Testosterone is considered the main male sex hormone. It’s responsible for male sex characteristics and development, including the growth of the penis and testes, male-pattern body hair, and a lowered vocal range. People assigned female at birth produce less testosterone than people assigned male at birth, but testosterone is found in both sexes.

Anyone can have high testosterone levels, a condition called hyperandrogenism. High testosterone levels don’t usually produce obvious symptoms in people assigned male at birth unless they are pre-pubescent (under age 12). However, high testosterone levels in people assigned female at birth can cause symptoms like male-pattern facial hair, acne, irregular periods, infertility, and mood changes.

Skin symptoms are some of the most prominent signs of high testosterone levels. In people assigned female at birth, this might include oily skin and acne. Acne and oily skin are also common in males during puberty due to elevated testosterone levels.

High testosterone causes these symptoms because testosterone causes increased sebum production. Sebum is an oily substance produced by your sebaceous glands, mostly on your face and scalp. Increased sebum is associated with oily skin and acne.

When people assigned female at birth have higher than normal testosterone levels, they may develop hair growth patterns similar to people assigned male at birth.

One symptom is a condition called hirsutism, or male-like hair growth. This may include increased hair growth on the face, thighs, and buttocks. People may also experience hair loss, which can look like hair thinning and loss at the top of the head and in the hair part.

High testosterone in women can cause irregular periods and difficulty getting pregnant. It’s associated with polycystic ovarian syndrome (PCOS), a condition characterized by high testosterone and linked to reproductive issues like infertility.

In some cases, high testosterone in women can cause enlargement of the clitoris and an increased sex drive.

Elevated testosterone levels in women can lead to metabolic issues, such as a natural tendency to gain weight.

Hyperandrogenism in people assigned female at birth is also associated with insulin resistance, which is when your body becomes less sensitive to insulin. Insulin resistance can raise your blood glucose (sugar) levels, putting you at risk of type 2 diabetes.

People assigned female at birth who have high testosterone levels associated with PCOS often have an increased risk of mental health challenges, including depression and anxiety.

Some research has also found that elevated testosterone levels in people assigned male at birth can cause behavioral issues, including increased anger and aggression, risk-taking behaviors, and reactive aggression.

High testosterone doesn’t usually negatively affect children. However, in children assigned male at birth, high testosterone before the age of nine can cause early puberty.

Early puberty symptoms may include enlargement of the penis, hair growth patterns similar to adult males, and a deepening of the voice.

Males with high testosterone don’t usually have observable symptoms. For instance, it’s a misconception that high testosterone in males causes increased muscle mass or increased hair growth.

However, high testosterone in females can cause noticeable symptoms, such as facial hair, irregular periods, thinning hair, and mood changes.

High testosterone is usually caused by a medical condition or medication. These conditions may include:

• Polycystic ovarian syndrome (PCOS)
• Adrenal tumors
• Ovarian tumors
• Testicular tumors
• Cushing’s syndrome (also called hypercortisolism, a condition caused by excess levels of the stress hormone cortisol)
• Steroid use

The underlying conditions associated with testosterone elevation may include their own set of complications. For example, Cushing’s syndrome is associated with an increased risk of heart attacks, stroke, bone loss, and type 2 diabetes.

Long-term steroid use can lead to osteoporosis (bone thinning and weakening), elevated blood pressure, blood glucose issues, and an increased risk of infections.

Most of the time, elevated testosterone is linked to PCOS. In fact, 65-75% of people with PCOS have elevated testosterone. PCOS is associated with several complications, including a higher risk of developing:

• Hypertension (high blood pressure)
• Hypercholesterolemia (high cholesterol)
• Insulin resistance
• Diabetes
• Mood disorders like depression and anxiety
• Endometrial cancer
• Cardiovascular disease
• Infertility
• Irregular periods

It’s important to visit your healthcare provider if you show any signs of high testosterone. High testosterone is associated with medical conditions like testicular tumors, ovarian tumors, PCOS, and adrenal gland disorders. Visiting a healthcare provider can help you manage your symptoms and treat any underlying conditions that may be causing them.

Your provider will likely:

• Ask you about your symptoms and how long you’ve had them
• Ask you about your medical history and any medications you take
• Do a physical health exam

A blood test might be necessary to measure testosterone and other hormone levels. However, measuring testosterone levels can be difficult because they can naturally fluctuate during the day.

In males, testosterone is often measured in the morning, when it’s known to be highest. In females, it’s usually best to measure testosterone in the early morning and during the follicular phase of your menstrual cycle (the first two weeks).

High testosterone can occur in males and females, but females usually experience symptoms. These symptoms can include facial hair, hair loss, irregular periods, and infertility. PCOS most commonly causes high testosterone in females.

If you have signs of high testosterone, reach out to your provider for diagnosis and treatment.