Androgen Excess in Women Explained

Androgen excess in women is more common than most people realise, yet it often goes undiagnosed for years. If you have been dealing with persistent acne, unexplained hair thinning, irregular periods, or facial hair you cannot seem to get on top of, elevated androgens could be part of the picture. Understanding what androgen excess actually is, why it happens, and what it does to your body is the first step toward getting real answers.

Androgens are often labelled "male hormones," but women produce them too, and in the right amounts they play important roles in libido, energy, bone density, and muscle maintenance. The problem arises when levels climb too high. For a fuller picture of how all female hormones interact, start with The Complete Guide to Female Hormones, which covers the entire hormonal landscape. This article focuses specifically on what androgen excess looks like in women, why it develops, and what you can do about it.

What is androgen excess in women?

Androgen excess in women, also called hyperandrogenism, is a condition where the body produces or responds to more androgens than normal. These hormones include testosterone, DHEA-S, and androstenedione. Even mildly elevated levels can disrupt the menstrual cycle, affect skin and hair, and interfere with ovulation and fertility.

Androgens in women are produced in three main places: the ovaries, the adrenal glands, and peripheral tissues such as fat cells, which can convert other hormones into active androgens. In a healthy hormonal environment, androgens remain relatively low, balanced by oestrogen and progesterone. When something disrupts this balance, whether through a condition affecting the ovaries, adrenal glands, or insulin signalling, androgen levels can rise beyond what the body needs.

Clinically, hyperandrogenism can be diagnosed through blood tests measuring total testosterone, free testosterone, and DHEA-S, or through the visible signs it causes. Some women have elevated androgens on a lab test without obvious symptoms; others have classic physical signs with levels that sit within the "normal" range. This is because sensitivity to androgens varies from person to person.

"Androgen excess is the most common endocrine disorder in women of reproductive age, yet it remains underdiagnosed, partly because its symptoms overlap with so many other conditions."

Dr. Ricardo Azziz, MD, PhD, Professor of Obstetrics, Gynaecology and Medicine, Augusta University

What are the symptoms of androgen excess?

Hyperandrogenism symptoms in women typically include hirsutism (excess facial or body hair), acne particularly along the jawline and chin, scalp hair thinning or androgenic alopecia, irregular or absent periods, oily skin, and in some cases a deepening of the voice or clitoral enlargement in severe cases.

Not all women experience every symptom, and the presentation depends on which androgens are elevated, by how much, and how sensitive your tissues are to their effects. Here is a closer look at the most common signs:

• Hirsutism: Coarse, dark hair appearing on the face, chin, chest, abdomen, or inner thighs. This is one of the most distressing hyperandrogenism symptoms for many women.
• Acne: Particularly hormonal acne concentrated along the jawline, chin, and neck. This pattern is a strong indicator of androgen involvement. You can read more in the article on PCOS acne on the jawline.
• Hair loss: Thinning at the crown or temples, following a male-pattern distribution. High androgens convert to DHT, which shrinks hair follicles.
• Irregular cycles: Androgens can suppress ovulation, leading to long, irregular, or absent cycles.
• Oily skin: Androgens stimulate sebum production, so persistently oily skin may reflect elevated levels.
• Acanthosis nigricans: Dark, velvety patches on the neck, underarms, or groin, often associated with insulin resistance driving androgen excess.

If several of these signs resonate with you, it is worth asking your GP or gynaecologist to run a full androgen panel. The article on how to read your hormone blood test can help you make sense of your results when they arrive.

What causes high androgens in women?

The most common androgen excess causes in women are polycystic ovary syndrome (PCOS), adrenal disorders such as congenital adrenal hyperplasia (CAH), insulin resistance, and, less commonly, androgen-secreting tumours of the ovary or adrenal gland. Chronic stress, obesity, and certain medications can also raise androgen levels.

Polycystic ovary syndrome (PCOS)

PCOS accounts for approximately 70 to 80 percent of hyperandrogenism cases in women of reproductive age, according to research published by the National Institutes of Health. In PCOS, the ovaries produce excess testosterone and androstenedione, often driven by elevated LH levels and insulin resistance. The two do not always go hand in hand, but when insulin resistance is present, it directly stimulates the ovaries to produce more androgens.

Adrenal androgen excess

The adrenal glands produce DHEA and DHEA-S, precursor androgens that can be converted into more potent forms. Congenital adrenal hyperplasia (CAH), even in its milder "non-classic" form, is a genetic condition that causes the adrenals to over-produce androgens due to an enzyme deficiency. Chronic stress can also push adrenal androgen output upward, as the same pathways that produce cortisol also produce androgens.

Insulin resistance

High insulin levels directly signal the ovaries to produce more testosterone. This is why blood sugar management is so central to treating high androgens in women, particularly those with PCOS. Adipose tissue also produces androgens, so excess body fat can amplify the effect.

Other causes

Less common androgen excess causes include hyperprolactinaemia (elevated prolactin), hypothyroidism, and, rarely, androgen-secreting tumours. Certain medications, including some types of progestins and anabolic steroids, can also raise androgenic activity.

