From the Guidelines
Women with PCOS generally have total testosterone levels between 30-95 ng/dL, compared to the normal female range of 15-70 ng/dL, though values can vary based on the laboratory and testing method used, as supported by the most recent evidence from 2025 1.
Testosterone Levels in PCOS
The hormonal imbalance in PCOS occurs because the ovaries and sometimes the adrenal glands produce excess androgens (male hormones) in PCOS. The elevated testosterone contributes to many common PCOS symptoms including:
- irregular periods
- acne
- excess facial and body hair growth (hirsutism)
- male-pattern hair loss
- difficulty conceiving Testing for testosterone levels typically involves blood tests measuring both total and free testosterone, ideally performed during the early follicular phase of the menstrual cycle (days 3-5) for the most accurate results, as recommended by recent guidelines 1.
Diagnosis and Treatment
Treatment approaches that can help lower testosterone levels include:
- weight loss (if overweight)
- hormonal birth control pills
- anti-androgen medications like spironolactone
- insulin-sensitizing drugs like metformin if insulin resistance is present According to a systematic review and diagnostic meta-analysis, the first-line laboratory test should be total testosterone (TT) and free testosterone (FT) using mass spectrometry, with free androgen index (FAI) as an alternative if mass spectrometry is unavailable 1. It is essential to note that the accuracy of androgen measurements can vary depending on the method used, with liquid chromatography with tandem mass spectrometry (LC-MS/MS) having superior sensitivity and specificity compared to direct immunoassay 1.
From the Research
Testosterone Levels in PCOS
- Testosterone levels in women with Polycystic Ovary Syndrome (PCOS) can vary, with some studies suggesting that around 20%-50% of PCOS women do not display hyperandrogenemia 2.
- A study found that 64.9% of PCOS patients with normal serum androgen levels displayed abnormally high follicular fluid androgen levels, indicating that there may be a subgroup of PCOS patients with excessive follicular fluid androgen despite normal circulating testosterone levels 2.
- Another study found that women with PCOS whose testosterone levels were >1 standard deviation above the mean had significantly better sexual functioning compared to those within 1 SD and those >1 SD below the mean 3.
- Treatment with oral contraceptives containing ethinylestradiol and drospirenone (EE-DRSP) decreased serum androgens, including testosterone, in women with PCOS 4.
- A recent study found that 11-oxyandrogens, including 11-ketotestosterone, were significantly elevated in women with PCOS compared to age-matched controls, and may serve as better predictors of PCOS than testosterone and androstenedione 5.
- The relationship between testosterone and psychological functioning in women with PCOS is complex, with hypotheses suggesting that testosterone may impact women with PCOS both directly and indirectly, via activational and organizational effects 6.