If you have been diagnosed with polycystic ovary syndrome, you have probably heard the word androgen used in your doctor's office or in articles like this one. Androgens are often called "male hormones" because men produce them in larger amounts, but women produce them too — just normally at lower levels. In PCOS, the ovaries and adrenal glands can overproduce these hormones, leading to a cascade of symptoms that affect everything from your skin to your menstrual cycle.
This explainer helps you understand what high androgens actually do in your body, why they matter, and what you can do — with your healthcare team — to manage the effects.
What are androgens, and why do they go high in PCOS?
Androgens include hormones such as testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEA-S). In women with PCOS, the ovaries often make more of these hormones than normal. This can happen because of a combination of factors: elevated luteinizing hormone from the pituitary gland, resistance to the hormone that normally stops the ovaries from making too much androgen, and sometimes high insulin levels that stimulate the ovaries directly.
Not every woman with PCOS has high androgens. But when they are present, they are a key diagnostic feature — part of what doctors call the "biochemical hyperandrogenism" in the Rotterdam diagnostic criteria.
How high androgens change your body
1. Skin and hair changes
One of the most visible effects is on the skin. Androgens can increase oil production in the sebaceous glands, leading to acne — often along the jawline, chin, and upper neck — even in adulthood. They also cause the hair follicles on the scalp to shrink over time, which can lead to thinning hair, or androgenic alopecia. Meanwhile, sensitive hair follicles on the face, chest, back, and abdomen may switch from fine, vellus hair to coarse, dark terminal hair — a condition called hirsutism.
Hirsutism affects roughly 70 percent of women with PCOS who have elevated androgens. It is one of the most common reasons women seek help for PCOS.
2. Menstrual and ovulation disruption
Inside the ovary, androgens interfere with the normal process of follicle development. Instead of maturing and releasing an egg each month, many small follicles accumulate — giving the ovaries their "polycystic" look on an ultrasound. High androgens also signal the pituitary gland to release too much LH, which further throws off the hormonal cycle. The result: irregular or absent periods, and difficulty with ovulation and fertility.
3. Metabolic effects
Androgens are linked to insulin resistance. When your cells do not respond well to insulin, the pancreas produces more insulin to compensate. That extra insulin, in turn, makes the ovaries produce even more androgens — creating a difficult loop. This can raise the risk of type 2 diabetes, high cholesterol, and fatty liver disease. High androgens are also associated with a higher waist-to-hip ratio, meaning more fat is stored in the abdomen, which comes with its own set of health concerns.
Think of it as a triangle: high insulin, high androgens, and disrupted ovulation all feed into each other. Managing one can help improve the others.
How high androgens are measured
Blood tests can measure total testosterone, free testosterone (the active form), and sometimes other androgens like DHEA-S. Your doctor may also order tests for SHBG (sex hormone-binding globulin). When SHBG is low — which is common in PCOS — more of your testosterone is "free" and available to affect tissues. The most common pattern in PCOS is an elevated free testosterone with a normal or only slightly elevated total testosterone.
Make sure your doctor uses a sensitive assay for testosterone, especially if you are a woman, because standard male-level tests are not precise enough at the lower female range. If you have symptoms and your lab work looks normal, ask about testing free testosterone or considering a clinical diagnosis based on symptoms.
Treatments and management strategies
Treatment is highly individual. No single approach works for everyone, but the following are common tools that healthcare providers use:
- Combination birth control pills — The estrogen in the pill boosts SHBG, which binds up free androgens. This often improves acne and hirsutism within a few months.
- Anti-androgen medications like spironolactone block androgens at the receptor level in the skin and hair follicles. They are often used for hirsutism and hair thinning but are not safe during pregnancy, so doctors usually combine them with birth control.
- Metformin — This insulin-sensitizing drug lowers insulin levels, which can in turn lower androgens released from the ovary. It works best for women with clear insulin resistance or prediabetes.
- Lifestyle changes — A balanced diet and regular physical activity can reduce insulin resistance, lower free testosterone, and help with weight management. Even a 5-percent loss of body weight can improve symptoms in some women.
None of these are a cure, but they can significantly improve quality of life. Work with an endocrinologist, gynecologist, or a PCOS-knowledgeable primary care doctor to find what works for you.
When should you see a doctor?
If you have symptoms that sound like high androgens — especially if you are also having irregular periods — it is worth checking in with a healthcare provider. Sudden or rapid progression of hirsutism, deepening voice, or male-pattern baldness can sometimes point to other conditions like adrenal hyperplasia or a tumor, so those need immediate evaluation. For most women with PCOS, the increases are gradual and manageable.
Keep a simple symptom diary: when did your periods start to change? How long has the acne been a problem? Is the hair growth new or getting worse? That information helps your doctor put the pieces together.
Androgens and PCOS: the bottom line
High androgen levels are not something you need to live with silently. They are a measurable, treatable driver of many PCOS symptoms. Understanding the connection gives you the language to talk with your doctor about the right tests and treatments. Small steps — like tracking your cycle, asking about SHBG and free testosterone, and considering how insulin and androgens feed each other — put you in a much stronger position to navigate PCOS over the long term.
This article is for educational purposes only and does not replace individualized medical advice.
