Women are goddesses empowered by estrogen. Despite this, females also produce small amounts of testosterone. Sometimes hormones get imbalanced, androgens rise and may trigger acne and other conditions. So, what causes high testosterone in women? In this article, I review the causes and symptoms of high androgen levels in females and the best treatment based on my experience as a doctor and skin therapist.
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What Is Testosterone, and What function does it Have in Women?
Testosterone is a steroid sex hormone produced in small amounts in the ovaries and adrenal glands. It is important for women’s reproductive system, bone mass, and cognitive health. Yes, math skills are associated with testosterone.
Testosterone is also essential for libido and sex drive (that is why it usually increases just before ovulation – nature wants more generations to come). Also, estrogen is synthesized from testosterone.
What Is the Normal Level of Testosterone for a Woman?
A woman’s normal testosterone level is 15 to 70 ng/dL or 0.5 to 2.4 nmol/L. However, other hormone parameters are essential, such as dehydroepiandrosterone-sulfate (DHEA-S), free Androgen Index (FAI), and Sex Hormone Binding Globulin (SHBG).
In some cases, testosterone levels increase in women, causing many conditions, including infertility, facial hair, and, of course, acne.
10 Causes of High Testosterone in Women
1. Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome affects adolescents and young women and is characterized by polycystic ovaries, increased androgens, and irregular periods.
Polycystic ovaries become enlarged and contain many fluid-filled follicles. These follicles are harmless but can not release an egg or release it very infrequently.
This means that ovulation does not occur, periods are irregular, or there are no periods. Women also have difficulty getting pregnant.
Women with PCOS experience hormonal imbalance. Usually, these women are overweight and are resistant to insulin. To compensate for this resistance, the body produces more insulin.
High insulin leads to an increase in testosterone. Elevated insulin also prevents testosterone from being released from the body by decreasing sex hormone binding globulin (SHBG) levels (1). So, PCOS is the main reason which causes high testosterone in women.
High testosterone causes hirsutism (male pattern hair growth on the face, chest, and back), hair loss from the head, and acne. It is a type of hormonal acne because androgens stimulate sebum production in oil glands. PCOS-related hormonal acne flares on the lower third of the face – cheeks, jawline, chin, and upper neck.
2. Ovarian hyperthecosis (OHT)
Ovarian hyperthecosis affects postmenopausal and occasionally perimenopausal women. Some cells start to produce way more testosterone, and women experience very high levels of androgens.
The condition progresses slowly, and symptoms develop gradually. Later, women experience hirsutism, hair loss, and slowly developing acne.
If you are in postmenopause or perimenopause and experience acne or are interested in OHT, read this article, in which I have covered all possible causes of acne during menopause.
3. Cushing’s Syndrome
Cushing syndrome is a disease when the body makes too much of the stress hormone cortisol over time. Cortisol is synthesized in adrenal glands.
The leading causes of Cushing’s syndrome are:
- The use of glucocorticoids, which are considered steroids.
- Tumors: pituitary gland, adrenal glands, pancreas, thyroid tumors, but most often – lung tumors. These tumors signal to adrenal glands to produce more cortisol. Some of the tumors might be malignant.
Cushing’s syndrome is characterized by abnormal weight gain, pendulous abdomen, stretch marks, a round face, fat pads on the neck, red cheeks, and easy bruising.
The underlying causes or tumors that produce adrenocorticotropic hormone (ACTH), which signals to adrenal glands to produce more cortisol, also makes them produce more androgens (2). It is a pretty common disorder that causes high testosterone in women.
Women may experience excess body hair, irregular periods, and acne. Cortisol alone is associated with acne as well. I have already written about cortisol acne here.
Acromegaly is a disease where the pituitary gland produces too much growth hormone, leading to abnormal growth of the body, hands, feet, and facial bones.
The causes of acromegaly include pituitary, lung, or pancreas tumors.
Acromegaly is also associated with testosterone increase in women. Growth hormone induces insulin resistance and high insulin levels. High insulin increases testosterone and prevents it from being eliminated from the body (3). Increased testosterone levels may cause facial hair, acne, and hair loss in women.
5. Congenital Adrenal Hyperplasia (CAH)
Adrenal glands are located above the kidneys and produce cortisol, androgens, and aldosterone (which regulates water and salt amounts in the body).
People with CAH cannot synthesize normal amounts of cortisol but produce too much testosterone and other androgens. In some cases, children do not produce cortisol at all and have minimum amounts of aldosterone, making the condition life-threatening. Other cases are not that severe (usually, late-onset CAH).
Late-onset CAH is associated with high testosterone and other androgens rather than cortisol and aldosterone deficiency. Excess testosterone leads to early puberty, severe acne (may affect the face and the body), facial hair, irregular periods, and deepening of the voice in women (4).
It is a genetic condition and is inherited.
6. Some Cancers
Some cancers produce high amounts of androgens, including testosterone. These tumors are rare. The two types of androgen-secreting tumors are:
- Ovarian tumors
- Adrenal tumors
Note that not all ovarian tumors secrete androgens. Less than 1% of ovarian tumors are associated with high testosterone levels.
