Combined oral contraceptive pills are the most widely prescribed treatment for lowering testosterone in women, reducing free testosterone by roughly 60% on average through multiple mechanisms. Beyond the pill, doctors have a range of prescription options, from antiandrogen drugs like spironolactone to insulin-sensitizing medications like metformin, depending on why testosterone is elevated in the first place. A few over-the-counter supplements and herbal teas also show modest anti-androgen effects in clinical trials, though the evidence behind them is thinner. The right approach depends on the underlying cause, your symptoms, and whether pregnancy is a possibility.
Why Testosterone Gets Too High in the First Place
Polycystic ovary syndrome (PCOS) is by far the most common reason women end up with elevated testosterone. When researchers have looked closely at how the excess androgen arises in PCOS, about two-thirds of cases trace back to the ovaries overproducing androgens in response to hormonal stimulation. Most of the remaining cases still involve ovarian androgen overproduction that only becomes apparent after adrenal sources are ruled out, and a small percentage (around 3%) involve the adrenal glands alone.1Endocrine Reviews. The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited This matters for treatment because different medications target different sources. A drug that quiets ovarian androgen production may not help much if the adrenals are the problem, and vice versa.
Other causes include congenital adrenal hyperplasia, Cushing’s syndrome, and, more rarely, androgen-secreting tumors of the ovary or adrenal gland. In postmenopausal women the picture shifts: some degree of relative androgen excess can be a normal part of aging as estrogen drops, but new or worsening signs like rapid-onset facial hair growth or voice deepening warrant investigation for a tumor.2PubMed Central. Postmenopausal Hyperandrogenism: Evaluation and Treatment Strategies
Combined Oral Contraceptive Pills
For most premenopausal women with high testosterone, the combined pill is the first-line treatment. It works through three reinforcing mechanisms: suppressing ovarian androgen production, reducing adrenal androgen output, and boosting a protein called sex hormone-binding globulin (SHBG) in the blood. SHBG acts like a sponge, soaking up free testosterone so it can no longer act on tissues. The estrogen component of the pill drives SHBG production in a dose-dependent way, meaning higher-estrogen formulations tend to bind more testosterone.3PubMed Central. The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis
A systematic review and meta-analysis found that combined pills decrease total testosterone by about 30% and free testosterone by about 60%. That gap between total and free testosterone highlights how much of the effect comes from the SHBG increase rather than just shutting down androgen production at the source.3PubMed Central. The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis For many women with PCOS, this single medication can improve acne, slow excess hair growth, and regulate menstrual cycles all at once. Pills containing anti-androgenic progestins (like drospirenone or cyproterone acetate) may provide additional benefit over those with androgenic progestins, though the estrogen-driven SHBG increase does most of the heavy lifting regardless of progestin type.
Spironolactone
Spironolactone is the go-to antiandrogen medication in the United States and many other countries. Originally developed as a blood-pressure drug, it happens to block androgen receptors and also reduce the rate at which the body produces testosterone.4PubMed. Use of spironolactone in treatment of hirsutism It is typically prescribed at 100 to 200 mg per day for androgen-related symptoms. In clinical studies of hirsute women, spironolactone lowered serum testosterone and produced visible reductions in hair growth, with effects becoming noticeable three to five months after starting treatment.5The Journal of Clinical Endocrinology & Metabolism. A Novel Use of Spironolactone: Treatment of Hirsutism
The timeline matters because hair follicles cycle slowly. Even after testosterone levels drop, it takes months for existing hairs to thin or stop growing. Doctors almost always prescribe spironolactone alongside contraception, partly because the two work synergistically and partly because spironolactone can cause birth defects in a male fetus. Common side effects include increased urination (it is still a diuretic), occasional dizziness, breast tenderness, and irregular periods when used without a contraceptive pill. Potassium levels should be monitored, especially in women with kidney problems.
