when it is contributing to androgen excess. Never stop a prescribed medication without medical guidance.
Ovarian, adrenal, or pituitary disorders: These may require care from an endocrinologist, gynecologist, reproductive endocrinologist, or surgeon.

Hormonal treatments usually do not remove hair that is already present, and improvement in acne or hair growth may take several months. Treatment should be monitored for effectiveness, side effects, menstrual changes, and pregnancy considerations.

When to Seek Care

Schedule an appointment with a primary care clinician, gynecologist, or endocrinologist if you develop persistent facial hair, difficult-to-control acne, scalp hair loss, irregular periods, or trouble becoming pregnant. Evaluation is also appropriate after an unexpectedly high testosterone result, even if symptoms are mild.

Seek prompt care for rapidly developing symptoms, a deepening voice, clitoral enlargement, sudden severe hair growth, or new androgen-related symptoms after menopause. These findings do not necessarily indicate a tumor, but they warrant timely testing to exclude uncommon ovarian or adrenal causes.

This information is for general education and cannot determine why an individual testosterone result is high. A healthcare professional can interpret the result in the context of age, symptoms, menstrual status, medications, and other test findings.