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High Testosterone In Women: How To Diagnose and Treat It?

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Testosterone is a male hormone produced by the ovaries and female adrenal glands in small quantities.

Along with estrogen, the female sex hormone testosterone helps maintain, grow, and repair a woman’s reproductive tissues, human behavior, and bone mass. 

Causes Of High Testosterone Levels In Women:

Various hormonal disorders and diseases cause hormonal changes in women. 

Commonly found causes of high testosterone levels in women include Polycystic Ovary Syndrome, Congenital Adrenal Hyperplasia, Hirsutism, Thyroid Problem, and Insulin Resistance.

1. Polycystic Ovary Syndrome Or PCOS

Polycystic Ovary Syndrome refers to the endocrine condition which affects 1 in 10 women worldwide. It interferes with the menstrual cycle and causes difficulty in conceiving. 

These are some common symptoms of PCOS:

  • Enlarged ovaries with increased number of small follicles
  • Obesity
  • Hormonal Acne
  • Apple-shaped body
  • Irregular menstruation, infrequency (6-9 cycles per year), or longevity (cycle length more than 35 days)

PCOS also leads to numerous infertility challenges, Sleep Apnea, Type 2 Diabetes, increased risk of heart failure. 

The underlying cause of PCOS is still unknown to us. On the other hand, most women with PCOS have similar symptoms to high testosterone levels in women. 

Excessive insulin and genetics are some of the contributing factors of PCOS. In addition, Polycystic Ovary Syndrome is also associated with low levels of HDL,  heightened triglycerides, insulin resistance, obesity, cardiovascular disease, and high LDL.

2. Congenital Adrenal Hyperplasia (CAH)

Congenital Adrenal Hyperplasia refers to a group of inherited disorders related to the adrenal glands, that produce cortisol and androgens. 

These hormones help in regulating blood pressure and the body’s metabolism. Adrenal glands are also responsible for the production of male sex hormones DHEA and testosterone. 

Due to CAH, an enzyme needed to help regulate the secretion of these hormones is lacking. This in return causes too much testosterone and too little cortisol to be produced. CAH can be “severe” i.e classic CAH or “mild” i.e non-classic CAH. 

Symptoms of CAH are similar to other conditions associated with high testosterone in women.

These include:

  • Acne
  • Early Appearance Of Pubic Hair
  • Excessive Facial And Body Hair
  • Deepening Of Voice
  • Enlarged Clitoris
  • Irregular And Infrequent Periods
  • Stunted Growth In Adulthood
  • Rapid Growth During Childhood

3. Hirsutism

Hirsutism in women refers to the excessive growth of facial and body hair. Symptoms of hirsutism include male-patterned hair growth that is usually coarse and dark on the back, face, and chest. 

High testosterone levels in women can at times go beyond simple hirsutism and cause other symptoms to occur in a process called virilization. 

Signs and symptoms of virilization include:

  • Excessive Hair Loss
  • Enlarged Clitoris
  • Acne
  • Bulky Muscles
  • Deepening Of Voice
  • Reduced Breast Size

4. Insulin Resistance

Insulin resistance happens when a woman’s body fails to recognize the insulin hormone which in return increases blood sugar levels. Insulin then does not get utilized properly and remains in the bloodstream, which makes the ovaries produce extra testosterone. 

5. Thyroid Problems

Our thyroid glands are involved in a wide range of bodily functions. These include metabolism and the production and concentration of hormones in a women’s body. 

Studies have found an indirect link between hypothyroidism which is an underactive thyroid condition and testosterone levels.

Hypothyroidism may cause a decline in the production of sex hormone-binding globulin or SHBG which is essential for balancing the sex hormones in a women’s blood. In case SHBG falls very low, the body may produce more testosterone causing associated symptoms.

Normal Range Of Testosterone In Women:

According to the Mayo Clinic, the normal range of testosterone for women as per age is:

  • Ages 10–11: < 7– 44 nanograms per deciliter
  • Ages 12–16: < 7 – 75 nanograms per deciliter
  • Ages 17–18: 20 –75 nanograms per deciliter
  • Ages 19+: 8 – 60 nanograms per deciliter

Signs And Symptoms Of High Testosterone In Women:

Too much testosterone in a woman’s body can cause issues that affect her physical, mental, and emotional health.

The symptoms of high testosterone in women include:

  • Balding
  • Acne
  • Enlarged Clitoris 
  • Deepening Of The Voice
  • Increased Muscle Mass
  • Excessive Body Hair, Especially Facial 
  • Decreased Breast Size
  • Low Libido
  • Changes In Mood
  • Irregular Menstrual Cycles

Severe cases of testosterone imbalance in women can also cause infertility and obesity. 

How To Diagnose High Testosterone?

If you notice any of the symptoms mentioned above, we recommend talking to a medical practitioner. 

Any doctor will then perform a physical assessment based on your symptoms. This will help you determine whether or not you need additional tests. During the assessment, a doctor will look for these signs:

  • Acne
  • Excess Body Hair
  • Abnormal Facial Hair

If a woman’s symptoms seem abnormal, a doctor will suggest a testosterone test to measure the hormone levels. This test is performed by drawing out blood and examining it for high testosterone levels. 

A testosterone levels test gets performed in the morning as testosterone levels are highest in the morning. Before performing this test, a doctor may ask the woman not to take any medications that affect the result.

How To Treat High Testosterone Levels In Women?

Before starting any regime or medication to lower testosterone, it is essential to consult a medical expert. The treatment they recommend depends upon what is the cause of high testosterone. 

In most cases, a healthcare provider will recommend lifestyle and dietary changes for sustained results. Sometimes, they may also recommend treatment or medication to control symptoms such as acne or unwanted hair.

Lifestyle Changes

Lifestyle changes have been proven to dramatically improve the quality of life of women with high testosterone levels. 

Achieving a healthy weight and also maintaining it can assist with managing hormonal imbalance symptoms. 

If your doctor recommends losing weight then losing 5 – 10% of your weight can significantly improve PCOS symptoms, reduce testosterone levels, and even resolve complications associated with infertility.

Medical Treatments

Medication is usually prescribed to treat the cause of high testosterone production. These treatments may include oral contraceptives, surgery, or a combination of anti-androgens or other hormonal therapies. 

High testosterone levels in women can also be treated with prescribed hormone medications. 

In some cases, oral contraceptives also get prescribed to help block and treat the production of excess testosterone. The best oral contraceptives for women with high testosterone levels and hirsutism are ones with low doses of desogestrel, gestodene, and norgestimate. 

Oral contraceptives are not ideal for women trying to get pregnant. Thus, it is important to share your reproductive plans with your doctor. This will help them determine the best possible treatment for you.

The Takeaway:

High testosterone levels in women can cause a variety of symptoms. From facial and body hair, fertility issues to infertility. In most cases, these symptoms are usually a result of an undiagnosed medical condition. 

Generally, the treatment of the underlying medical condition helps in improving a woman’s quality of life and reducing the symptoms. 

In case, you may feel you are experiencing symptoms of high testosterone level, we recommend consulting your doctor to help determine the cause. Once that is done you will be advised to start appropriate treatment for your condition. 

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