Usually, these tumors grow rapidly, and symptoms of hyperandrogenism (high levels of androgens) develop very fast. But some benign tumors may grow slowly, and the symptoms of high androgens, such as masculinization, facial hair, and acne, will develop gradually (5).
Steroid hormones producing adrenal tumors might be benign or malignant. They can secrete estrogens (female hormones), androgens (male hormones), or both. Androgen-producing tumors masculinize females: deepen the voice, induce acne and baldness, and increase hair growth.
7. Insulin Resistance
Insulin is a hormone that regulates the amount of glucose in the bloodstream by allowing muscles, liver, and fat cells to use it for energy.
Insulin resistance happens when these cells cannot take up glucose from the blood. Then pancreas tries to compensate for this deficiency by increasing insulin secretion.
Overweight women above 45, physically inactive, or those with PCOS tend to develop insulin resistance more often.
Insulin resistance usually does not have any symptoms. So how do you know you have insulin resistance? You may suspect resistance if you have high glucose levels in your blood, high triglycerides (fat), high LDL (bad cholesterol), and low HDL (good cholesterol).
Insulin is known to increase androgen, including testosterone, secretion in the ovaries and adrenal glands (6).
How to treat or avoid insulin resistance? Lose weight, stay physically active, avoid carbs, and reduce stress – it is that easy (or not?).
8. Metabolic Syndrome
Metabolic syndrome is not a separate disease but a bunch of conditions. The main 5 signs of metabolic syndrome are:
- Large waist
- High blood glucose levels
- High blood pressure
- High triglyceride level
- Reduce HDL (good cholesterol) level
All this leads to insulin resistance which causes high testosterone in women. High testosterone, in turn, triggers acne, facial hair, and head hair loss (7).
And the steps of prevention of metabolic disorder include losing weight, better-eating habits, and physical activity.
Obesity is often associated with high testosterone. Androgen excess may also contribute to the expansion of fat and increase obesity. Moreover, it can trigger the development of PCOS, insulin resistance, and metabolic syndrome (8). Everything is so overlapping.
10. Drug-induced High Testosterone
Some drugs may be androgens themselves or act as androgens. Here are the most common drugs that increase testosterone in women:
- Testosterone is used in women to treat some forms of breast cancer. Also, some women may take testosterone supplements to increase libido, especially pre- and post-menopause.
- Anabolic steroids used in sports.
- Progestin-only contraceptives, such as Minipill.
- Antiepileptic drugs, such as valproic acid (valproate) or oxcarbazepine.
- Danazol, which is used to treat endometriosis, and breast fibroids.
How to Lower High Testosterone Naturally in Women?
Consider these easy natural ways to lower your testosterone levels:
- Exercise, lose weight, eat healthy foods, and avoid carbs. This is the most important and most beneficial advice. As you already read, everything may start with being overweight, leading to insulin resistance, metabolic syndrome, and PCOS.
- Try herbs, such as spearmint, licorice, white peony, and garden angelica (wild celery), which are known (and scientifically proven!) as anti-androgens, capable of reducing the level of testosterone and eliminating the excess of androgens.
- Best supplements to lower high testosterone are zinc and vitamin B6 as they are good androgen blockers.
What are the Medical Treatment Options to lower High Testosterone in Women?
Medications most commonly used to treat excess testosterone in women include:
- Glucocorticosteroids, such as prednisone. It was estimated that corticosteroids lower blood levels of testosterone in women (9). On the other hand, you must be careful when weaning out of the glucocorticoids and slowly decrease the dosage. Otherwise, you may experience severe side effects.
- Spironolactone is a prescription medication that reduces the activity of testosterone. But it may take up to 6 months to see the result, and it does not work for every woman. I would not also recommend taking spironolactone for a woman who has low or normal blood pressure, as it may reduce it even more.
- Metformin is used to treat high blood sugar levels and reduce symptoms of diabetes, metabolic syndrome, and PCOS (but no medications are approved for insulin resistance yet!).
- Oral contraceptives are one of the most common treatments in women. They contain large doses of estrogen and progestin, making them dominant hormones in the body (in other words, lowering the levels of testosterone). However, oral contraceptives were invented for birth control with no intention of treating different conditions. These pills disturb the natural reproductive system, speed up menopause, raise blood pressure, cause dark spots (on the face also), and even thrombosis (blood clots).
Takeaway of High Testosterone in Women with Acne
Testosterone is a crucial hormone in women that is important for the reproductive system and cognitive health.
In some conditions, testosterone may rise. The most common disorders associated with high testosterone include polycystic ovary syndrome (PCOS), metabolic syndrome, insulin resistance, congenital adrenal hyperplasia, obesity, and others.
You may consider taking medical drugs or natural herbs and supplements to reduce the level of testosterone but always consult your doctor.
The best way to lower testosterone is by exercising, losing weight, and developing healthy eating habits.
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- Steinberger E, Rodriguez-Rigau LJ, Petak SM, Weidman ER, Smith KD, Ayala C. Glucocorticoid therapy in hyperandrogenism. Baillieres Clin Obstet Gynaecol. 1990 Sep;4(3):457-71. doi: 10.1016/s0950-3552(05)80304-9. PMID: 2282738. Read