Testosterone 101: Understanding Your Testosterone Levels

It’s become a common misconception, that when it comes to sex hormones, those born female are driven by oestrogen and those born male are driven by testosterone. But the reality is, all sexes have these hormones running through their bodies, just in different quantities. So if testosterone isn’t just for testes-bearers, what does it do in your body? And what can the knock-on effects of an imbalance be? Welcome to testosterone 101 – where we cover all you need to know and the hormone, and what your testosterone levels mean.

What is testosterone?

Testosterone belongs to a group of hormones called androgens. There are a lot of misconceptions about it being just a “male” hormone. 

Although they are important hormones for the sexual development of people with male sex organs, everyone, irrespective of biological sex, produce and require some level of androgens for reproductive development.

What does it do inside my body?

In women and gender diverse people assigned female at birth, it is produced by the ovaries and by adrenal glands. It is then converted to the primary sex hormone – oestrogen. Testosterone production is age-dependent and gradually declines with age.

Most of the testosterone in our body is inactivated as it remains bound to two proteins, sex hormone-binding globulin (SHBG) and albumin. The small fraction of testosterone that remains unbound is called freely circulating testosterone (free T) which can enter a cell and bring about its effect. 

The levels of free T in the body are determined by how fast testosterone is made, how fast it is broken down, and the level of SHBG. Low levels of SHBG result in higher free testosterone, whereas high levels result in lower free testosterone. You can read more about SHBG here. 

Some of the functions testosterone serve in the body include:

• Maintaining sex drive (libido)
• Maintaining muscle mass and bone density
• Menstrual health & fertility
• Stabilising mood
• Growth, repair, and maintenance of reproductive tissues
• May help support cardiovascular health

What do high testosterone levels l mean?

In cases where a hormonal imbalance leads to an excess amount of testosterone (hyperandrogenism), it may result in the following symptoms:

• Skin issues such as acne and oily skin, specifically concentrated around the jawline, back and chest.
• Excess facial & body hair (hirsutism)
• Thinning or loss of scalp hair (alopecia)
• Irregular or missed menstrual cycles, which in severe cases can result in fertility issues
• Changes in mood
• Deepening of the voice
• Increased muscle mass
• Issues with weight
• Enlargement of the clitoris

Some studies suggest that high testosterone levels may increase the risk of developing high cholesterol, heart disease and type 2 diabetes.

What could cause high testosterone levels? 

The most common causes of high testosterone levels due to underlying health conditions are polycystic ovary syndrome (PCOS), and congenital adrenal hyperplasia. In extreme cases, it may be a sign of tumours affecting the ovaries or adrenal glands.

Polycystic ovary syndrome (PCOS) is a hormonal & metabolic condition affecting 1 in 10 women & gender diverse people assigned female at birth. 

The exact cause is still being researched; however, the proposed causes include an excess of androgens and insulin, genetic factors and environmental factors. You can read more about PCOS here.

If you suspect you might have PCOS, our at-home tests can give you a better insight into your hormones. But at Hertility, we don’t believe in giving you results without the rest, we give you the what’s up and the what’s next. Our team of experts includes PCOS specialists who can help you manage your symptoms and create an actionable plan for the future.

Congenital adrenal hyperplasia (CAH) is an inherited condition that affects the adrenal glands. 

These are small glands located on top of the kidney. They produce the hormones cortisol (stress hormone) and aldosterone, which regulate metabolism and blood pressure. They also produce the hormones dehydroepiandrosterone (DHEA), and testosterone.

People with CAH are unable to produce an enzyme necessary to regulate the production of these hormones, which can result in an overproduction of testosterone.

It was found to be more common in some ethnic groups such as people of Hispanic, Mediterranean, Yugoslavian and Ashkenazi Jewish descent.

Cushing’s syndrome is another hormonal condition impacting the adrenal glands. It results in excessive cortisol and androgen production.

A recent study including 3124 people found that those who were premenopausal and showed symptoms of depression had higher free testosterone levels than those without them.

Testosterone levels can rise due to certain medications, such as:

• Anabolic steroids are made up of testosterone and other substances related to testosterone that promotes muscle growth. They are often used to improve athletic performance and enhance cosmetic appearance. 

Anabolic steroid use can be addictive, making it difficult to stop. However, there are significant negative physical and psychological effects of anabolic steroid use, one being elevated testosterone levels.

• Testosterone replacement therapy is a form of hormone replacement therapy. It is used to treat menopause symptoms and as part of the medical transitioning process for gender reaffirming therapy for trans men. 

• DHEA is a precursor to testosterone, and taking DHEA supplements could increase the levels of testosterone.

• Danazol is a synthetic steroid that possesses some structural similarities with testosterone. It is a drug used as part of
• treatment. It works by suppressing the number of hormones made by the ovaries and is also known for its affinity to bind with SHBG, which results in increased levels of free testosterone.  

