High Testosterone in Women: The Symptoms & How to Lower It

Research shows that high testosterone levels in women are a cause for concern for different reasons; as fluctuations in this hormone level can lead to infertility, irregular menstrual cycle, hirsutism, metabolic syndrome, and even can disturb sleep (1). Therefore, continue reading to discover about abnormal testosterone levels in women—including their causes and symptoms. Additionally, you’ll learn about natural treatments and medications that can help females with elevated testosterone levels.

Testosterone In Females

Testosterone is generated not only in males but also is produced in small amounts in the ovaries of women. In women, this hormone is responsible for an increase in sexual desire, maintains immune system health, and increases muscle mass. This hormone also works with estrogen collectively to help in the development, growth, maintenance, and repair of a female’s reproductive tissues. These are some normal functions of testosterone in women; however, when testosterone is released in excess for example in conditions like Polycystic Ovary Syndrome, it can result in irregular periods or infertility in women (2).

What causes high testosterone levels in females?

Numerous causes contribute to elevated testosterone levels in women, specifically the disorders that impact the adrenal glands and ovaries.

1.Poly Cystic Ovary Syndrome

Polycystic ovary syndrome is a complicated medical condition that can have a devastating effect on a woman’s body. This condition affects 5% to 15% of females between ages 15–49, in the United States (3).  PCOS is a hormonal imbalance that results in irregular menstruation periods, obesity, increased body and facial hair (hirsutism), and insulin resistance.  Additionally, it is one of the most frequently occurring causes of infertility. PCOS increases a woman’s chance of developing high blood pressure, diabetes, heart disease, and stroke (3). Although the accurate cause of PCOS is unknown, it is most likely caused by multiple factors with a strong genetic component.

One very important thing to mention is that ALL women with suspected PCOS should be evaluated for metabolic abnormalities, thyroid disease, high prolactin levels, and non classical congenital adrenal hyperplasia (discussed below) (4). Simply telling a suspected PCOS patient to eat less and go on birth control is not good enough (in my opinion). 

Fig Am Fam Physician. 2016 Jul 15;94(2):106-113.

2. Non Classical Congenital Adrenal Hyperplasia

This is a condition that affects the adrenal glands, responsible for the production of hormones in the body, including testosterone in women. The adrenal glands can overproduce testosterone as a result of CAH, resulting in severe acne and “behavioural and physical masculinization,” which occurs as a result of tissue’s reaction to androgens. Therefore, it’s critical to recognize that this is a particular illness that can be diagnosed and that physical and behavioural characteristics are all part of the symptom picture.  It is recommended that all women who present with PCOS symptoms be tested for CAH y running 17-OH Progesterone on blood work (4).

3.Cushing syndrome

Cushing syndrome is another possible reason for elevated testosterone levels in females. Your adrenal glands release more hormones, such as cortisol and androgens than usual when you have this disease. Other symptoms of Cushing syndrome include weight gain around the midsection, purple stretch marks on the abdomen, high blood pressure and what is called  a “buffalo hump” (fat mass on the back of the neck).   To evaluate for Cushing’s consider blood, urine, salivary cortisol levels and/or dexamethasone suppression test (4).

4. Topical Testosteorne 

While this might seem obvious that a women’s testosterone would be higher if she is using a testosterone replacement, I have had patients in my practice unknowingly be exposed to topical testosterone cream. I have had patients who their testosterones was increased as a result of intimate partners using topical testosterone. If your partner is using topical testosterone replacement ensure good hand washing after replacement and wait until the cream has absorbed before coming in contact.

How do you know if you have high testosterone levels?

Symptoms of high testosterone in women include:

• Hirsutism ((Excess growth of dark thick, hair on chest, abdomen, or back)
• A deeper voice
• Mood swings
• Acne
• Scalp hair loss
• Oily skin
• Sleeping problems
• Aggression
• Increased muscle mass
• Increased body odour
• Decreased breast size
• Infertility
• Irregular menstrual cycle

Consult your medical professional if you observe the following symptoms.

Ways To Reduce Testosterone In Women

There are various options available to treat higher levels of testosterone. Depending on your specific needs, this may involve herbal, pharmaceutical and dietary/lifestyle changes. It is also important to consider WHY the testosterone is high in the first place. If you also have high levels of insulin the first step is going to be addressing the high insulin as this is driving up the testosterone levels in the first place.

