High Androgens in Women: Signs, Causes & Natural Solutions

When women hear "testosterone" or "androgens," they often assume it's a men's health issue. But androgens are essential female hormones — and when they're elevated, the symptoms are some of the most visible and distressing in women's health: chin and jaw acne that won't clear, hair falling out from the scalp, dark or coarse hair growing where it shouldn't, irregular or absent periods.

Androgen excess is far more common than most women realise, and it goes well beyond PMOS (formerly PCOS) — though PMOS is the most common cause. Understanding what's driving the elevation, and how to address it specifically, is the key to actually resolving these symptoms rather than just managing them with medications that suppress the surface presentation.

What Androgens Are and Why Women Have Them

Androgens are a class of hormones that includes testosterone, dihydrotestosterone (DHT), androstenedione, and dehydroepiandrosterone (DHEA and its sulfated form, DHEA-S). They're produced in women primarily by the ovaries and the adrenal glands.

Women need androgens. They support libido, energy, mood, bone density, muscle maintenance, and cognitive function. The key is having the right amount — enough to support these functions, but not so much that they produce the symptoms of androgen excess. In women, the balance between androgens and estrogen is also important: androgens can be converted to estrogen (via the enzyme aromatase), and this conversion pathway matters in both directions.

Normal vs. Elevated: The Distinction That Matters

The clinical distinction between normal and elevated androgens isn't always straightforward. Laboratory reference ranges are wide, and some women experience significant androgen-excess symptoms with testosterone levels that sit in the upper portion of the "normal" range. Additionally, it's not just total testosterone that matters — it's the amount of free testosterone available to bind to receptors in tissues like the skin and hair follicles.

Total testosterone includes both free testosterone and testosterone bound to SHBG (sex hormone-binding globulin). Bound testosterone is inactive — it can't interact with receptors. Only free testosterone is biologically active. When SHBG is low — which is common with insulin resistance, obesity, and certain progestins — a larger proportion of testosterone is free and active, producing androgen-excess symptoms even when total testosterone appears normal.

Signs of High Androgens in Women

• •Acne — particularly on the chin, jaw, neck, back, and chest; often deep, cystic, and slow to heal; does not respond well to standard skincare
• •Hirsutism — excess coarse, dark hair growing in places more typical of male hair distribution: upper lip, chin, jawline, chest, abdomen, inner thighs
• •Female pattern hair loss — thinning across the crown and top of the scalp, widening part; driven by DHT acting on genetically sensitive hair follicles
• •Irregular or absent periods — excess androgens disrupt the LH/FSH ratio and suppress ovulation
• •Oily skin and scalp — androgens stimulate sebaceous gland activity, increasing oil production
• •Clitoral enlargement (virilisation) — in severe or long-standing androgen excess
• •Voice deepening — also a sign of significant androgen excess, worth investigating promptly

What Drives Androgen Excess

Insulin resistance and PMOS (formerly PCOS)

Insulin resistance is the primary driver of androgen excess in the majority of women with PMOS (formerly PCOS). High insulin directly stimulates the ovaries to produce more testosterone and androstenedione. It also reduces the liver's production of SHBG, leaving more free testosterone circulating. Insulin resistance affects 65–70% of women with PMOS — including many who are not overweight — making blood sugar regulation the cornerstone of treatment.

Adrenal androgen excess

The adrenal glands produce DHEA-S (the sulfated form of DHEA), which can contribute significantly to the overall androgen burden. Adrenal androgen production is driven by ACTH (adrenocorticotropic hormone) — the same pathway activated by stress. Women under chronic psychological or physiological stress often have elevated DHEA-S alongside elevated cortisol, contributing to androgen excess symptoms independent of PMOS (formerly PCOS). This is sometimes described as "adrenal PMOS" though it can occur without polycystic ovaries.

