High Androgens in Females: Symptoms, Causes, and Treatments

High levels of androgens in females, or hyperandrogenism, can result in health conditions caused by these sex hormone levels. Symptoms of high androgens in females include acne, excessive hair growth, and irregular or absent periods.

This is commonly due to polycystic ovary syndrome (PCOS), a hormonal disorder that impacts females and leads to cysts or small sacs found in the ovaries, which are glands that produce eggs. Other causes of high androgens include certain tumors and Cushing's disease, with treatment (including medication and surgery) depending on the cause.

This article explains the signs and symptoms of high androgens in females, their causes, and how these levels can impact your overall health as well as treatment options.

Signs of Hyperandrogenism - Illustration by Joules Garcia — Illustration by Joules Garcia for Verywell Health

What Are Androgens?

Androgens are essential hormones that help with:

Reproductive function
Cardiac health
Bone strength
Muscle tone and mass
Brain function
Sexual desire, or libido
Fat cell action and location
Body and pubic hair growth

In females, the androgen hormones are created in fat cells and the ovaries. They are also made in the adrenal glands, which are located above the kidneys and are responsible for releasing various hormones.

Androgen hormones are steroid hormones, which are a group of hormones that include:

Androstenediol (A5), which is used to make the sex hormones estrogen and testosterone
Androstenedione (A4), which is used to make estrogen and testosterone
Androsterone, a byproduct of testosterone breaking down
Dehydroepiandrosterone sulfate (DHEAS), which is made into estrogen or testosterone
Dihydrotestosterone (DHT), a byproduct of testosterone

Testosterone, a commonly recognized androgen hormone, is associated with the development of sex characteristics, bone health, and sex drive.

A Note on Gender and Sex Terminology

Verywell Health acknowledges that sex and gender are related concepts, but they are not the same.

Sex refers to biology: chromosomal makeup, hormones, and anatomy. People are most often assigned male or female at birth based on their external anatomy; some people do not fit into that sex binary and are intersex.
Gender describes a person's internal sense of self as a woman, man, nonbinary person, or another gender, and the associated social and cultural ideas about roles, behaviors, expressions, and characteristics.

Research studies sometimes don't use the terminology in this way. Terms that describe gender (“woman,” “man”) may be used when terms for sex (“female,” “male”) are more appropriate. To reflect our sources accurately, this article uses terms like "female," "male," "woman," and "man" as the sources use them.

What Is Hyperandrogenism?

Hyperandrogenism occurs when androgens are higher than they should be. Hyperandrogenism is not the same as PCOS and can have a number of different causes. The most common one is PCOS.

There are two kinds of hyperandrogenism and both kinds can lead to a PCOS diagnosis:

Clinical hyperandrogenism occurs when there are visible signs or symptoms that show that androgen production may be higher than expected. These can be seen or experienced without medical testing.
Biochemical hyperandrogenism happens when lab work shows high levels of androgen hormones in the bloodstream.

By some estimates, hyperandrogenism occurs in about 20% of the female population. It is less common before puberty.

It is possible to have clinical signs of hyperandrogenism and for all blood work to come back normal. It is also possible to have labs indicate high androgen levels, with little to no clinical signs.

Symptoms of High Androgens

Signs and symptoms of hyperandrogenism may include abnormal hair growth, acne, male-pattern baldness, and virilization, which is when females develop traits typically associated with males.

Abnormal Hair Growth

Male-pattern hair growth, like facial hair or hair on the chest and back, in people of the female sex can be a sign of hyperandrogenism. The medical term for this is hirsutism. Hirsutism affects about 5% to 10% of females.

Hirsutism is a common symptom of PCOS. However, some people can have hirsutism without PCOS. Although not common, hirsutism can also occur in people with an adrenal gland problem or other disorders of male hormone overproduction.

Some individuals remove this type of hair growth and may not realize it’s a potential symptom of a medical condition. Be sure to tell your healthcare provider if you’re experiencing this.

Acne

In adulthood, mild acne is not considered abnormal. However, moderate to severe acne, especially when accompanied by other symptoms, may indicate high levels of androgens.

Lack of Menstrual Periods

High levels of androgen may make your menstrual period stop, a condition known as amenorrhea. Amenorrhea has been seen in people with PCOS. Adrenal tumors can also cause menstruation to cease.

Male-Pattern Balding

Individuals may experience hair loss as they get older. However, when females experience hair loss that looks similar to “male-pattern balding,” this may be a sign of hyperandrogenism.

Male-pattern balding happens when hair loss occurs either by the hairline, resulting in a receding hairline, or around the crown of the head. This is different than female-pattern balding, where hair thins out on the top of the head, but the hairline itself remains unchanged.