Excessive alcohol consumption may increase levels of testosterone in premenopausal women, however, research is conflicting. You can read more about the impact of alcohol on fertility here.

Bisphenol A (BPA) is a  chemical present in some plastics. Some research has shown that BPA can seep into food or beverages from containers that are made with BPA. It is considered to be an endocrine-disrupting chemical with reproductive toxicity. A study including 71 people with PCOS and 100 without it found a higher BPA level in people with PCOS and a statistically significant positive association between androgens and BPA.

What can I do to reduce my testosterone levels?

Treatment for high testosterone depends on the cause, but generally, it is a combination of lifestyle changes and medications. 

• Lifestyle modifications:

Achieving a healthy weight by including a healthy balanced diet & exercise routine may help with the symptoms of a hormonal balance. You can read more about the impact of lifestyle on fertility here.

Leading a healthy lifestyle and losing even 5 to 10% weight may improve PCOS symptoms. You can read more about managing PCOS. 

There is currently conflicting evidence on the role of soy products like edamame, tofu, soy milk and miso and their role in lowering testosterone levels. Researchers suggested that phytoestrogens in soy mimic the effects of oestrogen and might affect the body without changing the body’s hormone levels. However, there is a need for more high-quality research to understand the exact effects of soy on the body.

A small study including 42 women showed that drinking spearmint herbal tea daily caused a significant decline in testosterone levels within 30 days. However, this study was conducted on a small number of people and therefore we cannot say for certain that it might be effective for everyone.

A review in BMC Complementary & Alternative Medicine discussed 6 six herbal medicines which may have beneficial effects for those with menstrual cycle irregularities, hyperandrogenism and PCOS. However, there is not enough high-quality evidence to understand the effect of these herbs in general and more research is needed. It is always recommended to speak with a doctor before starting any medication or supplements.

Small studies have shown the benefits of flaxseeds in lowering testosterone levels. They are high in lignans, a plant compound that binds to testosterone and encourages it to be excreted from the body. They are also rich in omega-3 fatty acids, which may be linked to a decrease in testosterone as well.

Another study found that participants experienced a small but significant decrease in testosterone levels while following a low-fat and high-fibre diet. A study including 50 obese or overweight women suffering from hirsutism found that a high fibre diet can decrease weight and some androgens like testosterone.

The beneficial effects of green tea on reproductive health is limited; however, a study including 60 people with PCOS found that green tea decreased fasting insulin and free testosterone levels.

The U.S. Food and Drug Administration (FDA) says that BPA is safe at very low levels, and research around this is still ongoing. If you’re concerned about BPA, you can consider these steps to reduce your exposure:

• Use BPA-free products.
• Don’t put plastic containers in the microwave or dishwasher because over time, the heat may break them down, allowing BPA to leak into foods.
• Use alternatives such as glass, porcelain or stainless-steel containers for hot foods and liquids instead of plastic containers.

Considering the link shown between testosterone and depression, if you are experiencing these symptoms, it might be beneficial to consider self-help methods such as meditation and yoga etc. If you find that self-help measures are not sufficient, we advise you to seek professional help. You can read more about the impact of fertility issues on mental health here.

If you think you might be struggling with handling your emotions and stress during your fertility journey, our counsellor care pathway is here to allow you to express your emotions freely, help you make the right choices, and support you throughout your journey. You can find out more about our counselling services here.

• Medications used to treat high testosterone, and associated symptoms include:

• Oral contraceptives, in particular the combined oral contraceptive pill, have been shown an effective treatment for blocking testosterone by inhibiting ovarian and adrenal androgen synthesis and increasing levels of sex hormone-binding globulin (SHBG). 

Menstrual cycles may take up to 3-6 months to return to normal after stopping oral contraception, which is why it is important to share your reproductive goals with your healthcare provider while developing a treatment plan. 

• Spironolactone (Aldactone) is an anti-androgen drug that decreases the production of testosterone. It is often used to treat hormonal acne and excessive body hair.

• Glucocorticosteroids are a type of steroid hormone that has been found to be effective in reducing testosterone levels in those with hirsutism. 

• Metformin is prescribed to manage blood glucose and insulin levels.  For people with  PCOS, it is also often used to help with ovulation (ovulation induction). You can read more about it here.

• If excessive hair is a concern, there are multiple temporary options, including waxing, plucking, shaving, dermaplaning, bleaching or topical hair removal creams, and more permanent options such as electrolysis and laser therapy. You may also be prescribed anti-androgen medicines.

What does a low testosterone result mean?

In cases where a hormonal imbalance leads to a deficiency of testosterone, it can result in some of the following symptoms: 

• Reduced sex drive
• Negative impact on mood including increased risk of experiencing anxiety & depression
• Irregular menstrual cycles which in severe cases can result in fertility issues
• Lethargy
• Increased body fat
• Muscle weakness, loss of muscle mass & tone
• Osteoporosis
• Vaginal dryness
• Changes in breast tissue

Low testosterone over a long period of time may also contribute to long-term health conditions such as heart disease, memory issues, and loss of bone density.