Increased 5-alpha reductase activity

Even when testosterone levels are not dramatically elevated, women with high activity of the enzyme 5-alpha reductase convert more testosterone into the more potent DHT in peripheral tissues like the skin and hair follicles. This explains why some women have significant androgenic symptoms (acne, hair loss, hirsutism) with testosterone levels that appear relatively normal on standard testing — the problem is at the conversion level, not the production level.

The Role of SHBG

SHBG (sex hormone-binding globulin) is a protein produced by the liver that binds testosterone and estrogen, rendering them inactive. Low SHBG means that a higher proportion of total testosterone is in the free, biologically active form — amplifying androgenic effects even without total testosterone being elevated.

SHBG is suppressed by: high insulin (insulin directly inhibits hepatic SHBG synthesis); excess androgen itself (creating a self-reinforcing cycle); hypothyroidism; and some progestins. It is raised by: estrogen (which is why the oral contraceptive pill raises SHBG and reduces free testosterone); improving insulin sensitivity; thyroid optimisation; and liver support.

Improving SHBG — primarily by improving insulin sensitivity and reducing inflammation — is one of the most underutilised strategies for addressing androgen excess symptoms.

How to Test Properly

A comprehensive androgen assessment includes:

• •Total testosterone and free testosterone — free testosterone is more clinically relevant; always request both
• •SHBG — to calculate the free androgen index and understand the bioavailability of testosterone
• •DHEA-S — the primary adrenal androgen; elevated levels indicate an adrenal contribution to androgen excess
• •Androstenedione — an ovarian and adrenal androgen precursor
• •Fasting insulin — essential for understanding whether insulin resistance is the underlying driver
• •LH and FSH — an elevated LH:FSH ratio is a classic feature of PMOS
• •17-OH progesterone — to rule out congenital adrenal hyperplasia, which can mimic PMOS

Natural Approaches

Address insulin resistance first

In insulin-driven androgen excess, no other intervention will be as impactful as improving insulin sensitivity. A low-glycaemic, protein-and-fat-anchored diet, regular movement (particularly walking after meals and resistance training), and evidence-based supplements including myo-inositol (2–4 g per day), berberine, and magnesium are the foundations.

Spearmint tea

Two cups of spearmint tea daily has clinical trial evidence for reducing free testosterone in women with PMOS and hirsutism. It works through anti-androgenic mechanisms at the receptor level. It's a simple, low-cost, low-risk intervention that many women find genuinely helpful — particularly for acne and hirsutism — when practised consistently.

Zinc

Zinc is a natural inhibitor of 5-alpha reductase, reducing the conversion of testosterone to DHT. It's also important for insulin receptor function. At 25–30 mg per day, zinc picolinate is one of the most useful supplements for androgenic symptoms including acne and hair loss.

Saw palmetto

An herbal 5-alpha reductase inhibitor with growing evidence in women for reducing DHT-driven hair loss and hirsutism. At 160–320 mg per day of a standardised extract, it addresses the peripheral conversion of testosterone to DHT in skin and hair follicles.

Reduce stress and support the adrenals

For women with elevated DHEA-S suggesting an adrenal component to androgen excess, stress reduction and HPA axis support are essential. Adaptogenic herbs (ashwagandha, rhodiola), adequate sleep, and genuine reduction of the cortisol burden will lower adrenal androgen output over time.

The Big Picture

Androgen excess in women is almost never a standalone issue — it's a downstream signal of deeper imbalances: insulin dysregulation, adrenal overactivity, impaired SHBG, or disordered ovarian signalling. Treating the symptoms — with spironolactone, oral contraceptives, or topical treatments alone — suppresses the presentation without addressing the cause, and symptoms return when the treatment is stopped.

A root-cause approach — addressing insulin, stress, nutrition, and inflammation — gives the body the conditions it needs to normalise androgen production. It takes longer, but the results are lasting, and the benefits extend beyond the androgenic symptoms to every system that was affected by the underlying imbalance.