What causes high testosterone in women?

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Causes of High Testosterone in Females

Unlike popular belief, testosterone is not solely produced in male bodies as it is also produced in female bodies as well. The important glands involved in this process are the adrenal glands and ovaries. It is responsible for the growth, maintenance, and repair of the female reproductive tract and bones when produced in optimum concentrations. However, overproduction of this hormone may create severe issues in the female body.

Normal Range of Testosterone

Males produce around 300-900 ng/dl testosterone in one day as a normal male sex hormone. On the other hand, female bodies have 15-70 ng/dl of the same hormone from their glands. The exact concentration in the bloodstream for either gender remains variable throughout the day. It also depends on several physiological and ecological factors. On a general note, the hormone concentration is highest in the morning.

High-Testosterone Symptoms in Women:

Since Males have high levels of testosterone levels. Females produce minute amounts of testosterone, which are essential to perform a few bodily functions. high levels of testosterone in females may produce male-like symptoms in women. Women with high testosterone levels in the body may experience the following symptoms.

• Hirsutism- which means excessive body hair growth

• Infertility issues

• Weight gain may lead to obesity

• Baldness or thinning of hair

• Enlarged clitoris

• Deepening of the voice

• Irregular menstrual periods

• Sagging or atrophy of breast

• Never-ending acne

• Mood swings

Role of Testosterone in Women:

Testosterone regulates both androgenic and anabolic characteristics in females. The body’s musculature and better sex life depend on testosterone in circulation. It has the following roles:

• Promotes muscle strength

• It boosts libido and helps increase sensitivity to erogenous zones.

• Enhances assertiveness and competitiveness.

• Promotes general health and well-being in women.

Causes of High Testosterone

Just like men can have diseases that may alter the testosterone level in circulation, women can also have different conditions that elevate the testosterone level in the body. Here are significant reasons why women experience male-like testosterone levels:

Polycystic Ovary Syndrome (PCOS):

PCOS is a hormonal imbalance in which the body produces excess testosterone from the source ovaries. In this, the ovaries develop fluid-filled cystic sacs around themselves that disturb the ovary's normal functioning. Due to ovarian involvement, this syndrome occurs mainly in reproductively mature women with active ovaries.

Major symptoms associated with this are excess body hair, weight gain, insulin resistance, and even an irregular menstrual cycle. This condition may also predispose to secondary diabetes and high serum cholesterol levels, further aggravating high blood pressure, heart disease and stroke.

The cause of this disease is yet unknown. However, genetics and specific lifestyle changes are suspected of initiating the syndrome. The condition can be easily diagnosed with the respective signs and a regular check-up with the doctor.

Adrenal Hyperplasia:

This is another hormonal imbalance disease that causes the release of more than usual androgens in the body. Adrenal glands are two small bean-shaped endocrine glands resting on top of both kidneys. In this condition, the adrenal glands increase in size by multiplying their cells, resulting in the overproduction of their hormones. The result is excessive body hair, irregular menstrual cycle, and infertility, almost like PCOS.

The aetiology of the disease is linked to genetic predisposition, sometimes with high-stress levels that induce rapid cell division in adrenal glands. The condition can be easily picked up by a hormonal blood test which may reveal high androgens in serum.

Cushing Syndrome:

This is a severe condition similar to Adrenal hyperplasia, where adrenal glands increase in size and secrete abnormally high amounts of cortisol in the blood. The symptoms are identical to that of adrenal hyperplasia, except for a marked increase in blood pressure, heart rate, breathing rate, and glucose levels in the blood.

Unlike the previous cause, this is not linked to genetic predisposition. It occurs primarily due to factors like stress, glucocorticoid medications, and carcinogen exposure which causes a pituitary tumour, thyroid tumour, or adrenal cortical tumour. This condition can be fatal if left unchecked, mainly due to the high risks of developing heart diseases, diabetes, and immunodeficiency.

Adrenal or Ovarian Tumour:

If a tumour or cancerous growth occurs on either adrenal glands or ovaries, it may directly increase the number of hormone-producing cells in those organs. This results in increased androgens and testosterone concentration in blood serum.

Usually, the tumour manifests with symptoms similar to previously described conditions and is sometimes even attributed to causing one of them. In such instances, chemotherapy and medications are dealt with to counter the effects of those syndromes.

Genetic Predisposition:

This cause plays an indirect role in causing most of the aforementioned conditions. However, there is a direct link between high testosterone production with certain genetic factors. Some females have more than the usual number of receptors to accept the hormone their body produces. In others, they tend to make more than the normal amount of testosterone or androgen from their glands, particularly in a particular age window. This results in the uncontrollable overproduction of testosterone, eventually manifesting the related signs.

It is noteworthy that if the female produces such high testosterone levels during early puberty or sexual maturity, they are likely to have a less fertile genital tract, enlarged clitoris, small breasts, and a heavy voice. They may also fail to ovulate entirely if their testosterone is not converted back to oestrogen in sufficient concentrations.

Other Causes of high-testosterone levels in women:

Testosterone has many essential functions in women and men alike. Unfortunately, several diseases may affect testosterone levels. If you are suffering from any of these diseases, your testosterone level may be high:

• Gigantism

• Dwarfism

• Adrenal neoplasm disorder

• Acromegaly

• Cushing syndrome

• Conn’s syndrome

• Thyroid disorder

• Ovarian tumour

• Adrenal tumour

• Adrenal hyperplasia

There are multiple other unknown reasons for high testosterone levels in women but research is being carried out for confirmation.

