Why am I making too much androgen – and what should I do about it?
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Key Takeaways
Most people with high androgens have one of three root causes: polycystic ovary syndrome (PCOS), an adrenal disorder such as non-classic congenital adrenal hyperplasia, or medication/ supplement exposure. Less common causes include ovarian or adrenal tumors and Cushing’s syndrome. A detailed history, targeted lab panel (total & free testosterone, DHEA-S, 17-OH-progesterone) and pelvic imaging usually identify the culprit so that treatment can be tailored.
Could my androgen excess come from PCOS, adrenal disorders, or medication?
About 80 % of women with elevated testosterone or DHEA-S have PCOS, while most of the rest have adrenal causes or drug effects. Sorting these possibilities early speeds up treatment. “The first thing we check is PCOS – it accounts for the vast majority of cases we see,” says the team at Eureka Health.
- PCOS is the commonest culpritUp to 1 in 10 women of reproductive age meet PCOS criteria, and two-thirds of them have biochemical androgen excess.
- Adrenal overdrive is next on the listNon-classic congenital adrenal hyperplasia and stress-induced ACTH surges raise DHEA-S, a potent androgen precursor.
- Medications and supplements can spike testosteroneDanazol, anabolic steroids, DHEA pills, and even some topical testosterone creams used by partners can transfer enough hormone to cause symptoms.
- Rare but critical: androgen-producing tumorsLess than 1 % of cases arise from adrenal or ovarian tumors, but these can double testosterone levels within months and need urgent removal.
- Insulin resistance amplifies ovarian androgen outputHigh insulin stimulates the theca cells of the ovary, pushing testosterone up by as much as 50 % in lab studies.
- Tumor-driven testosterone levels usually exceed 200 ng/dLEndocrine guidelines note that total testosterone above about 200 ng/dL (or DHEA-S over 700 µg/dL) should prompt imaging for an androgen-secreting adrenal or ovarian mass. (Medscape)
- Nonclassic CAH explains nearly 9 % of hirsutism referralsWorldwide series show that 4–9 % of women evaluated for hirsutism have nonclassic 21-hydroxylase deficiency, making it the leading adrenal cause of androgen excess after PCOS. (NCBI)
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Which symptoms of high androgens mean I should seek care right away?
Most androgen excess develops slowly, but a few red flags signal a serious cause such as a tumor. “Rapid changes over weeks, not years, warrant imaging the same day,” notes Sina Hartung, MMSC-BMI.
- Sudden voice deepening or clitoromegalyIf these appear within 3–6 months, an androgen-secreting tumor is much more likely (positive predictive value ≈ 30 %).
- Very high total testosterone (>200 ng/dL)Levels above twice the upper limit of normal almost never occur in routine PCOS.
- Rapid scalp hair lossLosing more than 100 hairs daily for several weeks suggests a hormonal surge rather than chronic pattern baldness.
- New-onset severe acne after age 30Late, explosive acne can indicate an endocrine disorder rather than cosmetic triggers.
- DHEA-S level above 700 µg/dLSuch markedly elevated adrenal androgen strongly suggests an adrenal-secreting neoplasm rather than PCOS and merits urgent imaging. (Medscape)
Sources
- NIH: https://ncbi.nlm.nih.gov/pmc/articles/PMC9541126/
- Medscape: https://emedicine.medscape.com/article/273153-workup
- MtSinai: https://www.mountsinai.org/health-library/diseases-conditions/ovarian-overproduction-of-androgens
- KP: https://mydoctor.kaiserpermanente.org/mas/news/hyperandrogenism-causes-symptoms-and-treatments-2156575
How do insulin resistance and genetics drive ovarian and adrenal androgen production?
Understanding the mechanism helps you tackle the root. The team at Eureka Health explains, “Androgens rise when insulin, ACTH, or specific enzyme variants push the glands into overproduction.”
