High Testosterone in Women: What Does the Blood Test Mean?

High testosterone in women means the blood level of this androgen (a hormone found in higher amounts in men) is above the laboratory's reference range for women. The most common cause is polycystic ovary syndrome, but adrenal, pituitary and ovarian conditions are also possible. A single result cannot diagnose any condition on its own.

This guide is for adult women who have a raised testosterone result or symptoms that led to the test. It explains the result and what to ask. If your concern is a low result, see our separate guide to the low testosterone blood test.

The NHS advises getting an urgent GP appointment for signs that develop quickly. Do not wait for a routine repeat test if you notice any of the following.

• New thick, dark hair that suddenly appears on the face and body.
• A voice that is becoming deeper.
• Muscles that are noticeably getting bigger.

MedlinePlus lists the main reasons women are tested: excess hair on the face or body (hirsutism), male-pattern scalp hair loss, voice changes, irregular or absent periods, difficulty getting pregnant and acne. Some people have no obvious symptoms and the result comes from a wider hormone panel.

Fine, light body hair is usually normal, and some increase in facial hair after menopause is common, according to the NHS.

MedlinePlus stresses that a testosterone test alone cannot diagnose a condition, and an abnormal result does not always mean treatment is needed. Clinicians interpret it alongside age, symptoms, other test results and other health conditions.

Causes named by MedlinePlus and the NHS include the following. Sometimes no cause is found.

• Polycystic ovary syndrome (PCOS), the most common cause of hirsutism. The NHS now uses the name polyendocrine metabolic ovarian syndrome (PMOS).
• Congenital adrenal hyperplasia or other adrenal gland disorders.
• Pituitary gland disorders.
• Cushing's syndrome and acromegaly.
• Ovarian problems, including ovarian cancer, and rare hormone-affecting tumours.
• Some medicines, including some epilepsy medicines and steroids, including anabolic steroids.

PCOS (PMOS) can cause irregular periods, excess hair or hair loss, acne, weight gain, difficulty getting pregnant and dark skin patches on the neck or armpits. The NHS says the cause is unknown but may involve insulin and testosterone not working properly.

The NHS notes that the risk is higher if a close relative has the condition or if you have an Asian background. Symptoms can be mild, severe or absent, and some may ease after menopause.

Diagnosis does not rest on testosterone alone. The NHS describes blood tests for hormones and insulin resistance, and an ovarian ultrasound for people over 18. A clinician will usually check that other causes are not more likely before settling on PCOS.

Most testosterone in blood is bound to proteins, mainly sex hormone-binding globulin (SHBG) and albumin. Only the unbound, or free, part acts on tissues. MedlinePlus explains that a low SHBG means more testosterone is likely free, so symptoms can occur even when total testosterone looks normal. An SHBG result supports, but cannot by itself confirm, a diagnosis such as PCOS.

SHBG can be lowered by obesity, insulin resistance or type 2 diabetes, an underactive thyroid, PCOS, anabolic steroids and Cushing's syndrome. Liver disease, an overactive thyroid, some eating disorders and oestrogen-containing medicines such as the combined pill can raise it.

Many UK laboratories report a free androgen index (FAI) when testosterone and SHBG are measured on the same sample. Reference ranges for FAI and SHBG differ by age and by laboratory, so compare your result only with the range printed on your own report.

Check the exact test name on your report. Total testosterone, the most common test, measures both the bound and unbound hormone. Free testosterone measures only the unbound part and is ordered less often. Bioavailable testosterone counts free testosterone plus the part loosely bound to proteins other than SHBG, and is rarely ordered.

Because these tests measure different things, their ranges are not interchangeable. A raised free result with a normal total, or the reverse, is a question to bring to your clinician rather than a contradiction to resolve yourself.

Yes. Testosterone levels in women are much lower than in men, and measuring small amounts accurately is harder. In a CDC-led study comparing laboratories, results for the lowest-concentration sample varied far more than for higher ones. The CDC runs a standardisation programme to help laboratories and test makers produce accurate results.

Practical points also matter. MedlinePlus says samples are usually taken in the morning, and some medicines may need to be paused only if your clinician advises it. Hormonal contraception can change SHBG. If a result is unexpected, ask whether a repeat test, a different method or a specialist laboratory is appropriate.

Bring your full report, earlier results if you have them, and a list of medicines, contraception and supplements.

• How high is my result compared with this laboratory's range for women, and should it be repeated?
• Was SHBG or a free androgen index measured, and how does it change the picture?
• Which method did the laboratory use, and could my medicines or contraception affect the result?
• Do I need other hormone tests or an ultrasound to look for PCOS or adrenal, pituitary or ovarian causes?
• Should I see an endocrinologist or gynaecologist?
• Which changes should make me come back sooner?

On SameCase, patients and verified doctors share de-identified cases. Seeing how others with high testosterone in women were investigated, such as which repeat tests, SHBG checks or scans were discussed, can help you prepare focused questions for your appointment.

Another person's case cannot explain your result or confirm a diagnosis. Use it to plan the conversation with your clinician, not to choose treatment.