High testosterone in women: causes, symptoms, tests and treatment

Testosterone is an androgen, often described as a male hormone, but all women make small amounts in the ovaries and adrenal glands. The NHS explains that hirsutism is usually linked to changes in androgen levels, which can happen if the level of these hormones increases or if the body becomes more sensitive to them. NICE CKS adds that the effect can arise from increased androgens, increased sensitivity of the hair follicle unit to androgens, or the way androgens are metabolised in the periphery.

This is important for how results are interpreted: a number on a blood test is not the whole story. Symptoms, your periods, your medical history and examination all matter, and some women with typical symptoms have a normal testosterone level.

Medical teams sometimes use the word hyperandrogenism for the combination of raised androgen effects, and hirsutism when the effect is on hair growth specifically.

The NHS describes hirsutism as thick, dark hair on the face, neck, chest, tummy, lower back, buttocks or thighs. It says that lighter, finer hair on the face or body is probably not hirsutism and that most women get more of this type of hair as they get older, particularly after the menopause.

The NHS lists other symptoms of PMOS that often accompany raised androgens, including irregular periods or long gaps between periods, hair loss, weight gain or difficulty losing weight, difficulty getting pregnant, oily skin and acne, tiredness and thick dark patches of skin on the neck or armpits.

• Thick, dark hair in a male-pattern distribution.

• Irregular or absent periods.

• Acne or oily skin.

• Hair thinning on the scalp.

• Difficulty getting pregnant.

• Weight gain or difficulty losing weight.

• New hair growth that is sudden, a deepening voice or increased muscle bulk, which need prompt assessment.

NICE CKS says polycystic ovary syndrome is the most common cause of hirsutism, accounting for more than 70 per cent of cases, and that no apparent cause is found in about half of women with mild hirsutism. The NHS calls the condition polyendocrine metabolic ovarian syndrome (PMOS) and says it used to be called PCOS. The cause of PMOS is unknown, but it may be to do with hormones such as insulin and testosterone not working properly, and it can run in families.

Less common causes listed by NICE CKS include androgen-secreting tumours, adrenal hyperplasia, Cushing's syndrome, acromegaly, raised prolactin, thyroid disorders and some drugs. The NHS adds certain medicines, such as some epilepsy medicines and steroids including anabolic steroids, and notes that rarely a tumour affecting hormone levels is responsible.

Testosterone use, whether prescribed or taken without prescription, can also raise levels. Tell your doctor about everything you take, including supplements and any products bought online.

The NHS says a GP will check what is causing the hair growth and you may have a blood test to measure hormone levels. NICE CKS says that in women with local, isolated hair growth, a normal hirsutism score and no other signs of a hyperandrogenic disorder, investigations are not usually necessary unless the hair growth progresses despite treatment. In women with an abnormal hirsutism score, or with clinical evidence of a hyperandrogenic endocrine disorder, serum total testosterone should be tested.

For suspected PMOS, the NHS says tests include blood tests to check hormone levels and insulin resistance, and an ultrasound scan of the ovaries, which is only done if you are over 18. Other tests, such as those for thyroid function, prolactin or adrenal hormones, may be added depending on the picture. Ask the person who arranges the test whether any medicines you take, such as hormonal contraception, could affect how the result is read.

The NHS says to ask for an urgent GP appointment if you are a woman and new thick, dark hair suddenly starts growing on the face and body, your voice is getting lower, or your muscles are getting bigger. NICE CKS lists sudden onset and rapid progression of hair growth, signs of virilisation and an abdominal or pelvic mass as features suggestive of an androgen-secreting tumour, which warrants urgent referral.

These features are uncommon, and most women with raised testosterone have a more usual explanation, but they should not be left to settle.

Treatment depends on the cause and on what bothers you most. The NHS says a GP may suggest losing weight if overweight, which can help control hormone levels, hair removal or lightening at home, a prescription cream to slow facial hair growth (eflornithine) and a contraceptive pill if you have not been through the menopause, which can help control hormone levels. NICE CKS describes the same primary care options.

If these do not help, or if further tests are needed, a specialist referral is made. NICE CKS lists treatments that specialists may offer, including anti-androgen medicines such as cyproterone acetate, finasteride, spironolactone and flutamide, insulin-sensitising drugs and gonadotrophin-releasing hormone analogues, and recommends referral if treatment has not been effective after at least a 6-month trial. Longer-lasting hair removal such as electrolysis or laser is not usually available on the NHS, according to the NHS, and is not usually permanent.

On the NHS, a GP can arrange blood tests and first-line treatment, and refer to gynaecology or endocrinology where criteria are met, such as a testosterone level above the CKS threshold or features suggesting a tumour.

Private endocrinology or gynaecology appointments and direct-to-consumer hormone blood tests are available to those who want faster access. If you test privately, take the results to your GP, and ask for the units and reference range used by the laboratory, because they differ and results should be interpreted with the symptoms rather than as a single number.