High testosterone is one of three of the main features of PCOS, but not everyone with PCOS will present with hyperandrogenism. But why do some people with PCOS have high testosterone levels and what are the causes, signs and treatment of high testosterone? Keep reading to learn more about hyperandrogenism in people with PCOS.
What is PCOS?
Polycystic ovary syndrome (PCOS) is an endocrine disorder with reproductive and metabolic outcomes. High androgen levels including testosterone is known as hyperandrogenism. 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?
>> Read more | PCOS 101: A beginners guide to PCOS
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 high testosterone (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.
Your doctor or endocrinologist will take a detailed history and do a physical examination looking for signs of hyperandrogenism.
This is when blood tests are taken to see if certain androgen 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 and symptoms 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.
How to lower testosterone
In people with PCOS, lowering testosterone may improve symptoms of hyperandrogenism like hair loss, alopecia, hirsutism and acne. Speaking with your doctor or healthcare professional is key when attempting to manage your hormones.
Anti-androgens are a medication that can help lower testosterone in people with PCOS. There are two types of anti-androgens: testosterone receptor blockers and conversion blockers. Anti-androgens can either block the testosterone receptor on the hair follicle or they can stop testosterone from being converted into dihydrotestosterone, a more potent version of testosterone.
Inositol is an insulin sensitiser which may help lower testosterone levels in people with hyperandrogenism. It is believed that insulin contributes to higher testosterone levels so lowering insulin levels may reduce the likelihood of hyperandrogenism.
Spearmint is a herb from the mint family that has been used as a tea in traditional medicine to help lower androgen levels. Although more evidence is needed, there is positive evidence to suggest that it may help with signs of hirsutism.
Key takeaways: high testosterone and PCOS
High testosterone is diagnosing factor in PCOS and can contribute to symptoms like hair loss, excess hair growth on the face, chest and back, acne and oily skin. Although hyperandrogenism can be recognised clinically, for proper diagnosis a blood test should be completed. There are various medications, supplements and foods that may help with hyperandrogenism but speaking with your healthcare professional is always advised.
Founder and Editor | Registered Associate Nutritionist
Founder of Be The Collective LTD [The PCOS Collective & The Endo Collective] Alex Okell ANutr is a London-based reproductive health nutritionist with experience in research, private practice and digital media. She holds a Master’s degree in Nutrition from King’s College London and has co-authored papers with the University of Cambridge, King’s College London, The Food Foundation and the Food Standards Agency. Alex offers 1:1 PCOS support in our virtual PCOS clinic.