Androgen Testing in Women: The Link with Estrogen and Fertility

clinician gesturing at female patient

What Are Androgens?

Androgens are typically thought of as male hormones, but they’re also important for women’s health.

In men, androgens support sperm production and the development of male secondary sex characteristics.

In women, androgens are produced in the ovaries and adrenal cortex and converted into estrogen. Estrogen promotes the development of female secondary sex characteristics. It is also involved in thickening the endometrium and regulating the menstrual cycle. The androgens that are not converted into estrogen play a role in increasing sex drive and slowing bone loss.

Androgen hormones include testosterone and dehydroepiandrosterone-sulfate (DHEA-S).

Why Check Your Androgen Levels?

If you are having trouble conceiving and have irregular menstrual cycles, your doctor may check your androgen levels to see if you have a condition called polycystic ovarian syndrome (PCOS), which is the most common infertility-related diagnosis that is associated with excess androgen levels, and is a common cause of infertility. PCOS is characterized by irregular menstrual cycles, elevated androgen levels (and/or excessive hair or acne), and ovaries with many small follicles that have a “string of pearls” appearance.

Women who begin to display masculine physical features (such as excessive body hair, a deepening voice, or an enlarged clitoris) should also have their androgen levels checked.

When Can Androgen Levels be Checked?

Androgen levels can be checked at any time because they are stable across your menstrual cycle.

What Causes Elevated Androgen Levels?

The majority of women with elevated androgen levels have PCOS. It’s the most common infertility-related diagnosis associated with excess androgen levels.

Other rare, but possible causes of increased androgen levels include late-onset congenital adrenal hyperplasia and tumors of the ovaries or adrenal glands.

Testing the following can help evaluate for PCOS and rule out other conditions:

  • Testosterone
    • Mildly elevated (≤150 ng/dL) testosterone is most commonly associated with PCOS.
    • Testosterone values ≥200 ng/dL are concerning for an ovarian or adrenal tumor.
  • 17-hydroxyprogesterone (17-OHP)
    • Late-onset congenital adrenal hyperplasia is due to defective production of enzymes within the adrenal gland that lead to an increased level of 17-OHP.
    • If your 17-OHP levels are less than 200 ng/dL, you can rule out late-onset congenital adrenal hyperplasia. Levels ≥200 ng/dL require additional testing.
  • Dehydroepiandrosterone-sulfate (DHEA-S)
  • DHEA-S levels may be normal or slightly elevated in PCOS.
  • Very high DHEA-S values (≥800 µg/dL) are concerning for an adrenal tumor.

Fertility Treatment and Increased Androgen Levels

Treatment of increased androgen levels depends on the cause.

PCOS results in infertility due to lack of ovulation. While there is no cure for PCOS, a healthy diet and regular exercise can improve fertility by promoting weight loss. Weight loss, even in small amounts, can help regulate your menstrual cycle and initiate ovulation. In conjunction with lifestyle modifications, fertility drugs can be used to stimulate ovulation.

If the increased androgen levels are due to an ovarian or adrenal tumor, the tumor would need to be removed surgically to correct the increased androgen levels prior to attempting conception.

Dr. Sydney Chang is a Fellow in Reproductive Endocrinology and Infertility at the Icahn School of Medicine at Mount Sinai/Reproductive Medicine Associates of New York.  She earned her Bachelor of Arts in Human Biology at Stanford University, where she graduated with Honors and Distinction. She went on to complete her medical school education at Duke University School of Medicine. She completed her residency in Obstetrics, Gynecology, and Women’s Health at the Albert Einstein College of Medicine, where she served as an administrative chief resident.