Oily Skin

Androgens stimulate the activity of oil glands in the skin. When your oil glands are more active, they release more sebum, resulting in oily skin.

Having some sebum on your skin helps protect your skin and keeps it hydrated. However, the oiliness from too much sebum can block pores, leading to acne.

Virilization

Virilization occurs when females develop traits associated with males. Excess production of testosterone, specifically, may be what drives these changes in females.

Low levels of testosterone can cause male-pattern hair growth, oily skin, and irregular menstrual periods. Moderate levels can result in male-pattern baldness, loss of female fat distribution, and decreased breast size, whereas high levels can cause clitoris enlargement, deepening of the voice, and male muscle pattern.

How Are Androgen Levels Tested?

When diagnosing PCOS, healthcare providers want to test androgen levels. This is done through blood work. What is considered within the normal range for androgens will vary based on the specific lab, so be sure to discuss your results with your provider.

Normal Ranges of Androgens

Total testosterone: This is the total amount of all the testosterone in your bloodstream. Levels should be between 6.0 and 86 nanograms per deciliter (ng/dL) in females. In PCOS, total testosterone may be slightly elevated.

Free testosterone: This testosterone is unattached to any proteins and is a small percentage of the total testosterone. Normal levels of free testosterone are between 0.7 and 3.6 picograms per milliliter (pg/mL). Free testosterone levels may be elevated in PCOS.

Androstenedione: Normal levels in females are between 0.7 to 3.1 ng/mL. Elevated levels may indicate PCOS.

DHEAS: For females in their 20s, a normal level is usually in the high 300s. Those in their 30s may have normal levels in the 200s.

How PCOS Is Diagnosed

If your healthcare provider has diagnosed you with PCOS, but your lab results show normal androgen levels, you may feel confused. Keep in mind that not everyone agrees on how to diagnose PCOS:

Some healthcare providers say that you don't need high androgen levels to be diagnosed with PCOS.
The Androgen Excess and PCOS Society argues that usually these two symptoms are necessary to qualify for a diagnosis of PCOS: periods that are less regular and higher levels of androgen hormones as determined by a blood test or symptoms like excess body hair. If necessary, an ultrasound of the ovaries may be needed if only one of these symptoms is present.
One of the most commonly used diagnostic criteria for PCOS—the Rotterdam criteria—notes that either lab work or visible signs of hyperandrogenism qualify. It also doesn't require elevated androgen levels for a diagnosis.

If you have infrequent periods that are more than 35 days apart and occur only four to nine times a year, you may receive a diagnosis of PCOS, even without high androgen levels or any visible signs of hyperandrogenism.

Other Causes of High Androgen Levels

The majority of females with hyperandrogenism have PCOS. That said, there are other possible causes of hyperandrogenism which can lead to symptoms similar to PCOS:

Congenital adrenal hyperplasia is a group of inherited conditions where certain enzymes that help make hormones are missing from the body. These conditions affect the adrenal glands and can impact the body's ability to make androgens and other hormones.
Cushing's disease occurs when the body has too much cortisol, a stress hormone, either by overproduction or via medication. Overproduction may be caused by a growth on the adrenal gland or pituitary gland, which helps with hormone regulation. This growth may lead to high levels of a hormone that helps with cortisol production which can increase androgens.
Ovarian tumors can cause your ovaries to produce too much androgen. Symptoms of ovarian cancer include bloating, pelvic or belly pain, trouble eating or feeling full quickly, and feeling an urgent need to pee or having to pee often.
Tumors of the adrenal glands can cause changes in hormone levels. High levels of androgen caused by androgen-secreting tumors can lead to facial and body hair growth, receding hairline, irregular menstrual periods, and deepening of the voice in females.

Health Issues Caused by High Androgens

In females, increased androgen levels can lead to irregular periods, facial hair growth, and difficulty becoming pregnant. These high levels are also responsible for some other risk factors that often accompany PCOS.

Fat Distribution

Androgens seem to play a role in where fat is stored in the body. Females with high androgen levels may start to accumulate more fat in the abdominal region. Body shape changes as a result, with more weight being carried around the belly.

Hyperandrogenism can also be affected by diet. One study found lower-quality diets to be associated with higher rates of obesity, insulin resistance, and high levels of androgens. People who followed a Mediterranean diet or DASH diet tended to have lower androgen levels.

Insulin Resistance

The risk of insulin resistance is higher in females with excess androgens. Insulin resistance occurs when the body doesn't respond to the hormone insulin like it should. Insulin helps keep blood sugar levels in check.

Insulin resistance is also associated with PCOS. However, not everyone with PCOS will develop insulin resistance. For people who do, antiandrogen therapy may be able to reverse insulin resistance.

