From the Guidelines
Birth control, specifically combined oral contraceptives (COCs) containing estrogen and progestin, can effectively reduce female testosterone levels by 40-50% on average. This is achieved through the anti-androgenic properties of COCs, which decrease ovarian androgen production, increase sex hormone-binding globulin, and reduce free testosterone that would otherwise activate the androgen receptor 1. The testosterone-lowering effect of COCs is most pronounced with pills containing ethinyl estradiol at doses of 20-35 mcg.
Some key points to consider:
- COCs work by increasing sex hormone-binding globulin (SHBG) in the blood, which binds to testosterone and reduces its free, active form in the body 1.
- The use of COCs can lead to a significant reduction in acne, hirsutism, and other conditions related to excess testosterone in women 1.
- Progestin-only methods, such as the mini-pill, hormonal IUDs, or the implant, generally have minimal impact on testosterone levels and may even worsen acne in some cases 1.
- Fourth-generation progestins, such as drospirenone, have antiandrogenic properties and may be a good option for women who desire oral contraception and have acne or other conditions related to excess testosterone 1.
It's essential to note that while COCs can be effective in reducing female testosterone levels, they may not be suitable for all women, and individual results may vary. Women who experience unwanted side effects potentially related to lower testosterone, such as decreased libido, may want to consider alternative birth control methods or consult with their healthcare provider to determine the best course of treatment.
From the Research
Effect of Birth Control on Female Testosterone
- The use of combined oral contraceptives (COCs) has been shown to decrease levels of androgen, especially testosterone, in healthy women by inhibiting ovarian and adrenal androgen synthesis and increasing levels of sex hormone-binding globulin (SHBG) 2.
- A meta-analysis of 42 studies found that total testosterone levels significantly decreased during COC use, with a mean decrease of 0.49 nmol/l, and free testosterone levels decreased by 61% 2.
- Another study found that COCs decreased total and free testosterone levels, and increased SHBG concentrations, but coadministration with dehydroepiandrosterone (DHEA) restored physiological levels of total and free testosterone 3.
- The choice of progesterone in COCs can affect androgen levels, with some progestins having antiandrogenic activity, which can help reduce androgen-related side effects 4, 5.
- Hormonal contraceptives, including COCs, can be used to manage acne by reducing androgen levels and increasing estrogen levels and SHBG 6.
Types of Birth Control and Their Effects on Testosterone
- COCs containing 20-25 µg ethinyl estradiol (EE) had similar effects on total and free testosterone compared to COCs with 30-35 µg EE 2.
- The addition of DHEA to COCs can restore physiological levels of total and free testosterone, with a daily oral dose of 50-mg DHEA maintaining physiological free and total testosterone levels in women using an EE/levonorgestrel-containing COC 3.
- Drospirenone, a progestin available in certain COCs, has antiandrogenic activity and can help minimize the potential negative effect of progestin on acne 4, 6.
Individualization of Birth Control and Testosterone Levels
- The choice of birth control method should be individualized based on a woman's menstrual cycle characteristics, acne, and other factors 4.
- Women with hypermenorrhea may require a different type of COC, such as one containing 30 µg EE/drospirenone, to control spotting 4.
- Women with premenstrual tension may benefit from a COC containing at least 30 µg EE associated with drospirenone, while those with chronic headache or headache as a side effect of oral contraceptive use may require a lower dose of estrogen 4.