Although testosterone is typically considered a male hormone, women normally produce small amounts. Abnormally high levels of testosterone in women can cause an array of physical effects. High testosterone in women is known as hyperandrogenism and polycystic ovary syndrome (PCOS) is the most common cause. According to the Merck Manual, PCOS affects 5 to 10 percent of reproductive-aged women in the United States. Far less common causes of hyperanderogenism in women include Cushing syndrome and androgen-producing tumors of the ovaries or adrenal glands.
Excess Facial and Body Hair
The most common symtom experience by women with a high testosterone level is excess facial and/or body hair, a condition known as hirsutism. Approximately 60 to 80 percent of women with hyperandrogenism have hirsutism, according to an October 2008 Hospital Physician review article. The type of hair involved isn't the peach fuzz that you might notice on your face if you look closely but rather darker, coarser hair called terminal hair. The degree of hirsutism varies significantly among women with hyperandrogenism. Excess facial and/or body hair typically appear in one or more areas where terminal hair commonly occurs in men but not women, including:
- Above the upper lip
- Chin and lower jaw line
- Around the nipples or on the chest
- Stomach or lower abdomen above the pubic hair
- On the thighs, buttocks or back
Women with too much testosterone frequently experience menstrual problems. This can manifest in different ways, including:
- Menstrual cycles that occur more than 35 days apart
- Unpredictable menstrual cycles
- No menstrual periods for 3 months or longer
- Heavy periods
- Bleeding between periods
- Severe premenstrual symptoms
Women with hyperandrogenism commonly have anovulatory menstrual cycles, meaning a mature egg is not released from the ovary. For this reason, women with PCOS and other conditions that cause a high testosterone level common experience fertility difficulties.
Acne or Oily Skin
Women with high testosterone levels commonly experience oily skin and/or acne. This occurs because androgens stimulate oil glands in the skin. The severity of acne in women with hyperandrogenism, however, does not correlate to the degree of increase in the testosterone level. Furthermore, some women with hyperandrogenism do not have oily skin or acne, although most do. Nonetheless, acne or oily skin that persists into the early 20s or beyond suggests the possibility of underlying hyperandrogenism, especially if the acne fails to respond to standard treatments.
Scalp Hair Thinning
Women with high testosterone levels can experience a form of scalp hair loss called androgenic alopecia. This type of hair loss typically begins with thinning of the hair on top of the head. A woman might not notice obvious thinning of at first but rather increased hair coming out with brushing or hair washing. Widening of the scalp visible at the part is often the first noticeable change with androgenic alopecia associated with hyperandrogenism in women. According to the American Association of Clinical Endocrinologists, androgenic hair loss is the only symptom in approximately 15 percent of reproductive-aged women with high levels of male sex hormones.
Women with severely elevated levels of testosterone and other male hormones can experience physical changes known as virilization. Virilization changes are much more likely to occur in women with androgen-secreting tumors than in those with PCOS. These changes include:
- Deepening of the voice
- Enlargement of the clitoris
- Increased muscle bulk
- Reduced breast size
Next Steps and Precautions
See your healthcare provider if you experience symptoms that might suggest a high testosterone level, especially if 2 or more are present. Seek medical care without delay if you develop any physical changes associated with virilization to determine whether a tumor or another medical condition is responsible.
- Journal of Clinical Endocrinology and Metabolism: Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline
- Endocrine Practice: American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Hyperandrogenic Disorders
- American College of Obstetricians and Gynecologists: Polycystic Ovary Syndrome (PCOS)
- The Obstetrician and Gynaecologist: Polycystic Ovary Syndrome and the Differential Diagnosis of Hyperandrogenism
- Merck Manual Professional Version: Polycystic Ovary Syndrome (PCOS)
- Hospital Physician: Signs of Hyperandrogenism in Women
- Journal of Clinical Endocrinology and Metabolism: Diagnosis of Polycystic Ovarian Syndrome: The Rotterdam Criteria Are Premature
- Reproductive Endocrinology for the MRCOG and Beyond, 2nd Edition; Adam Balen
- Dermatoendocrinology: Hormones and the Pilosebaceous Unit