Insulin resistance can cause high levels of blood sugar. Too much blood sugar can cause considerable damage. When you are resistant to insulin, you also have high levels of insulin in the blood. Too much insulin in the blood can set the stage for prediabetes and type 2 diabetes.

Cardiovascular Problems

Having abnormally high levels of androgens is associated with an increased risk of heart problems in females.

Scientists are still teasing out the nuances in how high androgen levels affect heart health. It seems that having high androgen levels alone doesn't increase your risk of cardiovascular problems. When combined with irregularities in your period, however, hyperandrogenism may put you at increased risk of cardiovascular disease, coronary heart disease, and heart attack.

Difficulties With Pregnancy

It is known that PCOS can cause infertility in some people. Yet, many with PCOS can still get pregnant. If pregnancy does occur, there may be additional risks. High androgens affect the function of the ovaries and uterus, which could mean failure of the embryo to attach to the uterine wall, preeclampsia, and preterm birth. It can also increase the risk of gestational diabetes.

Treatment for Hyperandrogenism

Treatment for hyperandrogenism will vary since PCOS and hyperandrogenism don’t always present the same way.

All treatments have their advantages and disadvantages, and medications may carry side effects and risks. Talk to your healthcare provider about which option may be best for you.

Birth Control

For those who aren’t trying to get pregnant, hormonal birth control pills may be used to reduce androgens and treat symptoms. Combined estrogen-progesterone birth control may be tried first to treat PCOS symptoms. But, you may need to try a few options before finding the birth control that helps you feel best.

Not everyone does well on birth control and some prefer to avoid taking hormonal medications.

Antiandrogen Drugs

Another possible treatment is antiandrogen medication, which reduces the effects of excess androgens. Antiandrogen treatment can be started six months after starting birth control pills.

Antiandrogen drugs include the following:

Spironolactone may be used to treat hair loss, hirsutism, and acne. People who are pregnant should not use this medication. Due to its side effects, you may need to monitor your blood pressure, sodium, and potassium while you're taking this medication.
Finasteride is another antiandrogen drug used to treat hair loss and hirsutism. Its side effects include low libido, depression, and low blood pressure.
Cyproterone acetate has also been used in hyperandrogenism. However, it doesn't seem to be better in treating hirsutism than other birth control pills.

Insulin Reducing Drugs

Metformin, which improves insulin sensitivity, may be used to treat PCOS-related androgen symptoms. Aside from reducing androgen levels, metformin has been shown to improve menstrual patterns, hirsutism, and body fat distribution in people with PCOS.

Metformin is considered safe to take if you’re trying to get pregnant. It may also be able to aid in ovulation and reduce miscarriage rates in people with PCOS.

Hair Removal

Some may choose to directly remove unwanted hair growth, but keep in mind that most of these options will only work temporarily.

Electrolysis and laser therapy actually work really well. On the downside, they can be expensive and may require more than one session.

The following hair removal options are less expensive than electrolysis or laser therapy, but can irritate the skin:

Shaving
Plucking
Waxing
Threading
Topical creams
Bleaching

Acne Treatments

There are a number of over-the-counter acne treatments, but for those with PCOS-related acne, these may not make a significant difference. You may want to see a dermatologist, a doctor who specializes in treating skin, hair, and nails. The dermatologist may prescribe you treatments that are more effective than over-the-counter options.

How to Naturally Decrease High Androgens

One study found that drinking tea led to a significant decline of testosterone levels. Green tea produced the strongest effect, but spearmint herbal tea and marjoram tea may also help. Eating nutritious foods and maintaining a healthy weight are also thought to help minimize PCOS symptoms.

When to See a Healthcare Provider

If you have noticed any changes in your health that you think may be related to high androgen levels, contact a healthcare provider to get tested.

You may want to get checked out regularly if you know you have PCOS. PCOS can increase your risk of developing diabetes, high blood pressure, high cholesterol, obesity, and uterine cancer.

Summary

Hyperandrogenism occurs when androgens are higher than they should be. Excess androgens can have several causes, the most common being PCOS. Visible signs of hyperandrogenism and/or blood work that shows high levels of androgens can confirm a PCOS diagnosis.

Symptoms of hyperandrogenism may vary from person to person. High female levels of androgens can have negative health effects, including insulin resistance, body shape changes, and cardiovascular problems. Treatment may include various medications.

34 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Rachel Gurevich, RN
Rachel Gurevich is a fertility advocate, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association. She is the author of "The Doula Advantage" and "Birth Plans for Dummies," and a member of the Association for Health Care Journalists. She has contributed to Reuters Health, USA Today, and more.

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Symptoms of High Androgens in Females and How to Treat It