From the Guidelines
Testosterone is typically high in Polycystic Ovary Syndrome (PCOS). Women with PCOS often have elevated levels of androgens (male hormones), particularly testosterone, which is a hallmark feature of this condition 1. This hormonal imbalance occurs because the ovaries and sometimes the adrenal glands produce excessive amounts of androgens. The elevated testosterone contributes to many of the characteristic symptoms of PCOS, including:
- Irregular menstrual cycles
- Acne
- Excess facial and body hair growth (hirsutism)
- Male-pattern baldness
- Difficulty with ovulation
The high testosterone levels result from disruptions in the hypothalamic-pituitary-ovarian axis, which controls hormone production and ovulation. Insulin resistance, which is common in PCOS, also plays a role by stimulating the ovaries to produce more testosterone 2. Treatment approaches often focus on managing these elevated androgen levels through medications like combined hormonal contraceptives, anti-androgens such as spironolactone, or insulin-sensitizing medications like metformin, depending on the individual's symptoms and reproductive goals 3. Lifestyle interventions, including diet and exercise, have also been shown to be effective in reducing testosterone levels and improving symptoms in women with PCOS 1.
From the Research
Testosterone Levels in PCOS
- Testosterone levels are often elevated in women with Polycystic Ovary Syndrome (PCOS) compared to those without the condition 4.
- A study found that women with PCOS had higher total testosterone and free androgen index during pregnancy than women without PCOS matched for body mass index 4.
- Elevated testosterone levels in women with PCOS are associated with increased strength, muscularity, and athleticism, as well as higher dominance 5.
- The presence of high testosterone levels in PCOS is thought to be a maladaptive extreme of adaptations related to relatively high testosterone, which may have provided benefits in ancestral environments 5.
Comparison of Testosterone Levels
- Women with PCOS have higher testosterone levels than women without PCOS, with a median total testosterone level of 1.94 ng/mL compared to 1.41 ng/mL in women without PCOS 4.
- The free androgen index is also higher in women with PCOS, with a median of 0.25 compared to 0.18 in women without PCOS 4.
Clinical Implications
- Elevated testosterone levels in women with PCOS are associated with an increased risk of preeclampsia, particularly in those with the highest levels of testosterone 4.
- The management of hirsutism in PCOS, which is often associated with high testosterone levels, involves the suppression of androgen excess using combined oral contraceptives or other interventions 6.