High Testosterone in Women with PCOS: Causes + Solutions

Androgens are sometimes referred to as “male hormones” which is a bit of a misnomer because they actually play a major role in women’s health. The main androgens are testosterone and androstenedione but dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEA-S) are also androgens you may have heard of. 

Signs of Low Androgen Levels

• Low libido 
• Difficulty reaching orgasm
• Fatigue 
• Decreased motivation 
• Increased susceptibility to bone loss and bone-related conditions

It is important to note here that there’s currently no determined value or range for what constitutes “normal” androgen levels in women. Additionally, your androgen levels will fluctuate quite a bit due to your menstrual cycle and age. And, lastly, lab tests are optimized for measuring testosterone in men so they may not be sensitive enough to detect low levels in women. 

Signs of High Androgen Levels (Hyperandrogenemia)

• Hirsutism (excess facial or body hair)
• Acne 
• Insulin resistance
• Irregular periods
• Weight gain (especially around your midsection
• Hair loss or alopecia 
• Low HDL cholesterol (“good” kind) and high LDL cholesterol (“bad” kind)

Most women who have high androgen levels also have Polycystic Ovary Syndrome (PCOS). In order for a doctor to make an official PCOS diagnosis, they require 2 out of 3 of the following symptoms: high androgens (either biochemical – through blood work, or symptom-based – hirsutism), irregular periods, and cysts on the ovaries. This is called the Rotterdam Criteria. As you can see, there is almost a full overlap here in symptoms between PCOS and high androgen levels.

Causes of High Androgens:

Interestingly, birth control pills may cause high androgens in women, depending on what type of pills you are on (or were on). We often hear about estrogen and progesterone levels being off after taking the pill, but turns out androgens can get pretty out of whack as well. Some birth control pills and devices contain a certain kind of progestin that has a “high androgen index”, including Loestrin, Alesse, the Mirena IUD and the Nexplanon implant.

Of course, PCOS is the main cause of high androgen levels in women, which can ultimately be from insulin resistance or another underlying imbalance. It’s important to note here that obesity and metabolic syndrome can actually cause high androgens as well since your adrenals pump out more androgens in response to the release of insulin and IFG-1. This is one of the reasons why we see so much overlap between the symptoms of PCOS, metabolic syndrome, and obesity and they frequently go hand in hand.

Lastly, there are a number of other disorders that lead to high androgen levels in women such as congenital adrenal hyperplasia, Cushing syndrome, and acromegaly. Still, these are far more rare and are typically genetic.

How to Test for High Androgen Levels:

If you’re limited to one lab test, the simplest way to test for high androgen levels is to order a blood test for total and free testosterone. Yet if you’re able to order more, it’s recommended that you also look at your luteinizing hormone (LH) levels, follicle stimulating hormone (FSH) levels, prolactin levels, lipid profile, and fasting glucose. All of these lab tests are available through your primary care provider.

Treatment of High Androgen Levels

Diet – 

• Omega 3s! Eat cold water fatty fish like salmon, ocean trout, mackerel, sardines and anchovies at least 2x per week  (1)
• Nuts of any kind are great for delivering a punchy dose of monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) to reduce androgen levels, insulin levels, and cholesterol levels. Walnuts in particular are fantastic at boosting sex hormone binding globulin (SHBG) and therefore reducing androgens. 
• Flaxseeds have been shown to reduce free and total testosterone if you consume 30g per day (2).

Herbs – 

• Spearmint tea – Drinking 2 cups of spearmint tea per day can reduce total and free testosterone which in turn helps mitigate excess hair growth (hirsutism). One study showed that consuming 2 cups a day over the course of just 5 days reduced participants’ testosterone levels (3)! If you’re looking for cheap, easy, and accessible then this one is for you. 
• Red Reishi (Ganoderma) – This mushroom reduces the activity levels of 5-alpha reductase, an enzyme that converts testosterone to dihydrotestosterone (DHT). High DHT levels are associated with acne and hair loss (4).
• Saw Palmetto – The berries of the American dwarf palm work to block the conversion of testosterone to DHT, thus reducing symptoms associated with high DHT.
• Chaste Tree – This herb has been used for hundreds of years to correct hormone imbalances. Clinical studies have shown this herb’s effectiveness in reducing PMS symptoms while also helping to balance progesterone levels, especially when prolactin serum levels are elevated. Chaste Tree has dopaminergic effects on the pituitary gland. You can find Chaste Tree in our Flow Balance formula.

Lifestyle – 

• Managing insulin resistance and improving blood glucose levels is a biggie here! Read about our tips for balancing insulin and why strength training is one of the best things you can do for your blood sugar levels. One simple thing you can do starting tomorrow is eat a protein-rich breakfast within 30 minutes of waking up in the morning!