Often, the symptoms of low testosterone in women are underdiagnosed or misdiagnosed. Some of the conditions that low testosterone may be mistaken for include: stress, depression, and the side effects of menopausal changes in women.

What could cause low testosterone levels?

Testosterone levels naturally decrease as we age. As it is produced in the ovaries, the natural decrease in ovarian function with age means that some may experience low testosterone levels as they transition from the perimenopausal phase into menopause. You can read more about menopause here

Underlying health conditions impacting the pituitary, hypothalamus, or adrenal glands or surgery, such as removal of the ovaries. 

Normally, the hypothalamus in the brain releases a hormone called Gonadotropin-releasing hormone (GnRH). This stimulates the pituitary gland to release Follicle-Stimulating Hormone  (FSH) and Luteinising Hormone (LH).

These hormones tell the ovaries to release the reproductive hormones oestrogen, progesterone and testosterone that lead to sexual development in puberty and regulate the menstrual cycles.

Any change in this balance can cause a reduction in the reproductive hormone levels and stop the normal function of the ovaries. Hypogonadotropic hypogonadism is a form of hypogonadism, a condition in which the ovaries produce little or no sex hormones. that occurs due to a problem with the pituitary gland or hypothalamus. 

The pituitary gland also produces a hormone Adrenocorticotropic hormone (ACTH) that regulates the release of adrenal androgens. A disruption in the pituitary gland thus also impacts the adrenal gland. Addison’s disease or adrenal insufficiency is a hormonal condition that occurs due to underactive adrenal glands and can cause a low level of its hormones.

Premature ovarian insufficiency (POI) is a condition that results from the inability of the ovaries to produce adequate levels of reproductive hormones because of genetic factors, underlying autoimmune conditions or surgical procedures such as removal of the ovaries, chemotherapy or radiotherapy for cancer. This can increase the risk of reduction in testosterone. You can read more about POI here. 

For those living with PCOS, certain medications prescribed to alleviate symptoms have been found to lower testosterone levels, such as:

• Spironolactone
• Metformin
• Melatonin supplementation
• Omega 3 supplementation

As mentioned above, high fibre diets have been shown to reduce testosterone levels. 

It may also be linked to genetic conditions, such as Turner’s syndrome that affects only assigned female at birth individuals. It occurs when one of the X chromosomes is missing or partially missing. It can cause a variety of medical and developmental problems, including short height, failure of the ovaries to develop and heart defects.

What can I do to increase my testosterone levels?

Low testosterone levels (hypogonadism) effects and treatments in women and gender diverse people assigned female at birth haven’t been largely studied. 

As a result, treatment interventions for low testosterone are not usually recommended unless it is impacting health and quality of life. 

Testosterone replacement therapy is a form of hormone replacement therapy based on the replacement of testosterone. It may be prescribed orally, as injections, gels or skin patches.

The most recent guidelines of the Endocrine Society recommends against the general use of testosterone therapy in healthy people for the treatment of the following conditions: 

• Fertility issues
• Sexual dysfunction 
• Cognitive function
• Cardiovascular health
• Metabolic syndromes
• Bone health
• General well-being

Vulvovaginal atrophy, i.e the thinning of the walls of the vagina due to declining oestrogen levels during menopause, is generally treated with oestrogen replacement therapy; however, it is contraindicated for some people, such as those with breast cancer, for whom intravaginal testosterone has been proposed as an alternative.

It has been proved to have positive effects on sexual function and cognitive function for postmenopausal women; however, the long-term safety and effects of testosterone therapy on improving bone and muscle strength or levelling mood isn’t well understood. 

DHEA is a precursor to testosterone, and it is believed that taking DHEA supplements could increase the amount of testosterone. It is always recommended to speak with a doctor before starting any medication or supplements.

There is conflicting data on the use of zinc for testosterone levels. One study, including 116 postmenopausal women, found that zinc supplementation can increase testosterone levels; however, another study on those with PCOS found that it had beneficial effects on alopecia and hirsutism but did not affect hormonal levels. Zinc-rich foods include lean meat, oysters, dairy, whole grains, nuts, sesame, seeds, beans, bread & fortified cereals.

If you suspect you might be experiencing any of the symptoms mentioned above, our at-home tests can give you a better insight into your hormones. At Hertility, we don’t believe in giving you results without the rest, we give you the what’s up and the what’s next. Our team of experts can help you to manage your symptoms and create an actionable plan for the future.

Takeaways:

• Everybody produces testosterone irrespective of biological sex. It plays an important role in many of the body’s functions.

• Imbalances in testosterone levels can be due to various underlying health conditions. Excessive testosterone levels are most commonly seen in cases of PCOS.

• Treatment for imbalances in testosterone levels depends on the cause, but generally, it is a combination of lifestyle changes and medications.

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