1.Dietary Adjustments

Simple dietary adjustments can have a noticeable influence on testosterone levels. For instance, increasing the protein and fat content in your diet and decreasing the sugar content might help you gain optimal blood sugar control. When your blood sugar is ideal your insulin levels will be better managed.  This is why the drug classically used for type 2 diabetics called insulin is often prescribed in PCOS patients. I often also recommend avoiding or limiting dairy products.

2. Green Tea

You should drink green tea.  Green tea stimulates the production of Sex Hormone Binding Globulin (SHBG), a protein that binds excess testosterone. This protein does not allow excessive testosterone to be released in the body. Exercise and a high fiber diet may also help here.

3. Flax Seed

Similarly, you can use fresh ground flaxseed, which is an excellent source of anti-inflammatory omega-3 fatty acids and has been found to increase Sex Hormone Binding Globulin protein (5). In one study, PCOS patients that consumed 30g of flaxseeds for 12 weeks showed a significant reduction in body weight, insulin concentration.  Triglycerides, inflammation and leptin resistance (causes issues with hunger/satiety signalling) were also improved (5).

My favourite way to consume flaxseed is by making flaxseed granola. You can find the recipe in my 3 day cleanse guide. 

4. Oral contraceptives

Oral contraceptives are prescribed to treat high testosterone. The American Academy of Family Physicians recommends that you should choose a birth control pill that contains a low dose of desogestrel, norgestimate, and gestodene (4). However, oral contraceptives may not be the best option for women who are trying to conceive, so discuss your reproductive plans with your health care practitioner to decide the best course of therapy. In addition there are many risks involved with taking hormone birth control including worsening insulin resistance, mood changes, blood clot risk, low libido (may be irreversible), depletion of Magnesium, B vitamins, and Zinc. If you are on hormone based birth control you may want to speak to your practitioner about supplementing.

  Read more about known nutrient deficiencies with common medications. 

5.Metformin

This is a medication widely used to treat type 2 diabetes in women with polycystic ovary syndrome. It aids in the treatment of excess testosterone by decreasing blood sugar levels and assisting the body in regulating insulin. This is also frequently used to treat PCOS (6).

6. Glucocorticoids

These are steroid hormones that assist the body in reducing inflammation and may be administered in congenital adrenal hyperplasia (7). Glucocorticoids are naturally occurring substances in the body that assist cells in using fat and sugar. However, when testosterone levels are elevated, more glucocorticoids are required to balance higher testosterone levels.

7. Spironolactone

Spironolactone is a medication used to treat high blood pressure, acne, hirsutism, and alopecia. It is known as a diuretic (a pill to expel water) and is frequently referred to as a potassium-sparing drug because it causes the body to retain potassium while excreting sodium. Its primary function is to remove excess fluids from the body.  Spironolactone can decrease testosterone levels by decreasing this hormone level in blood and by blocking the hormone’s effects.  Be aware, that Spironolactone has its own side effects, for example, it can cause increased urination, potassium deficiency and can lower blood pressure. In addition spironolactone is not safe in pregnancy (8). While some studies have reported a 30-50% reduction in sebum (oil) production, which is beneficial for women struggling with oily skin, it is important to note that the FDA has not approved spironolactone as a treatment for hormonal acne, alopecia, or hirsutism (9).

8. Myo-inositol

A randomized clinical trial comparing myoinositol and metformin in PCOS patients showed that myoinositol helped in the resumption of spontaneous menstrual cycles in 66.66% of women with PCOS with menstrual complaints, whereas the same effect in patients who took metformin was only in 15.78%, which was not significant (10). Use of myoinositol in Infertile women with PCOS resulted in a pregnancy in 57.14% of women, without the need of any ovulation inducing agent while use of metformin gave a pregnancy in all the 9 patients, thought 5 out of them required clomiphene citrate for ovulation induction (10). With myoinositol there was a reduction in weight, BMI, LH/FSH ratio, acne and hirsutism. Metformin has resulted in a decrement of body weight, BMI and acne only.

