Testosterone — the primary male hormone, or androgen — is produced by women as well as men. In women, the adrenal glands and ovaries produce androgens. High testosterone levels in women cause excess facial and body hair, acne, irregular or absent menstrual periods and male pattern hair loss of the head.
The most common cause of increased androgen production in women is polycystic ovary syndrome (PCOS), a condition in which the ovaries produce too much androgen. This disorder affects 5 to 10 percent of women, Merck Manual reports.
Congenital adrenal hyperplasia — a disorder in which the adrenal glands produce too much androgen — and some ovarian tumors are among other causes of elevated testosterone levels in women. Treatments include prescription medications and lifestyle changes.
Oral contraceptives, commonly called birth control pills, can lower testosterone levels. They reduce acne and excess facial and body hair and help prevent male pattern hair loss in women. Oral contraceptives are useful for regulating periods but they are obviously not appropriate for women who want to become pregnant. Women with previous blood clots should not take oral contraceptives.
Metformin, a medication most commonly used to lower blood sugar levels in people with Type 2 diabetes, reduces testosterone levels in women. It may also help women lose weight, which can further lower androgen levels. Periods often become regular with metformin and the chances of having a baby may also improve, according to a systematic review of metformin use in women with PCOS published in "Cochrane Database of Systematic Reviews" in November 2017. Bloating, nausea, vomiting and diarrhea are some of the most common side effects of metformin. As metformin can lower sugar levels and also affect kidney and liver function, women taking this medication generally require periodic blood tests.
Spironolactone (Aldactone) is an antiandrogen drug that blocks the effects of testosterone and other androgens on body tissues. It may be most useful for improving acne. Spironolactone can cause birth defects, so it should not be taken by women who might become pregnant. Fatigue, dizziness, headaches and reduced sex drive are other possible side effects of spironolactone.
Glucocorticosteroids, such as prednisone (Deltasone, Predicot) or dexamethasone (Decadron), can reduce androgen production in the adrenal glands. They reduce acne and may improve fertility. These medications may also have a minor effect on excess facial and body hair. When used to treat high testosterone levels, glucocorticosteroids are typically taken in low doses for 2 to 3 months. This reduces the chances of side effects seen with higher doses and longer use, such as weight gain, elevated blood sugar, high blood pressure and weak bones.
As many as 65 percent of women with PCOS are overweight, according to an American Association of Clinical Endocrinologists report published in "Endocrine Practice" in March/April 2001. Weight loss of as little as 7 percent can reduce high androgen levels and improve fertility. Weight reduction can be accomplished by eating a healthy, well-balanced diet, avoiding excess calories. No specific diet or food is recommended for women with PCOS, according to a review article published in the December 2013 issue of "The Journal of Clinical Endocrinology and Metabolism."
Regular exercise can help with weight loss. Exercise and weight loss may also reduce blood sugar levels. This is beneficial because women with high testosterone, and especially PCOS, have an increased risk of developing diabetes.
Reviewed by Mary D. Daley, MD.
- Merck Manual Professional Version: Polycystic Ovary Syndrome (PCOS)
- Endocrine Practice: American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Hyperandrogenic Disorders
- American Family Physician: Diagnosis and Treatment of Polycystic Ovary Syndrome
- Cochrane Database of Systematic Reviews: Insulin-sensitising Drugs (Metformin, Rosiglitazone, Pioglitazone, D-chiro-inositol) for Women With Polycystic Ovary Syndrome, Oligo Amenorrhoea and Subfertility
- The Journal of Clinical Endocrinology and Metabolism: Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline