Is 800 ng/dL Total Testosterone Too High for a Female?
Yes, a total testosterone level of 800 ng/dL is dangerously elevated for a female and requires immediate investigation for an androgen-secreting tumor or other serious pathology—this level is not appropriate for therapeutic use in women with hypoactive sexual desire disorder (HSDD) or hypogonadism.
Normal Testosterone Ranges and Context
The normal total testosterone range for adult men is 300 to 800 ng/dL 1. For women, physiologic testosterone levels are dramatically lower—typically in the range of 15-70 ng/dL for premenopausal women. A level of 800 ng/dL in a female represents approximately 10-50 times the upper limit of normal female physiology.
Clinical Significance of Extremely Elevated Testosterone in Women
- Very high total testosterone levels (>2-3 standard deviations above normal reference) in women are most often associated with hyperandrogenic signs, menstrual irregularities, and rapid onset of virilization 2
- Testosterone levels of 800 ng/dL demand prompt investigation for androgen-secreting tumors, particularly ovarian steroid-cell tumors (SCT) 2
- Even in rare cases where virilization signs are absent despite extremely high testosterone, this represents a pathologic state requiring surgical intervention, not a therapeutic target 2
Therapeutic Testosterone Use in Women with HSDD
When testosterone therapy is appropriately used for HSDD in women, the goal is entirely different:
- Total testosterone levels should be monitored to maintain concentrations in the physiologic premenopausal range 3, 4
- Systemic transdermal testosterone is recommended at doses appropriate for women, not male doses 3, 4
- Patients must be assessed for signs of androgen excess during treatment 3, 4
- The International Society for the Study of Women's Sexual Health emphasizes that testosterone therapy should maintain physiologic levels, with safety data only supporting physiologic testosterone use 3, 4
Critical Pitfalls to Avoid
- Laboratory interference should be suspected when testosterone levels are extremely elevated without corresponding clinical manifestations—diethyl ether extraction can help detect assay interference 2
- Never assume that higher testosterone doses provide better therapeutic benefit in women—the evidence supports only physiologic replacement 3, 4, 5
- Compounded testosterone products cannot be recommended due to lack of efficacy and safety data 3, 4
Immediate Action Required
A female patient with a total testosterone of 800 ng/dL requires:
- Repeat testosterone measurement with consideration of laboratory interference 2
- Urgent evaluation for androgen-secreting tumors, particularly ovarian pathology 2
- Assessment of menstrual status and virilization signs 2
- This is not a therapeutic target for HSDD treatment—it represents a pathologic state requiring investigation and treatment of the underlying cause 3, 2, 4