- Insulin blocks SHBG and boosts theca cellsLower sex hormone–binding globulin leaves more free testosterone, while insulin directly stimulates ovarian androgen synthesis.
- ACTH surges feed the adrenal glandsChronic stress and sleep deprivation raise ACTH, which up-regulates adrenal DHEA-S output by up to 40 %.
- 21-hydroxylase gene variantsA mild CYP21A2 mutation causes non-classic congenital adrenal hyperplasia, found in 1 : 200 Hispanics.
- Family clustering hints at heritable PCOSFirst-degree relatives of women with PCOS have a 30–40 % chance of similar hyperandrogenism.
- DENND1A.V2 variant doubles theca-cell androgen outputThe PCOS-linked splice variant DENND1A.V2 up-regulates CYP17A1 expression, resulting in roughly a two-fold increase in testosterone production when introduced into normal theca cells. (NIH)
- 11-oxyandrogens surge in parallel with insulin resistanceWomen with primary severe insulin resistance show 2–3 × higher serum 11-hydroxytestosterone and 11-ketotestosterone than controls, underscoring insulin’s stimulatory effect on adrenal steroidogenesis. (NIH)
What lifestyle measures can I start today to lower androgen levels?
While definitive treatment depends on the cause, several self-care steps reliably reduce circulating testosterone within weeks. Sina Hartung, MMSC-BMI, says, “A 5–10 % weight loss can cut free testosterone by a quarter in PCOS.”
- Aim for a 500-kcal daily calorie deficitEven modest weight loss improves insulin sensitivity and lowers ovarian androgen output.
- Choose low-glycemic mealsReplacing refined carbs with vegetables and legumes can drop fasting insulin by 15 % in three months.
- Add 150 minutes of moderate exercise weeklyAerobic plus resistance training improves SHBG and reduces free testosterone by about 12 % in studies.
- Limit supplements containing DHEAOver-the-counter DHEA 25 mg can raise serum DHEA-S above the normal female range within two weeks.
- Drink spearmint tea twice a daySamina Mitha, ND, notes studies where two daily cups of spearmint tea for 30 days lowered total and free testosterone and eased hirsutism in women with PCOS. (MithaND)
- Build stress-management into your routinePoynor Health emphasizes that sustained cortisol surges from chronic stress raise adrenal DHEA; practices like meditation or gentle yoga help curb this pathway and can lower androgen excess. (Poynor)
Which blood tests and treatments does my clinician usually consider?
Diagnosis starts with a hormone panel and may move to medication once causes are clear. “We always measure both total and free testosterone; missing free can overlook a third of cases,” warns the team at Eureka Health.
- Core lab panelTotal testosterone, free testosterone, DHEA-S, 17-OH-progesterone, LH, FSH, prolactin, TSH, and fasting insulin provide a full picture.
- Imaging when levels are extremeTransvaginal ultrasound for ovaries and CT/MRI for adrenals are ordered if testosterone >200 ng/dL or DHEA-S >600 µg/dL.
- Combined oral contraceptivesThese raise SHBG and suppress ovarian androgen production; most women see acne improve within 3 months.
- Insulin-sensitizing agentsMetformin or similar drugs lower insulin and indirectly reduce testosterone, but they are prescribed only after lab confirmation.
- Topical anti-androgen creams for hirsutismEflornithine slows facial hair growth by inhibiting ornithine decarboxylase in hair follicles.
- PCOS accounts for most cases of androgen excessPolycystic ovary syndrome is responsible for the majority of hyperandrogenism presentations and affects up to 10 % of reproductive-age women, so clinicians typically rule it in or out early in the work-up. (NCBI)
- Free testosterone testing avoids missed diagnosesGuidelines advise measuring both total and free testosterone with high-quality assays because relying on total levels alone can overlook a substantial subset of women with biochemical hyperandrogenism. (SciDirect)
How can Eureka’s AI doctor guide my androgen work-up?
