Most people think of testosterone as a male hormone. Although it’s certainly true that testosterone has important effects in a man’s body, testosterone is also important for women. If a woman’s testosterone levels are too high or too low, then she may experience a variety of health effects.
What happens when a woman has high testosterone? How does testosterone affect females’ bodies? Is there anything that can be done to reverse the effects?
Testosterone is actually just one of a class of hormones known as androgens. Women produce testosterone in their ovaries, along with the other sex hormones, estrogens (which are also a group of hormones) and progesterone. Although a woman’s testosterone levels are far lower than those of men, this hormone is important for women’s health. Testosterone is important in regulating mood, maintaining sex drive, maintaining a healthy bone mass, and even making enough blood cells in the bone marrow.
In women, high levels of testosterone can lead to infertility. High androgens in females interfere with the maturation of eggs in the ovaries. They also block ovulation, which is the process of an egg being released from the ovary.
In addition, a woman with high testosterone may develop body characteristics that are typically associated with males. This process is known as virilization. Some of the effects include:
If a woman has signs that indicate a high testosterone level, then the next step is to test her testosterone levels. This is done by a blood test. The sample is usually collected early in the morning. Because the level of testosterone in the blood varies throughout the day, standardizing the time of day that the test is done allows for more accurate results. A regular STD blood test will not check hormone levels. You need to order a specific hormone test to find out your testosterone level.
Because of differences in the protocols used by different laboratories for measuring testosterone, the normal levels vary between labs. When you get your lab test, the range of normal values found in that lab will be listed. In general, the approximate normal level of testosterone in a woman is between about 8 and 60 ng/dL. By contrast, in men, normal testosterone levels range from about 240 to 1000 ng/dL. However, you should check your level against the normal range produced by that laboratory’s specific protocols to find out whether your level is considered to be elevated.
There are a variety of possible reasons for high testosterone in females. Some of these include:
There are also other possible causes of excess testosterone in women. In some cases, the cause is never determined. Genetics are believed to play a role, but researchers are still working to discover all the possible causes of high testosterone in women.
For women who are suffering from the effects of high testosterone on the body, the first line of treatment is usually birth control pills. These contain estrogen and progesterone. Because the effects of sex hormones in the body are mediated by the relative ratios of the various hormones more so than by the absolute levels, bringing the levels of these “female” hormones up can help to counter the effects of testosterone. However, in women who are actively trying to conceive, this will not be the best solution and another option will be tried instead.
In general, doctors will recommend trying birth control pills for a minimum of six months. This is because the impacts of changes in sex hormone levels can take a while to become obvious, and so it’s important to give the therapy a chance to work.
However, if a woman still shows signs of elevated testosterone, then there are medications known as anti-androgens. These medications block testosterone from attaching to its receptor, so that it doesn’t have the unwanted effects. Some of the options include spironolactone and metformin.
In general, men have a lower body fat percentage than women do. This has led to the idea that taking testosterone is a good way for a woman to reduce her body fat and lose weight.
However, studies have shown that testosterone is not effective for weight loss. It also tends to cause a woman to experience the side effects of high testosterone in females. Most women who are trying to lose weight are interested in having a thinner, but still feminine, body shape. Taking testosterone will generally cause the body to look more masculine, in addition to being ineffective for weight loss.
Testosterone is associated with increases in muscle mass. If a woman has high testosterone, then she may gain weight because of this increase.
In addition, testosterone can lead to insulin resistance, which can in turn lead to weight gain. At the same time, the effect goes both ways – insulin resistance can also lead to higher testosterone. When women with PCOS lose weight, they often experience a decrease in their testosterone levels.
Brand JS, van der Schouw YT. Testosterone, SHBG and cardiovascular health in postmenopausal women. Int J Impot Res Mar-Apr 2010;22(2):91-104. doi: 10.1038/ijir.2009.64.
Davis SR, Wahlin-Jacobsen S. Testosterone in women–the clinical significance. Lancet Diabetes Endocrinol 2015 Dec;3(12):980-92. doi: 10.1016/S2213-8587(15)00284-3.
Hirsutism. Mayo Clinic (2021). https://www.mayoclinic.org/diseases-conditions/hirsutism/symptoms-causes/syc-20354935. Accessed 5 Apr 2022.
Taub RL, Ellis SA, et al. The effect of testosterone on ovulatory function in transmasculine individuals. Am J Obstet Gynecol 2020 Aug;223(2):229.e1-229.e8. doi: 10.1016/j.ajog.2020.01.059.
Total Testosterone. Centers for Disease Control and Prevention (2012). https://www.cdc.gov/nchs/data/nhanes/nhanes_11_12/tst_g_met.pdf. Accessed 5 Apr 2022.
Testosterone – What it Does and Doesn’t Do. Harvard Medical School (2019). https://www.health.harvard.edu/medications/testosterone–what-it-does-and-doesnt-do. Accessed 5 Apr 2022.
Tosi F, Villani M, et al. Insulin-Mediated Substrate Use in Women With Different Phenotypes of PCOS: the Role of Androgens. J Clin Endocrinol Metab 2021 Aug 18;106(9):e3414-e3425. doi: 10.1210/clinem/dgab380.