Cyproterone Acetate
Widely used in Europe and Canada but not available in the United States, cyproterone acetate is a potent antiandrogen often combined with estradiol in a single pill. A Cochrane review found that the combination produces subjective improvement in hirsutism compared to placebo, and clinical differences between cyproterone acetate and other anti-androgen therapies were not clearly demonstrated in head-to-head trials.6PubMed Central. Cyproterone acetate for hirsutism A multicenter Canadian trial compared low-dose cyproterone acetate (2 mg, as found in the combined pill Diane-35) against a higher dose (100 mg). Both doses reduced hirsutism scores, but the higher dose produced a larger reduction, particularly for body hair on the chest and abdomen.7PubMed. Clinical efficacy and safety of cyproterone acetate in severe hirsutism: results of a multicentered Canadian study
Side effects include weight gain, fatigue, depression, breast tenderness, and reduced libido. At higher doses, liver function monitoring is recommended. Like spironolactone, cyproterone acetate must not be used during pregnancy.
Metformin for PCOS-Related Testosterone
When PCOS is the underlying driver, metformin can lower testosterone through a somewhat indirect route. Insulin resistance is a core feature of many PCOS cases: excess insulin stimulates the ovaries to produce more androgens. By improving insulin sensitivity, metformin reduces the hormonal signal telling the ovaries to ramp up testosterone production.8PubMed. Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome Clinical trials have found that metformin therapy produces a significant decrease in total testosterone levels in women with PCOS, along with improvements in fasting blood sugar and clinical signs of androgen excess.9PubMed. Effects of metformin therapy on hyperandrogenism in women with polycystic ovarian syndrome
Metformin is not as potent at lowering testosterone as the pill or spironolactone, and it works best in women who are overweight or show clear signs of insulin resistance. Its appeal is that it also addresses metabolic risk factors like blood sugar and lipids. Gastrointestinal side effects (nausea, diarrhea) are common early on but tend to settle with time, especially with the extended-release formulation.
5-Alpha Reductase Inhibitors
Finasteride does not actually lower circulating testosterone. Instead, it blocks an enzyme that converts testosterone into dihydrotestosterone (DHT), a much more potent androgen that drives hair-follicle miniaturization and stimulates body-hair growth.10PubMed Central. Finasteride and Its Potential for the Treatment of Female Pattern Hair Loss: Evidence to Date This makes finasteride useful for women whose main complaint is hair loss on the scalp or excess body hair, even when blood testosterone readings look normal or only mildly elevated. DHT is the androgen doing the damage at the hair follicle, so blocking its production can help even when total testosterone is not dramatically high.
Finasteride is typically prescribed at lower doses for women than for men. It carries the same pregnancy warning as other antiandrogens: exposure during pregnancy can interfere with the development of a male fetus’s genitalia.11International Journal of Women’s Dermatology. Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review Reliable contraception is mandatory during use.
GnRH Agonists for Severe or Refractory Cases
GnRH agonists like leuprolide (Lupron) are reserved for difficult or unusual cases. These drugs work by initially stimulating and then shutting down the pituitary’s release of the hormones that drive the ovaries. The result is a dramatic drop in ovarian estrogen and testosterone production. In a reported case of a postmenopausal woman with severe androgen excess, a GnRH agonist produced a striking decline in testosterone within a month, and the effect held over nearly a year of therapy.12PubMed. Hyperandrogenism in a postmenopausal woman: diagnostic and therapeutic challenges
Doctors also use GnRH agonists diagnostically. If testosterone falls by more than half after a dose, that strongly suggests the ovaries are the source of the excess rather than a tumor or adrenal problem.13JCEM Case Reports. Clinical Utility of GnRH Analogues in Female Androgen Excess: Highlighting Diagnostic and Therapeutic Applications Side effects essentially mimic menopause: hot flashes, bone loss, vaginal dryness. For this reason, long-term use usually requires “add-back” estrogen and progesterone to protect bones and quality of life.
