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April 18, 2016

High Testosterone in Women and Polycystic Ovary Syndrome

high testosterone in womenIs it possible to have a too high testosterone level?  The answer is “yes.” We have discussed the importance of increasing testosterone levels in men and women suffering from low testosterone levels. Today we are going to do something different and discuss lowering testosterone in women with high testosterone levels.

Women need testosterone the so-called male hormone just like men. Just not quite as much. A normal testosterone level in women is one-tenth of that seen in men. But, that one-tenth is very important to health. But, some women have naturally high levels of testosterone, in fact too high, and that’s what this article is about – high testosterone in women. But, before we get into that here are the health benefits of testosterone in women:

  • maintains bone strength and muscle strength
  • improves memory
  • decreases body fat
  • increases sexual interest
  • increases sense of well-being
  • protects against sagging skin
  • raises norepinephrine levels in brain (antidepressant effect)

Causes of High Testosterone in Women

High testosterone levels in women can be associated with acne and hirsutism, which is excessive hair in the wrong places like the chin and upper lips. High testosterone in women can also lead to thinning of the hair on the head and deepening of the voice as well as clitoral enlargement.

There are several causes of high testosterone in women. The most common one is polycystic ovary syndrome or PCOS which affects 6% to 8% of women of reproductive age. Other endocrine disorders that cause high testosterone levels include diabetes, adrenal problems, thyroid disorders, and disorders related to too much or too little growth hormone production. All of these including PCOS can be treated or managed.

Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age. It is represents 80% to 90% of the cases of hight testosterone in women and we will therefore focus on PCOS for much of the remainder of this article.

Polycystic Ovary Syndrome

Polycystic ovary syndrome is associated with female infertility, hirsutism, and acne and is associated with insulin resistance, type 2 diabetes, and metabolic syndrome. Its cause is unknown but has some hereditary basis. Normally a small amount of testosterone is produced in the ovaries (the adrenal glands produce testosterone too in women). If too much testosterone is produced women are unable to release eggs from the ovarian follicles (under the control of estrogen and progesterone). Ovarian follicles are fluid-filled and evolve into cysts if they do not release an egg each month. Therefore, the ovaries develop many cysts, hence the name polycystic. 

Since an egg is not released the normal monthly rise and fall of estrogen and progesterone in women is disrupted. This leads to a fragile endometrial lining and irregular bleeding. Because of the abnormal hormone balance there is a higher risk of endometrial cancer in women with PCOS as well. The high testosterone levels causes male pattern hair growth with facial hair and balding of the head. Women with PCOS may have dark thick skin in the armpits, too.

Women with PCOS produce too much insulin, too. High insulin is associated obesity (40% to 50% of women with PCOS are obese) and chronic inflammation that we have discussed previously including elevated blood pressure, diabetes, and high cholesterol levels.

PCOS is diagnosed based on the physical findings of high testosterone and confirmed with an elevated testosterone level in the blood (testosterone levels are unreliable if taking birth control pills). An ultrasound of the ovaries can help in making the diagnosis but not all women with PCOS develop ovarian cysts.

Treatment of PCOS

The goals of treatment in PCOS is to reduce testosterone levels, normalize menstrual cycles, induce fertility, and treat metabolic abnormalities. Lifestyle is vital to management of PCOS and this involves dietary changes, weight loss, and exercise. It’s hard to escape diet and exercise isn’t it?

Progesterone for 10-14 days each month will restore menstrual cycles, or in those who are not concerned about fertility birth control pills can be used to regulate menstrual periods. Birth control pills will eventually cause the ovaries to produce less testosterone. Clomid (clomiphene) or Serphene are used to help women with PCOS become pregnant and about 75% of women with PCOS will become pregnant.

Spironolactone is an anti-androgen (anti-testosterone) medicine that can be used to treat acne and unwanted hair seen in PCOS. Control of insulin resistance, diabetes, and metabolic syndrome can be managed with the diabetic drug metformin. Metformin has anti-aging properties. It also decreases testosterone levels in women with PCOS (and can lower testosterone levels in men with diabetes) and helps to restore menstrual cycles and fertility. Insulin resistance impairs fertility and metformin reduces insulin resistance.

Effectiveness of treatment for PCOS can be gauged by clinical response and repeat testing of testosterone levels and blood sugar and cholesterol levels in those with metabolic syndrome.

PCOS: A Very Treatable Cause of High Testosterone Levels

In the end, PCOS is a very treatable cause of high testosterone levels in women. If you are a woman with high testosterone levels and do not have PCOS then tests to assess adrenal, thyroid, and pituitary function should be performed.

Testosterone Therapy in Women

Though not approved by the FDA for use in women, testosterone replacement therapy is being used more and more in women. And, testosterone replacement therapy is one more cause of high testosterone in women where the dose of testosterone is too high. As with any other hormone replacement therapy close monitoring is necessary to make sure testosterone levels are optimal and not too high or too low in women receiving testosterone therapy.

The reason testosterone therapy is not approved for use in women is no pharmaceutical company has sought approval for use of a testosterone product for women. That is probably because the market for it is felt to be too small to justify the nearly billion dollars it takes to bring a drug to market. A pharmaceutical company has to request approval by the FDA. The FDA just doesn’t approve drugs unless a drug company has done clinical trials and is seeking specific approval for an indication of a drug. There are several non-pharmaceutical company studies on the use of testosterone in women, however. Testosterone for women can be obtained through compounding pharmacies and by use of the same injectable testosterone used by men.

 

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

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