Testosterone (DUTCH)

High Testosterone in Women: Causes, Symptoms, and Treatments

While low testosterone can contribute to health concerns, exceptionally high levels of testosterone are more often a health concern for women, particularly during their reproductive years. A high level of testosterone can occur for several reasons, with polycystic ovary syndrome (PCOS) being one of the most common causes.

PCOS is a prevalent endocrine disorder affecting approximately 6% to 10% of women of childbearing age. It is one of the leading causes of infertility in women. While PCOS tends to run in families, suggesting a genetic component, the exact inheritance pattern is still being researched. PCOS is closely related to insulin resistance and metabolic syndrome. Although many women with PCOS focus on irregular periods and fertility, it's important to note that PCOS is a lifelong condition that requires ongoing management.

Symptoms of High Testosterone in Women:

• Irregular menstrual cycles

• Hair loss on the scalp

• Excess body hair (especially upper lip, chin, chest, and abdomen)

• Infertility

• Acne and oily skin

• Increased body odor

• Sleep disturbances

• Mood changes, including irritability and aggression

• Deepening of the voice

• Enlarged clitoris

• Decreased breast size

• Increased muscle mass

Causes of High Testosterone in Women:

• Polycystic Ovarian Syndrome (PCOS): This is one of the most common causes of elevated testosterone levels in women.

• Insulin and blood sugar dysregulation: Chronic insulin overstimulation can trigger ovaries to produce testosterone.

• Congenital adrenal hyperplasia (CAH): A group of inherited disorders affecting the adrenal glands.

• Tumors: In rare cases, tumors on the ovaries or adrenal glands can cause high testosterone levels.

• High inflammation: Chronic inflammation can disrupt hormonal balance.

How to Treat High Testosterone Levels:

Treatment for high testosterone in women typically focuses on addressing the underlying cause. Here are some evidence-based approaches:

1. For PCOS:

   • Lifestyle changes: Regular exercise and a balanced diet to manage weight and insulin levels.

   • Medications: Metformin or other insulin-sensitizing drugs to treat insulin resistance.

   • Hormonal contraceptives: To regulate menstrual cycles and lower testosterone levels.

2. For other causes:

   • Treatment depends on the specific underlying condition and may involve medication or, in rare cases of tumors, surgery.

3. General approaches:

   • Decrease overall inflammation and stress through regular sleep, balanced meals, exercise, and stress-reduction techniques like yoga or meditation.

   • Consult with a healthcare provider about the potential benefits of supplements like zinc or saw palmetto, keeping in mind that their effectiveness for this purpose is not well-established.

While some natural remedies like green tea, flaxseed, and cruciferous vegetables have shown promise in preliminary studies for their potential to influence hormone levels, more research is needed to confirm their effectiveness in treating high testosterone. Always consult with a healthcare provider before starting any new treatment regimen.

It's important to note that while PCOS is a lifelong condition, its management and impact can change over time, especially after menopause. Regular check-ups and adjustments to treatment plans are crucial for optimal health outcomes.

Like estrogen and progesterone, testosterone normally declines with age. However, because women make testosterone in the ovaries and the adrenal glands, a low level of testosterone could indicate a problem with the function of either organ. Estrogen replacement therapy can also lower the level of testosterone.

If your testosterone level is low for your age and menstrual status, then you could be experiencing symptoms of low testosterone including:

- Decreased libido
- Muscle weakness
- Fatigue
- Depressed mood
- Weight gain

Testosterone also has some health-protective roles after menopause and low levels can increase some areas of health risk including:

- Bone loss/osteoporosis
- Muscle wasting/sarcopenia
- Obesity
- Depression
- Heart disease

Potential ways to increase testosterone:

There may also be some ways to boost testosterone naturally, including:

- eating a more balanced diet focused on fresh foods

- avoiding overeating

- avoiding obesity

- doing regular exercise

- getting plenty of sleep each night

Some foods can boost testosterone because they are high in certain vitamins or minerals, such as vitamin D or zinc, which are associated with increasing testosterone. The following foods can boost testosterone levels:

- Asparagus
- Beans (white/kidney/black)
- Pomegranate juice

Depending on your age, consider testosterone HRT or supplements that support low testosterone symptoms include Zinc, Maca, Tribulus, and Shatavari. If there are no symptoms of low testosterone, also carefully look at the 5a-metabolism and testosterone's downstream metabolites, 5a-androstanediol and 5b-androstanediol to confirm a low androgenic state.

If you are of Asian descent: 

There is a very common genetic variant in this population that, if present, disallows much of testosterone from being converted into the water-soluble form found in urine. Actual testosterone levels, if this genetic variant is present, would be better assessed in a blood serum test (ideally total and free testosterone). This variant metabolism has no known clinical impact and impacts testosterone, 5a-DHT and 5b-androstanediol. It is not known to impact epi-testosterone, 5a-androstanediol or ther androgens as they are metabolized by a different enzyme.

If your testosterone level is very low (less than 1 ng per mg):

Androgens (DHEA and testosterone) in women help with muscle and weight maintenance, memory and brain function, mood, libido and a sense of wellbeing. If testosterone is very low, or low but without symptoms of androgen deficiency, it is best to test serum levels to confirm before starting a treatment program due to the potential of falsely low urinary testosterone. Lifestyle and diet modifications alone could be helpful to increase androgens such as:

- weightlifting

- high intensity interval training

- DHEA or TRT (testosterone replacement therapy) if appropriate and indicated. 

- Tribulus, shatavari, maca

- Mitochondrial support and/or zinc

Testosterone is the major androgen in the body. It is converted to dihydrotestosterone by 5-alphareductase, and to estradiol by aromatase.