Testosterone Levels in Women: Normal Range and High Testosterone

What is testosterone and why do women have it?

Testosterone is often thought of as a male hormone, but it is produced in all sexes. In women, it is made primarily by the ovaries and, to a lesser extent, the adrenal glands. A portion also comes from conversion of other hormones in peripheral tissues.

At normal levels in women, testosterone contributes to: - Sexual desire and responsiveness - Bone density and muscle strength - Energy and mood - Skin and hair health

The key point is balance: women need some testosterone, but excess androgens — whether testosterone itself or related hormones like DHEA-S and androstenedione — cause characteristic symptoms.

What is a normal testosterone level in women?

Reference ranges vary between laboratories and between measurement methods (immunoassay vs. mass spectrometry — the latter is more accurate at low concentrations typical in women). General reference ranges:

• Total testosterone in premenopausal women: roughly 15–70 ng/dL (0.5–2.4 nmol/L), though some labs use slightly different ranges
• Free testosterone (the biologically active fraction not bound to sex hormone-binding globulin, SHBG) is a smaller proportion; it is particularly useful when SHBG is abnormal, as SHBG levels affect how much testosterone is available to tissues
• Levels naturally decline with age and fall more sharply after menopause

Because lab ranges differ, the clinical picture — your symptoms — matters as much as the absolute number. A number at the upper edge of normal may still cause symptoms in some individuals, and a mildly elevated number in an asymptomatic person may warrant monitoring but not immediate treatment. The 2023 international PCOS guideline recommends using assay-specific and population-specific reference ranges whenever possible 1Ref 1Teede HJ, Tay CT, Laven JJE, Dokras A, et al. (2023).Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.PCOS as most common cause of androgen excess; combined oral contraceptives and spironolactone as first-line treatment options.

What symptoms suggest testosterone may be elevated?

Androgen excess — including elevated testosterone — tends to cause a recognizable pattern of symptoms in women:

• Acne: Often persistent, cystic, appearing on the jaw, chin, lower face, or back
• Hirsutism: Unwanted hair in a male-pattern distribution — upper lip, chin, sideburns, chest, abdomen, inner thighs
• Androgenic alopecia: Scalp hair thinning, typically at the crown or in a wider part
• Irregular or absent periods: Particularly in the context of PCOS
• Oily skin
• Clitoromegaly or deepening voice (rare; suggests significantly elevated levels or an androgen-producing tumor)

What causes high testosterone in women?

The most common cause by far is polycystic ovary syndrome (PCOS), a condition affecting a significant proportion of reproductive-age women. In PCOS, the ovaries produce excess androgens, often in the context of insulin resistance and irregular ovulation 1Ref 1Teede HJ, Tay CT, Laven JJE, Dokras A, et al. (2023).Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.PCOS as most common cause of androgen excess; combined oral contraceptives and spironolactone as first-line treatment options. Diagnosis requires meeting specific criteria and ruling out other causes.

Less common causes include: - Congenital adrenal hyperplasia (CAH) — an adrenal enzyme deficiency causing androgen excess, often diagnosed in childhood but sometimes presenting in adults as a mild late-onset form - Androgen-secreting tumors — rare; should be considered when testosterone is very markedly elevated or when symptoms develop rapidly - Cushing's syndrome — excess cortisol from the adrenal glands, which can also cause androgen-related symptoms - Certain medications — some anabolic steroids, DHEA supplements, and other androgen-containing preparations

Evaluation of androgen excess typically includes total and free testosterone, DHEA-S (an adrenal androgen), and SHBG — alongside pelvic ultrasound, thyroid function tests, and sometimes a 17-hydroxyprogesterone level to screen for CAH.

How is elevated testosterone in women treated?

Treatment depends entirely on the underlying cause:

• PCOS with androgen excess: The most commonly used first-line treatments are combined oral contraceptives (which suppress ovarian androgen production and raise SHBG, reducing free testosterone) and spironolactone (an anti-androgen that blocks androgen effects at the skin and follicle level) 1Ref 1Teede HJ, Tay CT, Laven JJE, Dokras A, et al. (2023).Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.PCOS as most common cause of androgen excess; combined oral contraceptives and spironolactone as first-line treatment options2Ref 2Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK (2013).Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.Endocrine Society guideline on PCOS diagnosis and anti-androgen treatment including spironolactone and oral contraceptives. Metformin helps when insulin resistance is prominent.
• Late-onset congenital adrenal hyperplasia: Often managed with low-dose corticosteroids to suppress excess adrenal androgen production
• Androgen-producing tumor: Requires surgical evaluation

Who manages this? Elevated testosterone and androgen excess are typically evaluated by an endocrinologist or a gynecologist familiar with PCOS. A Gale clinician can order initial hormone bloodwork, review your results in context, and refer you to the right specialist.