Both men and women have testosterone and estrogen. Males have much higher testosterone levels than females, and females have much higher estrogen levels than males. Hormone levels are tightly regulated because they affect tissues and organs throughout the body. A small increase in one hormone can affect the levels of other hormones, ultimately leading to abnormal organ function and disease.
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The pituitary gland controls testosterone production in the body by releasing a hormone called luteinizing hormone. In the male, this hormone prods the testes to produce more testosterone. Likewise, the ovaries produce testosterone in females, and the adrenal glands produce it in both sexes. Therefore, any disorder affecting the testes, ovaries, or adrenal glands can cause overproduction or underproduction of testosterone.
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Both men and women can have abnormally high testosterone levels, but the definition of high will be significantly different between the two sexes. Many people have a vision of a male with excess testosterone. They might imagine bulky muscles, a short temper, and a healthy libido. What they might not think about are infertility, acne, blood clots, insomnia, and high blood pressure. Women with high testosterone levels can experience infertility, weight gain, severe acne, mood disorders, and insomnia.
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Low testosterone levels are much more common in males than are high levels. Abnormally high levels of testosterone is known as hypergonadism. The most common cause of high testosterone levels is using anabolic-androgenic steroids and testosterone replacement therapy.
When testosterone levels are too high, potential side-effects include:
Excess testosterone can cause infertility by suppressing the production of three other hormones:
When the production of these hormones declines, testosterone levels in the testes decline as well. The effect of high testosterone levels on sperm is so significant. It can almost be considered a contraceptive.
Low testosterone levels can also cause infertility and, sometimes, may be associated with erectile dysfunction. There are many causes of erectile dysfunction. Most commonly, they are associated with blood flow or, more precisely, the lack of blood flow into the penis.
Read More: Let’s Talk About Erectile Dysfunction
Abnormally high testosterone levels can cause the following signs and symptoms in women:
Synthetic derivatives or human-made versions of testosterone are called anabolic-androgenic steroids. This term encompasses the growth-promoting effects of anabolic steroids and the androgenic effect of a male sex hormone.
Adrenal tumors are a rare cause of excess testosterone in both men and women. Tumors of the testes are another rare cause of high testosterone production in males. The most common cause of high testosterone levels in males is anabolic-androgenic steroid use.
In women, high testosterone levels can be due to anabolic androgenic steroid use or a tumor in the adrenal gland or ovary. However, the most common cause of high testosterone levels in women is polycystic ovary syndrome.
High levels of androgens due to polycystic ovary syndrome are fairly common, affecting up to 20% of women of reproductive age.
Testosterone levels begin to increase in girls between the ages of 6 and 8. During puberty and throughout a woman’s reproductive years, testosterone levels fluctuate according to the menstrual cycle. Testosterone levels peak in women in their 30s and 40s and then begin a steady decline with aging.
Women with polycystic ovary syndrome may notice excessive body hair, acne, missed periods, and weight gain as symptoms that point to an abnormal testosterone level.
This constellation of symptoms may prompt a gynecology exam, followed by blood work, to check hormone levels.
If polycystic ovary syndrome is suspected, an ultrasound of the uterus and ovaries may show enlargement and cysts covering the ovary.
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In men, suspicion of abnormal testosterone levels is usually focused on low testosterone levels, not high. However, concerns about excess body hair, acne, and increased muscle mass may prompt a full medical history and physical exam to explore potential causes of high testosterone levels, especially using anabolic-androgenic steroids.
Labs that may be requested when evaluating testosterone levels include:
Lab values for normal testosterone levels vary. However, these are the values used by Kaiser Permanente.
|Total Testosterone||Free Testosterone|
|Men||270–1070 ng/dL (9–38 nmol/L)||50–210 pg/mL (174–729 pmol/L)|
|Women||15–70 ng/dL (0.52–2.4 nmol/L)||1.0–8.5 pg/mL (3.5–29.5 pmol/L)|
The most common cause of high testosterone in men is anabolic-androgenic steroid use or testosterone supplementation. Stopping the use of these substances will typically allow testosterone levels to fall within a normal range.
It is extremely rare for ovarian, testicular, or adrenal tumors to cause elevated testosterone levels as a single symptom. However, if either benign or malignant tumors are suspected, a series of labs and X-ray studies will probably be requested, followed by a biopsy.
For women with polycystic ovary syndrome, treatment options depend on the symptoms. Spironolactone is a water pill that has the side effect of blocking the action of male sex hormones. Spironolactone cannot be used in women who are trying to conceive, neither can another potential treatment, low dose birth control pills. Metformin is a medication used to treat diabetes. Treating insulin resistance can help normal ovulation resume.
Recent research shows that high testosterone levels have been linked to an increased risk of type 2 diabetes in women and polycystic ovary syndrome. Yet, ironically, it seems to decrease the risk of type 2 diabetes in men. High testosterone levels may also increase the risk of breast and endometrial cancers in women and prostate cancer in men. However, more research is needed in this area.
If you suspect that you might have an endocrine disorder of any type, whether high or low levels of a hormone, consult with your doctor. The impact of abnormal hormone levels can be far-reaching, causing many symptoms that may be difficult to explain.
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.