While testosterone is considered a male sex hormone, females produce small amounts in the ovaries and adrenal glands. High levels can be caused by certain conditions and may affect physical appearance and overall health.

Together with the female sex hormone estrogen, testosterone plays a role in the growth and maintenance of female reproductive tissue and bone mass. These hormones also influence behavior.

In this article, learn about conditions that cause high testosterone in females, as well as about symptoms and treatment.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

According to the American Urology Association, average blood levels of testosterone in males are at least 300 nanograms per deciliter (ng/dL).

Females secrete much lower amounts, with average levels considered to be between 15 and 70 ng/dL.

The level of hormones produced in the body varies each day and throughout the day. However, testosterone levels are generally highest in the morning.

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Symptoms of high testosterone in females may include mood changes, a deep voice, thinning hair, and acne. Image credit: iStock

Testosterone imbalances in females can affect their physical appearance and overall health.

Symptoms of high testosterone in females include:

Severely high levels of testosterone in females can cause obesity and infertility.

High testosterone in females is usually caused by an underlying medical condition, such as:

Congenital adrenal hyperplasia (CAH)

CAH is the term given to a group of inherited disorders that affect the adrenal glands. These glands secrete the hormones cortisol and aldosterone, which play a role in managing metabolism and blood pressure.

The adrenal glands also produce the male sex hormones DHEA and testosterone.

People with CAH lack one of the enzymes necessary to regulate the production of these hormones, so they secrete too little cortisol and too much testosterone.

CAH may be mild (nonclassic CAH) or severe (classic CAH).

Symptoms in females include:

  • deep voice
  • early appearance of pubic hair
  • enlarged clitoris
  • excess body hair
  • facial hair
  • irregular or absent menstrual periods
  • severe acne
  • shorter height as an adult after rapid childhood growth

While there is no cure for CAH, most people with the condition can receive treatment that will reduce symptoms and improve their quality of life.

Hirsutism

Hirsutism is characterized by unwanted hair growth in females. It is a hormonal condition thought to be linked to genetics.

Symptoms include male-pattern hair growth that is dark and coarse. It typically affects the:

  • back
  • chest
  • face

In cases of excessively high testosterone, other symptoms will also be present, including:

  • acne
  • balding
  • deepening voice
  • enlarged clitoris
  • increased muscle mass
  • reduced breast size

Home remedies and medical treatments help many people control the symptoms of hirsutism.

Polycystic ovary syndrome (PCOS)

PCOS is a common hormonal disorder that affects females of reproductive age. It is estimated that PCOS affects between 6–12% of people in the United States.

People are not usually diagnosed until they are in their 20s and 30s. However, children as young as 11 years old can be affected.

Symptoms of PCOS include:

  • enlarged ovaries that develop follicles and do not release eggs regularly
  • excess body hair
  • irregular, infrequent, or long menstrual periods

PCOS may lead to several health complications, including:

Doctors do not know what causes PCOS, although excess insulin and genetics may play a role.

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A doctor may order a blood sample to diagnose high testosterone in females. Image credit: Shutterstock

A doctor can diagnose high testosterone in females based on the following:

Physical examination

During a physical examination, the doctor will look for symptoms such as:

  • acne
  • excess body hair
  • facial hair growth

They will also inquire about:

If PCOS is suspected, the doctor may visually and manually examine the pelvic region to look for abnormalities.

Blood test

If symptoms suggest high testosterone levels, the doctor will take a blood sample and have hormone levels tested. They may also check glucose and cholesterol levels.

Usually, the blood will be drawn in the morning when testosterone levels are highest.

Ultrasound

To check for PCOS, the doctor may perform an ultrasound of the ovaries and uterus.

The treatment recommended for high testosterone will depend on its underlying cause.

Typically, a doctor will recommend both lifestyle changes and medication. Some treatments may also be used to control unwanted hair.

Medication

High testosterone and associated conditions can be treated with the following medications:

  • Eflornithine: This is a cream applied directly to the skin that slows the growth of new facial hair.
  • Glucocorticosteroids: This is a type of steroid hormone that reduces inflammation in the body.
  • Metformin: This is a treatment for type 2 diabetes, which is sometimes used to lower blood sugar and insulin levels in people with PCOS.
  • Progestin: This is a hormone that may regulate periods and improve fertility.
  • Spironolactone: This is a diuretic that helps balance water and salt levels and reduces excessive female hair growth.

Oral contraceptives may also be prescribed, as this treatment helps to block excess testosterone.

According to a 2019 review, pairing oral contraceptives that contain estrogen and progestin with antiandrogens and metformin may be most effective for the treatment of hirsutism.

However, keep in mind that oral contraceptives may not be suitable for people who are trying to get pregnant, and they can also cause adverse side effects.

Hair removal treatments

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Laser therapy may help to control unwanted hair. Image credit: Gilaxia/iStock

Both electrolysis and laser therapy may be used to control unwanted hair. However, these treatments will not resolve an underlying hormonal imbalance.

  • Electrolysis: This involves inserting a tiny needle into each hair follicle. A pulse of electric current travels through the needle and damages the follicle so that it cannot grow new hair. Multiple treatments may be required.
  • Laser therapy: During this treatment, laser light is applied to the hair follicles to damage them. Again, multiple treatments may be required.

Note that these hair removal treatments can cause adverse reactions and may have other associated risks.

Anyone with a hormonal imbalance should speak with a doctor before trying medical treatments for excess hair growth.

Lifestyle changes

Some lifestyle changes can reduce high testosterone in females, while others simply manage symptoms.

Here are a few lifestyle changes that may be beneficial:

  • Reach and maintain a moderate weight: Some research shows that losing even 5–10% of body weight can improve fertility, help to balance menstrual cycles, and reduce symptoms in people with PCOS.
  • Follow a balanced diet: A person can improve symptoms of PCOS by following a nutritious, well-rounded diet and limiting their intake of foods high in sugar, refined carbs, saturated fat, and trans fat.
  • Manage unwanted hair growth: A person can choose to treat their facial and body hair growth by plucking, shaving, waxing, or using chemical depilatories. Others bleach their hair to make it less visible.

High testosterone in females can cause a range of symptoms, from excess facial hair to infertility, and is usually caused by an underlying medical condition.

Treating the underlying disorder will often reduce symptoms and improve a person’s quality of life.

People who are or think they may be experiencing high testosterone symptoms should consult a doctor to determine the cause and to determine the best course of treatment.