Diagnosis

A blood test is the most common method of diagnosing high circulating testosterone levels. Different diagnostic approaches can be followed, such as:

Physical Examination by a Physician

Specific symptoms and signs in females give away the possibility of high testosterone concentration in their bodies. This can be judged effectively by a doctor of regular check-ups by clinicians. It is better to ask opinions from a family doctor or a regular physician who is aware of the patient's history and with whom the patient feels comfortable describing their symptoms and activities.

If a doctor notices any signs of high testosterone levels, they may suspect a possible anomaly linked to ovaries and adrenals. Hence, they will recommend blood tests for further confirmation and prescribe medications to counter the effects of those suspected syndromes.

Blood/Serum Tests

Usually, a clinician suspects too much testosterone levels in the female patient. They recommend running a hormone profile test to determine the serum's concentration of androgens and testosterone. Alongside hormone tests, it is also recommended to run glucose concentration tests and cholesterol or lipid profiles. Samples are usually taken in the morning at fasting when hormonal levels in the blood are at their highest. A Free Testosterone Blood Test is the easiest way to diagnose higher levels of testosterone.

Radiology

Ultrasonography is preferred to check possible tumours, cysts, or any abnormal growth over ovaries and adrenal glands. Other possibly involved glands may be the thyroid, pituitary, and liver, which may be examined by X-ray instead. Ultrasound is also used to examine the uterus and overall female genital tract. This gives a vague idea about the condition and possibly rules out physical aberrations as the cause of abortion or impaired ovulation.

Possible Solutions

Medications:

Specific chemical agents help directly reduce testosterone levels in the blood or counter its effects by acting in place.

• Eflornithine helps reduce unwanted hair growth.

• Glucocorticosteroids should not be given if an adrenal issue is suspected, as it may aggravate the symptoms and may even lead to fatal conditions.

• Metformin lowers serum glucose levels, particularly in type II diabetes.

• Progestin improves menstrual cycle regularity and fertility of the overall tract.

• Spironolactone removes excess salts and hormones from the body via frequent urination.

Oral Contraceptives

These are widely available in the market and can safely limit testosterone levels in the blood while improving progesterone or oestrogen levels. This improves the overall female tract and helps keep the female reproductive cycle in check. It also limits excessive hair growth and the development of masculine characteristics. However, each birth control pill may have a different constituent and may not be suitable for all patients at all times. So it is advised to consult a doctor before taking them. Also, this solution is useless for females trying to conceive a child.

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Hair Removal Options

These are effective procedures to eliminate unwanted hair from the body. However, it does not cure the underlying hormonal imbalance, and the high testosterone level continues to display its effects in other ways on the body. It is also likely that this option would require a continuous dependency on hair removal if the hair follicles develop again and start growing unwanted hair. The two most common methods used here are Electrolysis and Laser therapy.

Electrolysis:

A microneedle is inserted on the skin into each hair follicle to be removed. A mild electric pulse is provided to the needle that weakens and loosens the follicles. The follicles may fall off or be removed manually. For this procedure, several rounds of electrolysis may be necessary to produce effective results, and even then, the follicles can develop again and grow normally.

Laser Therapy:

A thin beam of intense laser is applied over the skin to burn or damage the unwanted hair follicles. This method also needs several rounds before effective noticeable results can be seen. Also, this method may pose the risk of skin infections and skin burns.

Lifestyle changes

Diet:

Certain food items that may potentially aggravate symptoms associated with high testosterone levels should be avoided. For example, the consumption of high amounts of sugar may tip the patient into being a diabetic. Food with high cholesterol levels may create heart problems. High levels of saturated fatty acids, cholesterol, and proteins combined may further increase testosterone production in the body.

Stress:

An important factor in controlling androgens, in general, is limiting the amount of stress the patient experiences during the day. If high levels of stress are subjected to the body, it leads to enlarged adrenal glands and consequently elevated androgens and testosterone levels. Practically, not all factors can be managed. But reducing stress levels in the body is possible through many healthy activities like yoga, massage, music, reading, holidays, etc.

Weight:

Managing optimal body weight is essential, especially for female bodies. Their metabolism favours fat accumulation, and in the wake of high testosterone levels, their bodies are prone to storing even more unhealthy fats. Since hormonal imbalance impairs normal mobility and utilization of these fats, they can create serious problems like stroke, hypertension, and obesity. Weight can be managed by a healthy, controlled diet and by introducing exercises in a routine. This also helps counter the possible diabetes chances in such patients.

Regular medical examination:

Every individual must undergo a regular check-up every once in a while to prevent possible diseases from harming the body. In female patients with a history of hirsutism, ovarian cysts, or high serum testosterone, it is essential to regularly get an appointment with their doctor and discuss their issues in detail. The clinician may be keen to note possible signs of recurrence of hormonal imbalance and may suggest preventive measures to counter the effects of those imbalances.

Conclusion

Though typical in females, testosterone may lead to several physiological and behavioural issues if present in higher concentrations. The most notable is the impaired reproductive function and excessive body hair growth. Measures against the hormonal imbalance counter the problem, but usually, there are high chances of it relapsing in the patients. For this, it is advised to such patients to monitor themselves, their behaviour, their diet, and their body changes so that effective measures can be taken to avoid further repercussions of the condition.

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