Androgen testing and estrogen: How hormones affect fertility | Progyny

Updated by the Progyny Clinical Team — August 2025.

What are androgens?

Androgens are often called “male” hormones, but they play an important role in the health of everyone. Common androgen hormones include testosterone, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEA-S).

• Androgens are produced by the ovaries and adrenal glands (the glands that sit on top of the kidneys). The ovary makes testosterone and DHEA, which are converted to estrogen as it grows a follicle each month prior to ovulation.
• Androgens also play a role in sperm production, facial hair growth, libido, and bone health.
• There are conditions where people can make too few or too many androgen hormones, which can have important impacts on reproductive health.

How do androgen levels affect reproduction?

Low levels

• Testosterone is needed for proper development of the male reproductive tract when a fetus is growing. If there isn’t enough testosterone, or it doesn’t work properly, a child may be born without typical male structures. This may not be discovered until later in life.
• Testosterone is also essential to helping sperm mature. Low testosterone levels may affect sperm production, which can be seen in a semen analysis.

High levels

• Too much testosterone while a fetus is growing can also affect the appearance and function of the female genitalia after birth.
• High androgen levels later in life can stop eggs from maturing. This can cause irregular periods, unpredictable ovulation, or bleeding. The most common cause is polycystic ovarian syndrome (PCOS), but other conditions should also be checked.

What are the signs of high androgen levels?

The most common signs of high androgens:

• Excessive hair growth on the body
• Irregular periods
• A receding or thinning hair line (also known as male-pattern balding)
• Acne

Talk to your gynecologist or reproductive endocrinologist and infertility specialist if you have these symptoms. They’ll perform a history and physical exam and let you know if they recommend testing your androgen levels.

What androgen levels are tested in blood work?

The majority of testosterone is bound to proteins in the blood. Only free testosterone is active and responsible for the symptoms associated with high androgen levels, but free testosterone can be difficult to test. Because of this, it is most common for your doctor to test the total testosterone level.

Sometimes it’s helpful to test other hormones that can lead to high androgen levels. It is important to know that some hormone levels can be affected by age, medications, where someone is in their menstrual cycle, and the timing of blood draw. The results don’t always provide a specific diagnosis but using the clinical symptoms and lab results can help piece together what’s going on.

The most commonly tested androgens and precursor hormones include:

• Total testosterone
• Free testosterone
• Androstenedione
• DHEA-S
• 17-hydroxy-progesterone
• Progesterone

Depending on your symptoms and results, there may be other tests that are performed as well. Your doctor will interpret the results and review them with you.

Diagnosis and treatment

PCOS is the most common diagnosis for those with high androgen levels. For patients with PCOS who are overweight, many will have successful return of regular menstrual cycles when they lose a relatively small amount weight. Plus, improving the management of metabolic conditions, like diabetes and high cholesterol.

High androgen levels can also be caused by certain medications and other conditions, such as:

• Congenital adrenal hyperplasia
• Androgen-secreting tumors (rare)
• Cushing’s syndrome

You may need specific treatment for these conditions.

It’s also important to remember that even if you are not trying to get pregnant, there are other health consequences associated with conditions that have high androgen levels that need to be managed. Irregular periods should always be discussed with your doctor to understand your risks.

If you have questions or concerns, Progyny is here for you. Please contact your Progyny Care Advocate for support.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.