Weight Loss and Exercise
Lifestyle changes alone can meaningfully reduce testosterone, especially in women who are overweight. A randomized controlled trial in postmenopausal women found that a reduced-calorie diet lowered free testosterone by about 10%, and combining caloric restriction with exercise lowered it by nearly 16%. Both approaches also increased SHBG by over 20%, further reducing the amount of active, unbound testosterone.14PubMed Central. Reduced-calorie dietary weight loss, exercise, and sex hormones in postmenopausal women: randomized controlled trial A broader analysis of exercise and dietary interventions confirmed that caloric restriction alone significantly lowered free testosterone and raised SHBG compared to control groups.15PubMed Central. Effect of exercise and/or reduced calorie dietary interventions on breast cancer-related endogenous sex hormones in healthy postmenopausal women
These are not dramatic reductions compared to what medications achieve, but for women who are overweight and have mildly elevated testosterone, losing even a moderate amount of weight can improve symptoms and insulin sensitivity simultaneously. In women with PCOS, weight loss often restores ovulation and can reduce acne and hirsutism without any medication at all.
Spearmint Tea and Licorice
Two herbal remedies have attracted genuine research attention. Spearmint tea, consumed twice daily over 30 days, produced significant reductions in both free and total testosterone in women with PCOS in a randomized controlled trial.16PubMed. Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial An earlier pilot study in hirsute women (some with PCOS, some without) found a similar pattern: free testosterone decreased significantly during the spearmint-tea period.17PubMed. Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in women with hirsutism The studies were small, and whether the testosterone drop translates to meaningful clinical improvement in hirsutism or acne over months has not been rigorously demonstrated.
Licorice root is the other herbal candidate with published data. In healthy women given licorice (containing glycyrrhizin), total testosterone dropped from about 28 ng/dL to roughly 17 ng/dL over two months and returned to baseline after stopping.18PubMed. Licorice reduces serum testosterone in healthy women The mechanism appears to involve blocking enzymes in the testosterone production pathway. However, glycyrrhizin can raise blood pressure and lower potassium, so daily use is not without risk, especially for women who already take blood-pressure medication or diuretics. Neither spearmint nor licorice should be treated as a substitute for prescription therapy when symptoms are moderate to severe.
Inositol Supplements
Myo-inositol and D-chiro-inositol are supplements that have gained popularity in the PCOS community, and the evidence behind them is more solid than for most over-the-counter options. A meta-analysis of randomized controlled trials found that inositol treatment significantly reduced free testosterone, total testosterone, and androstenedione compared to placebo. It also raised SHBG levels and improved fasting glucose and insulin response.19PubMed Central. Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials
An earlier meta-analysis noted that the SHBG-raising effect of myo-inositol became statistically significant only after at least 24 weeks of use, suggesting that patience is required.20PubMed Central. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials Inositol works along a similar pathway to metformin by improving insulin signaling, which in turn reduces the insulin-driven ovarian androgen production characteristic of PCOS. The side-effect profile is mild, mostly limited to digestive discomfort at high doses. For women reluctant to start prescription medication, inositol is a reasonable first step to discuss with a doctor, keeping in mind that the testosterone-lowering effect is modest compared to pharmaceuticals.
Pregnancy Risk With Antiandrogen Drugs
One safety issue runs through nearly every medication on this list: the risk to a developing male fetus. Spironolactone, cyproterone acetate, and finasteride all interfere with androgen signaling, which is essential for normal male genital development in utero. For spironolactone, the concern is well enough established that pregnancy is an absolute contraindication, primarily because of its potential to feminize a male fetus.21PubMed Central. Case report: A pregnant woman accidental treated with spironolactone in mid-gestation The same reasoning applies to finasteride and cyproterone acetate.
This is why doctors almost universally pair antiandrogen prescriptions with reliable contraception. If you are trying to conceive or there is any chance of pregnancy, the standard approach shifts toward options that are considered safe or at least better studied in pregnancy, like metformin or lifestyle changes alone. Inositol supplements also have a more favorable safety profile in women who may become pregnant, though you should always discuss timing with your doctor.