"When we see high androgens in women, the first question is always: where are they coming from? Ovarian, adrenal, or peripheral conversion, each source points you toward a different treatment strategy."

Dr. Felice Gersh, MD, Integrative Gynaecologist, Integrative Medical Group of Irvine

How does androgen excess affect the menstrual cycle?

High androgens in women disrupt the normal hormonal signalling that drives ovulation. Elevated testosterone and related androgens interfere with follicle development in the ovaries, suppress the LH surge needed to trigger ovulation, and can cause anovulatory cycles, resulting in irregular, heavy, or absent periods.

When androgens are chronically elevated, follicles in the ovaries may begin to develop but fail to reach full maturity and release an egg. This creates the "cystic" appearance associated with PCOS on ultrasound, even though the follicles themselves are not true cysts. Without regular ovulation, progesterone production drops, the cycle loses its normal rhythm, and symptoms like spotting, long gaps between periods, or prolonged bleeding can follow.

The hormonal disruption does not stop there. Low progesterone relative to oestrogen creates a state of relative oestrogen dominance, and the absence of a proper luteal phase can affect mood, sleep, and metabolism throughout the cycle.

Is androgen excess always PCOS?

No. While PCOS is the most common cause of androgen excess in women, hyperandrogenism can also result from congenital adrenal hyperplasia, adrenal tumours, ovarian tumours, hyperprolactinaemia, or thyroid dysfunction. A full hormonal workup is essential to identify the actual source before treatment begins.

A 2018 review in the Journal of Clinical Medicine highlighted that non-classic CAH, in particular, is frequently mistaken for PCOS because it produces almost identical clinical symptoms including hirsutism, acne, and irregular cycles. The key difference lies in specific blood markers, particularly 17-hydroxyprogesterone, which is elevated in CAH but not in PCOS.

This distinction matters enormously for treatment. A woman with adrenal-origin androgen excess will not respond to the same interventions as someone whose androgens are driven by ovarian insulin signalling. Getting an accurate diagnosis first saves years of frustration.

How is androgen excess diagnosed?

Diagnosis involves a combination of clinical assessment and laboratory testing. Your doctor will typically check:

• Total and free testosterone
• DHEA-S (to assess adrenal contribution)
• LH and FSH ratio (often elevated in PCOS)
• 17-hydroxyprogesterone (to rule out CAH)
• Fasting insulin and glucose (to assess insulin resistance)
• Prolactin and thyroid function (to rule out secondary causes)

A pelvic ultrasound may also be recommended to assess ovarian morphology. It is important to note that not every woman with PCOS will have cystic-looking ovaries, and not everyone with polycystic ovaries has PCOS. The Rotterdam criteria for PCOS diagnosis require at least two of three features: irregular ovulation, clinical or biochemical signs of hyperandrogenism, and polycystic ovarian morphology on ultrasound, according to guidelines from the NIH PCOS Evidence-Based Methodology Workshop.

How do you treat androgen excess naturally?

Natural approaches to reducing high androgens in women include improving insulin sensitivity through a lower glycaemic diet and regular strength training, reducing chronic stress to lower adrenal androgen output, supplementing with evidence-supported options like spearmint tea, inositol, and zinc, and prioritising sleep and anti-inflammatory eating.

Dietary strategies

Because insulin resistance is a major driver of androgen excess, stabilising blood sugar is one of the most impactful things you can do. Focus on reducing refined carbohydrates and ultra-processed foods, increasing fibre, protein, and healthy fats, and spreading carbohydrate intake across meals rather than in large single servings. Anti-inflammatory eating patterns have also been shown to reduce androgenic activity, particularly when inflammation is a contributing factor, as it often is in inflammatory PCOS.

Exercise

Resistance training improves insulin sensitivity and helps lower free testosterone by increasing sex hormone-binding globulin (SHBG), which binds androgens and reduces their activity. Regular, moderate-intensity movement is preferable to excessive high-intensity exercise, which can raise cortisol and, in turn, adrenal androgen output.

Targeted supplements

Spearmint tea has shown promise in reducing free testosterone in women with PCOS, and inositol (particularly the myo-inositol and D-chiro combination) has strong evidence for improving insulin signalling and lowering androgens. Zinc is involved in reducing 5-alpha reductase activity, the enzyme that converts testosterone to the more potent DHT. You can explore the comparison between spearmint tea and spironolactone for PCOS for a deeper look at how natural and pharmaceutical anti-androgens compare.

Stress management

Chronic stress elevates cortisol, which shares biosynthetic pathways with adrenal androgens. Managing stress through sleep, breathwork, and reducing overtraining can meaningfully reduce adrenal contributions to androgen excess over time.

Medical options

For women who need more support, medical options include combined oral contraceptives (which increase SHBG and suppress ovarian androgen production), spironolactone (an anti-androgen that blocks androgen receptors), and metformin or GLP-1 medications to address insulin resistance. A detailed diagnosis guides which approach is most appropriate.