Conclusions: This study conclusively proves that myoinositol has a definitive role in decreasing the ovarian dysfunction of PCOS. There has been a significant improvement in the symptom profile, weight loss and a significant change in the hormonal parameters (10).

9. Saw Palmetto 

10 . Lifestyle changes

Certain lifestyle modifications have been shown to significantly enhance the quality of life of females with elevated testosterone. Obtaining and maintaining a healthy weight may aid in the treatment of symptoms associated with hormone imbalance. If recommended by a health care professional, reducing 5–10% of your body weight can help lower testosterone levels, prevent complications linked with infertility and can improve PCOS symptoms. *** NOTE *** it is not simple for PCOS patients to lose weight. The underlying root cause of the weight gain must be treated. Simply eating less & exercising more is often unsuccessful and its not your fault.

12. Berberine 

Berberine is one of my favourite herbs.  Not only has berberine been shown to lower androgens but it also can improve insulin resistance and cholesterol levels (12).  This is especially important for patient who the root cause of the high testosterone is insulin resistance.  In addition berberine can create favourable shifts in the gut microbiome and has been shown to promote weight loss (13).

Takeaway

Women with high testosterone levels suffer from a variety of symptoms, ranging from excessive face and body hair to infertility. Most of these symptoms are caused by an underlying medical problem. Treatment of the underlying condition, can lessen symptoms and enhance the quality of life.

So, if you believe you could be suffering from high testosterone symptoms, go to your doctor to figure out what’s causing it and how to treat it. Knowing your unique cause will help develop your unique plan. There is not a one size fits all.

If you suspect high testosterone related to the underlying root cause of insulin resistance and/0r PCOS check out  my PCOS presentation.  In this presentation I discuss the options above in more detail

Dr. Breanne Kallonen, ND

References

1. Glintborg, Dorte, et al. “Evaluation of metabolic risk markers in polycystic ovary syndrome (PCOS). Adiponectin, ghrelin, leptin and body composition in hirsute PCOS patients and controls.” European journal of endocrinology 155.2 (2006): 337-345.
2. Valdimarsdottir, Ragnheidur, et al. “Pregnancy outcome in women with polycystic ovary syndrome in relation to second-trimester testosterone levels.” Reproductive BioMedicine Online 42.1 (2021): 217-225.
3. Lim, Siew, et al. “An Analysis on the Implementation of the Evidence-based PCOS Lifestyle Guideline: Recommendations from Women with PCOS.” Seminars in Reproductive Medicine. Thieme Medical Publishers, Inc., 2021.
4. Am Fam Physician. 2016 Jul 15;94(2):106-113.
5. Haidari, Fatemeh, et al. “The effects of flaxseed supplementation on metabolic status in women with polycystic ovary syndrome: A randomized open-labeled controlled clinical trial.” Nutrition journal 19.1 (2020): 1-11.
6. Harborne, Lyndal, et al. “Descriptive review of the evidence for the use of metformin in polycystic ovary syndrome.” The Lancet 361.9372 (2003): 1894-1901.
7.  Ng, Sze May, Karolina M. Stepien, and Ashma Krishan. “Glucocorticoid replacement regimens for treating congenital adrenal hyperplasia.” Cochrane Database of Systematic Reviews 3 (2020).
8. Muhlemann, M. F., et al. “Oral spironolactone: an effective treatment for acne vulgaris in women.” British Journal of Dermatology 115.2 (1986): 227-232.
9. Thiboutot, Diane, and WenChieh Chen. “Update and future of hormonal therapy in acne.” Dermatology 206.1 (2003): 57-67.
10. Chirania, Kishan, Sujata Misra, and Sandhya Behera. “A randomised clinical trial comparing myoinositol and metformin in PCOS.” Int J Reprod Contracept Obstet Gynecol 6.5 (2017): 1814-20.
11. Arentz, Susan, et al. “Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings.” BMC complementary and alternative medicine 14.1 (2014): 1-19.
12. Zhang, Si-wei, et al. “Effect and mechanism of berberine against polycystic ovary syndrome.” Biomedicine & Pharmacotherapy 138 (2021): 111468.
13. Ilyas, Zahra, et al. “The effect of Berberine on weight loss in order to prevent obesity: A systematic review.” Biomedicine & Pharmacotherapy 127 (2020): 110137.