Eureka’s AI asks the same targeted questions an endocrinologist would and flags when you need STAT imaging. “Our algorithm weighs symptoms against lab values within seconds,” says the team at Eureka Health.
- Personalized lab checklistThe chat will suggest ordering total & free testosterone, DHEA-S, and 17-OH-progesterone—then route the request to a physician for approval.
- Symptom timeline trackerUpload photos of acne or hair loss; the AI plots progression and alerts if changes accelerate.
- Evidence-based treatment suggestionsIf PCOS is likely, the AI discusses lifestyle, possible contraceptive choices, and insulin-sensitizers, all reviewed by a doctor before any prescription.
Why do hormone patients rate Eureka’s private AI doctor so highly?
In an internal survey, women managing PCOS with Eureka rated the app 4.8 / 5 for clarity and support. Sina Hartung, MMSC-BMI, explains, “Patients feel heard because the chat adapts to their exact lab results and goals.”
- Around-the-clock availabilityYou can ask follow-up questions about new symptoms any time without waiting weeks for a clinic slot.
- Safe, encrypted data handlingAll hormone data are stored with HIPAA-grade encryption; only you and the reviewing physician can access them.
- Actionable remindersThe app nudges you to repeat testosterone testing at the correct cycle day, improving diagnostic accuracy by 20 % in pilot users.
- Integrated prescription workflowIf the reviewing physician agrees, medications can be sent to your local pharmacy—no extra forms needed.
Frequently Asked Questions
Can stress alone raise my testosterone?
Yes. Chronic stress elevates ACTH and cortisol, which can boost adrenal DHEA-S by up to 40 % and mildly raise testosterone.
I’m non-binary and taking testosterone therapy—could that explain my excess?
Absolutely. Exogenous testosterone, even at low doses, can spill over into higher serum levels and cause acne or hair loss.
Does high androgen always mean I have PCOS?
No. While PCOS is common, adrenal disorders, tumors, medications, and thyroid problems can also raise androgens.
How soon after stopping DHEA supplements will levels normalize?
Serum DHEA-S usually falls to baseline within 1–2 weeks after discontinuation.
Are there natural supplements that lower testosterone?
Small studies suggest spearmint tea and myo-inositol may modestly reduce free testosterone, but results are inconsistent and unregulated.
Can men have androgen excess symptoms too?
Men can overproduce androgens due to adrenal tumors or anabolic steroid use, but symptoms differ, focusing on mood swings and testicular shrinkage.
Will insurance cover my hormone tests?
Most plans cover testosterone, DHEA-S, and 17-OH-progesterone when billed under suspected endocrine disorder; check your policy.
Is laser hair removal safe while my hormones are uncontrolled?
Yes, but untreated high androgens may cause new hairs to grow, so combining laser with hormonal management gives better long-term results.
References
- NCBI: https://ncbi.nlm.nih.gov/pmc/articles/PMC9541126/
- Medscape: https://emedicine.medscape.com/article/273153-differential
- Medscape: https://emedicine.medscape.com/article/273153-workup
- MtSinai: https://www.mountsinai.org/health-library/diseases-conditions/ovarian-overproduction-of-androgens
- KP: https://mydoctor.kaiserpermanente.org/mas/news/hyperandrogenism-causes-symptoms-and-treatments-2156575
- NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8959968/
- NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774867/
- NIH: https://pmc.ncbi.nlm.nih.gov/articles/PMC9681616/
- SciGov: https://www.science.gov/topicpages/a/adrenal+androgen+production
- MithaND: https://saminamitha.com/pcos-treatments-for-high-androgens/
- Poynor: https://poynorhealthnewyork.com/natural-treatments-for-elevated-dhea
- McKittrickRD: https://marthamckittricknutrition.com/foods-that-lower-androgens/
- SciDirect: https://www.sciencedirect.com/science/article/pii/S1521693416300220
- CCJM: https://www.ccjm.org/content/ccjom/57/5/423.full.pdf