When High Testosterone Might Signal Something Serious
Most women with elevated testosterone have PCOS or another benign cause, but there are red flags that should prompt a more urgent workup. Rapid onset of symptoms, especially virilization (deepening voice, male-pattern balding, clitoral enlargement), raises concern for an androgen-secreting tumor of the ovary or adrenal gland. In postmenopausal women, any new or worsening hyperandrogenic symptoms deserve attention because the differential includes both benign conditions like ovarian hyperthecosis and tumors.2PubMed Central. Postmenopausal Hyperandrogenism: Evaluation and Treatment Strategies
Testosterone level itself can help distinguish these causes. One study using high-accuracy lab methods found that a total testosterone at or above a certain threshold in premenopausal women predicted an androgen-producing tumor with high sensitivity. In postmenopausal women specifically, the threshold for pathologic androgen excess (tumors and ovarian hyperthecosis combined) was lower, reflecting the fact that even modestly elevated testosterone in this age group is less likely to be benign.22Clinical Chemistry. Diagnostic Thresholds for Androgen-Producing Tumors or Pathologic Hyperandrogenism in Women by Use of Total Testosterone Concentrations Measured by Liquid Chromatography-Tandem Mass Spectrometry A suppression test using low-dose dexamethasone can also help: in one study, women with tumors failed to suppress testosterone by more than 40%, while the vast majority with non-tumor causes did.23The Journal of Clinical Endocrinology & Metabolism. The Value of the Low-Dose Dexamethasone Suppression Test in the Differential Diagnosis of Hyperandrogenism in Women If your doctor suspects a tumor, imaging and possibly surgery will take priority over the medications discussed elsewhere in this article.
The Lab Test Itself Can Be Misleading
An underappreciated wrinkle in this whole picture is that standard testosterone blood tests are not particularly reliable in women. The assays used in most clinical labs were designed for the much higher testosterone ranges seen in men. At the low concentrations typical in women, common immunoassay methods can give falsely high readings in some samples due to cross-reacting substances or calibration issues, and the degree of error is unpredictable from one sample to the next.24PubMed Central. Measurement of serum testosterone in women; what should we do? Experts recommend that any unexpectedly high testosterone result in a woman should be verified by a more accurate method, such as liquid chromatography-tandem mass spectrometry, before treatment decisions are made. If you have been told your testosterone is elevated but the number is only mildly above the reference range and your symptoms are minimal, asking about confirmatory testing is reasonable.
The Gut Microbiome Connection
An emerging area of research links gut bacteria to androgen metabolism, though this is far from ready for clinical application. Certain gut bacteria can chemically modify androgens. For example, testosterone and DHT that the liver packages for excretion through bile can be “unpackaged” by intestinal bacteria, allowing these hormones to be reabsorbed into the bloodstream rather than eliminated.25PubMed Central. Potential relationship of the gut microbiome with testosterone level in men: a systematic review Some bacterial species can even convert other steroid hormones into androgens. Researchers have proposed the term “microgenderome” to describe this bidirectional relationship between gut microbes and sex hormones.26PubMed Central. Roles of Sex Hormones and Gender in the Gut Microbiota
What does this mean practically? Not much yet. There is no probiotic or prebiotic you can take today with good evidence that it will lower testosterone. But it may help explain why some women with PCOS have testosterone levels that seem stubbornly resistant to treatment, and it opens a window into potential future therapies. The gut microbial composition and circulating testosterone levels are tightly enough linked that some researchers believe microbial signatures could one day help predict hormone levels.27PubMed. Bidirectional relationships between the gut microbiome and sexual traits For now, the practical takeaway is that overall gut health, supported by a varied diet rich in fiber, is unlikely to hurt and might play a small supporting role in hormonal balance.