Testosterone is a steroid hormone produced primarily in the testes (in males) and in smaller amounts by the ovaries and adrenal glands (in females). While often characterized as a “male” hormone, it plays an important role in women’s health, contributing to bone strength, libido, and energy. When circulating levels become abnormally elevated, a condition known as hyperandrogenism occurs, causing physical symptoms like excessive hair growth, acne, and menstrual irregularities. Elevated testosterone requires consultation with a healthcare provider to determine the precise cause and appropriate management strategy.
Lifestyle and Dietary Adjustments
Non-pharmaceutical strategies focusing on diet and lifestyle are often the first line of defense for managing elevated testosterone, particularly when related to insulin resistance. Losing even a modest amount of weight (typically 5 to 10 percent of body weight) can significantly improve hormonal balance by enhancing insulin sensitivity. This helps reduce the overproduction of androgens often triggered by high insulin levels in conditions like Polycystic Ovary Syndrome (PCOS).
Dietary composition plays a direct role in this metabolic pathway, making a low-glycemic index (GI) diet particularly beneficial. Low-GI foods, such as whole grains and non-starchy vegetables, are digested slowly, preventing the sharp spikes in blood sugar and insulin that can stimulate ovarian androgen production. Reducing the consumption of refined carbohydrates and processed sugars is a practical step toward improving insulin signaling and, consequently, lowering testosterone.
Certain foods and supplements may interfere directly with androgen activity or production. Spearmint tea, for instance, has been studied for its anti-androgenic effects; consuming it twice daily may help reduce free testosterone levels and lessen hirsutism. Flaxseeds are another dietary component that may assist, as they are rich in lignans, compounds that promote the production of Sex Hormone-Binding Globulin (SHBG). SHBG binds to testosterone, reducing its active, free form in the bloodstream.
Soy products contain phytoestrogens, plant-derived compounds that can weakly mimic estrogen and may indirectly help balance elevated androgen levels. However, individuals should approach all supplements and significant dietary changes with caution and discuss them with a physician, as their efficacy and interaction with other medications can vary widely. The overall goal remains a balanced, nutrient-dense diet that supports stable blood sugar and healthy metabolism.
Physical activity also influences hormonal milieu, though the type of exercise matters for androgen balance. Moderate-intensity aerobic exercise, such as brisk walking or swimming, alongside regular strength training, is recommended to manage weight and improve insulin sensitivity. Excessive high-intensity or prolonged endurance training, however, may sometimes increase cortisol and other stress hormones, potentially worsening the underlying hormonal imbalance.
The body’s response to stress is mediated by the hormone cortisol, which is released by the adrenal glands. Chronic stress can disrupt the delicate hormonal axis, indirectly affecting the production of sex hormones like testosterone. Prioritizing consistent, high-quality sleep, generally aiming for seven to nine hours per night, is a foundational element in stress reduction and hormonal regulation.
Clinical Diagnosis and Underlying Conditions
A proper diagnosis is necessary before any treatment to lower testosterone can be implemented, as elevated levels are almost always a symptom of an underlying condition. The most frequent cause of hyperandrogenism in women is Polycystic Ovary Syndrome (PCOS), which affects approximately 6 to 13 percent of women of reproductive age. In PCOS, the ovaries produce excess androgens, often due to genetic factors and insulin resistance.
Other possible causes must be systematically ruled out, as they require different treatment approaches. These conditions include non-classic Congenital Adrenal Hyperplasia (CAH), a genetic disorder that causes the adrenal glands to overproduce androgens, and, less commonly, androgen-secreting tumors of the ovary or adrenal gland. The rapid onset of symptoms like voice deepening or significant muscle mass increase, known as virilization, is a warning sign that warrants immediate investigation for a tumor.
The diagnostic process begins with a careful history and physical examination, where a physician will look for clinical signs of hyperandrogenism, such as hirsutism. Blood tests are then used to measure hormone levels, including total and free testosterone, androstenedione, and DHEA-S. These tests are ideally performed in the morning when testosterone levels are highest, and often during the early follicular phase of the menstrual cycle.
Measuring free testosterone is particularly informative, as this is the biologically active portion of the hormone not bound to SHBG. Total testosterone levels significantly above the normal range raise concern for a tumor, while moderately elevated levels are more typical of PCOS. Imaging tests, such as a pelvic ultrasound, may also be ordered to check for polycystic ovarian morphology, though this finding alone is not sufficient for a diagnosis.
Prescription Treatments and Medical Management
Once the underlying cause of elevated testosterone is confirmed, a healthcare provider, often an endocrinologist or gynecologist, will prescribe targeted medical management. For managing the physical symptoms of hyperandrogenism, anti-androgen medications are frequently used. Spironolactone is a common anti-androgen that works by blocking the testosterone receptors in the skin and hair follicles, which helps reduce excessive hair growth and acne.
Oral contraceptive pills (OCPs) are another widely used treatment, particularly for women with PCOS who do not wish to become pregnant. OCPs contain estrogen and progestin, and they work primarily by suppressing the production of androgens by the ovaries. Additionally, the estrogen component increases the liver’s production of SHBG, effectively binding more free testosterone and reducing its activity in the body.
For patients with underlying insulin resistance, which is common in PCOS, insulin-sensitizing medications like metformin may be prescribed. While primarily used to manage blood sugar, metformin can indirectly lower androgen levels by improving insulin sensitivity, thus reducing the hormonal stimulus for the ovaries to produce testosterone. This approach addresses the metabolic root of the hormonal imbalance.
Specific conditions like Congenital Adrenal Hyperplasia may require treatment with glucocorticosteroids to suppress the excessive adrenal production of androgens. Continuous specialist supervision is required to monitor for side effects and assess the treatment’s effectiveness through regular blood work. The ultimate goal of medical management is to alleviate symptoms, regulate the menstrual cycle, and mitigate long-term health risks associated with chronic hyperandrogenism.