Polycystic ovary syndrome (PCOS) is a condition that affects how the ovaries work. The presence of high androgen levels including testosterone is known as hyperandrogenism and is one of three of the main features of PCOS. The others include irregular periods, and polycystic ovaries, of which at least two must be present to be diagnosed with PCOS. But why do some people with PCOS have high testosterone levels and what is the impact?
What is testosterone?
Testosterone is a hormone found in animals. Testosterone is part of the androgen family and a primary sex hormone in people assigned male at birth. The testicles and ovaries make testosterone in humans.
What is hyperandrogenism?
Hyperandrogenism is when androgen levels are higher than expected in the body. In people with PCOS, hyperandrogenism may present as clinical hyperandrogenism and/or biochemical hyperandrogenism.
Clinical hyperandrogenism
Your doctor or endocrinologist will take a detailed history and do a physical examination looking for signs of hyperandrogenism.
Biochemical hyperandrogenism
This is when blood tests are taken to see if certain hormones like testosterone are high.
Why is testosterone high in people with PCOS?
Although the exact reason why hormonal changes in PCOS occur is unknown, it is believed that insulin resistance, a common occurrence in PCOS, may be the culprit. Insulin resistance means high levels of insulin in circulation which can stimulate the ovaries to produce too much testosterone. When high levels of androgens are present in people with PCOS, it can present clinically as hirsutism (excess hair growth on the chest, back, face, tummy etc.), acne, oily skin and/or thinning hair/loss (alopecia/male pattern baldness).
What counts as a high testosterone level?
The reference range for testosterone in people assigned female at birth is 0.3 – 1.9 nmol/L. Most testosterone values in people with PCOS will be less than 5.2 nmol/L. Testosterone values of more than 4.0 nmol/L will need to be repeated and, if testosterone levels are still over 4.0 nmol/L, further investigation is required.
What are the signs of high testosterone in PCOS?
There are a few signs of high testosterone levels in people with PCOS but speaking with your doctor and having a blood test is the only way to be sure.
Hirsutism and PCOS
Hirsutism is the growth of coarse hair presenting in a “male pattern”, such as on the; upper lip, chin, chest, upper abdomen, back etc. It is important to note this is separate from a condition known as hypertrichosis which displays as a distribution of fine hair over the whole body. In people with PCOS, testosterone switches on hair growth. Treatment for hirsutism includes the combined oral contraceptive pill, anti-androgen medication, and cosmetic hair removal including IPL.
Acne, Oily Skin and PCOS
Acne and oily skin that is persistent into adulthood may be a sign of high testosterone levels. Testosterone causes sebaceous and sweat glands in the skin to work overtime, causing clogging of pores plus inflammation and infection – the basis of acne. Treatment for acne and oily skin includes specialist treatment by a dermatologist or the combined oral contraceptive pill.
Thinning of Hair, Hair Loss, Alopecia and PCOS
Thinning of hair and/or hair loss specifically from the head, may also be a result of high levels of testosterone. Testosterone switches off hair growth in scalp hair follicles in susceptible individuals (those with a high genetic predisposition). If hair loss, hair thinning or alopecia are a concern, testing for an underactive thyroid may be necessary. To promote healthy hair and scalp, ensure iron levels are optimal. Although, most commonly, iron deficiency is at a low level and may not be detected in blood tests. Other blood tests of interest are zinc, vitamin B12 and vitamin D.
