From the Guidelines
Testosterone levels in PCOS are typically elevated, with most women showing total testosterone levels between 30-95 ng/dL, compared to normal female ranges of 15-70 ng/dL, as supported by the most recent study 1.
Key Findings
- The study published in 2025 1 provides the most recent and highest quality evidence on the diagnostic accuracy of androgen measurement in PCOS.
- The evidence suggests that total testosterone levels are elevated in PCOS, with a range of 30-95 ng/dL, which is higher than the normal female range of 15-70 ng/dL.
- Free testosterone, the biologically active form, is often more significantly elevated, typically 2-3 times higher than normal female levels.
Diagnostic Considerations
- Laboratory testing for testosterone should ideally include both total and free testosterone measurements for accurate diagnosis.
- Testosterone levels may fluctuate throughout the menstrual cycle in women who still have regular periods.
- The increased testosterone results from insulin resistance stimulating the ovaries to produce excess androgens, combined with decreased sex hormone binding globulin (SHBG) which leads to more free testosterone in circulation.
Clinical Implications
- The hormonal imbalance contributes to many PCOS symptoms including irregular periods, acne, hirsutism (excess hair growth), and male-pattern hair loss.
- Accurate diagnosis of biochemical hyperandrogenism is crucial for the diagnosis and management of PCOS.
- The 2023 International PCOS Guidelines recommend the use of accurate androgen measurement methods, such as liquid chromatography-tandem mass spectrometry (LC-MS/MS), for the diagnosis of PCOS 1.
From the Research
Testosterone Levels in PCOS
- Testosterone levels in PCOS patients are typically elevated, indicating hyperandrogenism 2, 3, 4.
- A study found that circulating testosterone significantly decreased in PCOS patients treated with metformin alone or in combination with low-dose spironolactone 2.
- Another study reported that spironolactone caused a statistically significant reduction in testosterone values in women with hyperandrogenism, including those with PCOS 4.
- However, a systematic review and meta-analysis found that a lower dose of spironolactone (50 mg/day) exhibited no significant difference relative to metformin on serum total testosterone among PCOS women 5.
Treatment Effects on Testosterone Levels
- Metformin and anti-androgens, such as spironolactone, are used to ameliorate hyperandrogenism in PCOS patients 2, 3, 6.
- The addition of low-dose spironolactone to metformin induces a more marked reduction of clinical and biochemical hyperandrogenism, including testosterone levels, compared to metformin alone 2.
- Spironolactone has been shown to be effective in reducing testosterone levels and improving hirsutism in women with PCOS and idiopathic hirsutism 4, 5.