Testosterone Production in Healthy Women
In a healthy woman, testosterone is produced by both the ovaries and the adrenal glands in approximately equal amounts, with each contributing about 50% of the total daily production 1, 2.
Primary Sources of Testosterone Production
The evidence from multiple endocrinology guidelines consistently identifies two major organs responsible for testosterone synthesis in women:
Ovaries (approximately 50%)
- The ovaries directly secrete testosterone and also produce androstenedione, which is converted to testosterone peripherally 3
- Ovarian testosterone production is regulated by luteinizing hormone (LH)
- The postmenopausal ovary continues to produce some testosterone in many women, which is why surgically menopausal women (after bilateral oophorectomy) have significantly lower testosterone levels than naturally menopausal women 4
Adrenal Glands (approximately 50%)
- The adrenal glands produce testosterone both directly and through secretion of precursor hormones (primarily DHEA and DHEAS) that are converted to testosterone in peripheral tissues 5
- Adrenal androgen production is regulated by adrenocorticotropic hormone (ACTH)
- DHEAS is almost exclusively an adrenal product, making it a useful marker for adrenal androgen contribution 4
Daily Production Rates
Healthy young women produce approximately 300 micrograms of testosterone per day, with roughly half derived from each source 1. This makes testosterone quantitatively the most abundant biologically active sex hormone in women 2.
Peripheral Conversion
Beyond direct secretion, peripheral tissues (including fat and skin) convert androgen precursors into active testosterone 5. This peripheral conversion represents an additional source that supplements direct ovarian and adrenal secretion.
Clinical Implications
Understanding these dual sources is critical when evaluating androgen disorders. The 2001 AACE guidelines 3 describe dexamethasone suppression testing to differentiate the contribution of each organ: if testosterone suppresses >40% with dexamethasone, the source is primarily adrenal; if testosterone fails to suppress while DHEAS and cortisol do suppress, the source is primarily ovarian.
Conditions affecting either organ can lead to testosterone deficiency: hypopituitarism affects both sources, isolated adrenal insufficiency primarily affects adrenal androgens while preserving ovarian function, and bilateral oophorectomy eliminates ovarian but not adrenal contribution 4.