The Acne Came Back at 34. Then the Chin Hairs.
The acne came back at thirty-four, in the same spots it used to show up in high school. Then came the coarse, dark hairs along your jawline, the ones you started plucking before anyone else could notice. Your cycle, which used to run like clockwork, now drifts by a week here, ten days there. Somewhere in the middle of all of it, you typed how to lower testosterone in women into your phone, sitting in a parking lot after an appointment that ended with “it’s probably PCOS” and not much else.
If that sounds close to your own week, you are not imagining a pattern, and PCOS may not be the entire explanation. Appointments like that often leave a lot of women with a label and very few answers. Wanting to understand what your body is actually doing is not vanity, and it is not overreacting. It’s the sensible response to signals your body has been sending for a while.
What Androgen Excess Looks Like
Androgens are the family of hormones that includes testosterone, and every woman’s body makes some. High testosterone in women doesn’t look identical from one person to the next, so the question isn’t whether you have any: it’s whether the level, or how your tissue responds to it, has drifted outside what works well for you.
The visible signs cluster together more often than not. Hair that grows coarser and darker along the jaw, chin, or chest (hirsutism) is one of the clearest markers of androgen excess, and the international guideline on PCOS treats it as one of the strongest predictors of an underlying hormonal pattern (Teede et al., 2023). Adult acne along the jawline, hair thinning at the scalp, and a cycle that runs long, short, or unpredictable often show up alongside it. Any one of these on its own can have other explanations; several of them together are worth a real conversation.
Here’s the part that surprises a lot of women: your testosterone level on paper and your symptoms in the mirror don’t always match. Some women have a lab result comfortably inside the “normal” range and still deal with real hirsutism and acne, because their tissue is unusually sensitive to a normal amount of the hormone. Others have a genuinely elevated number with barely a visible sign. Both patterns are real, and neither deserves to be dismissed just because one piece of the picture looks fine.
Four Drivers, One Pattern
PCOS is, by a wide margin, the most common reason a woman’s testosterone runs high. In the largest study of its kind, out of hundreds of women evaluated for androgen excess, roughly eight in ten had PCOS. A smaller group, about 5 to 6 in a hundred, had a specific identifiable cause instead: an inherited adrenal condition called congenital adrenal hyperplasia (most often its milder, non-classic form), a severe insulin-resistance syndrome, or, rarely, a hormone-producing tumor. An even larger share had real symptoms with no single cause found on full evaluation, a pattern sometimes called idiopathic hirsutism or idiopathic hyperandrogenism, which is its own kind of useful information: a genuine workup that didn’t turn up something more serious (Azziz et al., 2004).
If you already carry a PCOS diagnosis, our PCOS page walks through what that looks like day to day and how we approach it here; we won’t re-cover that ground in this post. What we want to talk about is the smaller group of women for whom PCOS isn’t the answer, or isn’t the whole answer, whether that turns out to be a specific cause or no single cause at all.
Insulin resistance is one of those other drivers, and it often travels alongside PCOS rather than replacing it as an explanation. Think of insulin as a key that’s supposed to unlock your cells so sugar can get in for fuel. When cells stop responding well, your body sends out more and more of that key, and the excess appears to push your ovaries toward producing more androgen along the way (Unluhizarci et al., 2021).
We see this pattern often in women coming from Cool Springs, already frustrated because cutting carbs on their own hasn’t moved the needle. Our insulin resistance page covers that mechanism and the testing behind it in more depth.
A smaller group of women are dealing with an adrenal source instead of, or in addition to, an ovarian one. Your adrenal glands make their own androgen, DHEA-S, and in some women that output runs high on its own, sometimes from a mild, inherited enzyme variation called non-classic congenital adrenal hyperplasia. Current guidelines recommend an early-morning 17-hydroxyprogesterone test to screen for this pattern when it’s suspected (Speiser et al., 2018), a test your provider may order, not something we run as a standalone panel.
Chronic stress plays a role here too: when your nervous system stays in survival mode for long stretches, your adrenal glands are part of that same stress response, and androgen output can be one more thing that drifts. This is part of why we track nervous system function directly with INSIGHT scanning: it gives us an objective read on whether a woman’s body is actually settling out of that stress state, rather than guessing from symptoms alone.
However these drivers combine, there’s a category that needs a physician’s attention quickly rather than a blog post. If hair growth or other masculinizing changes come on fast, over months rather than years, or your provider flags a level as markedly elevated, that pattern calls for a more urgent workup to rule out a rarer adrenal or ovarian source. That’s not meant to alarm you; it’s meant to make sure the small number of women who need it get seen quickly.
The Testing That Tells Them Apart
Separating these drivers starts with the right tests, in the right order. Total testosterone is the number most panels report, but free testosterone (the small fraction that isn’t bound to a carrier protein called sex hormone-binding globulin, or SHBG) is often the more useful number, because SHBG itself tends to run low in women with insulin resistance, which frees up more testosterone to act on tissue even when the total number looks unremarkable (Dinakaran et al., 2024). We’ve written more about what drives SHBG up or down if you want the fuller picture.
DHEA-S adds another layer, because it mainly reflects what your adrenal glands are doing rather than your ovaries, which helps sort out where an elevated pattern is actually coming from (Medenica et al., 2024). Timing matters too: androgens shift across your cycle, so when a sample is drawn can change what it shows.
This is where a DUTCH test can add something a single blood draw doesn’t. Alongside DHEA-S, it reports the metabolites your body makes as it breaks androgens down, which gives us more of the pattern than a total number alone. We won’t walk through every marker here; the DUTCH page covers that. What matters for this conversation is that labs are one piece of that picture, not the whole story by themselves, and understanding what’s driving your numbers still starts with a real conversation about what you’re experiencing.
How to Lower Testosterone in Women: What the Evidence May Support
So: how to lower testosterone in women, when PCOS or insulin resistance is part of the pattern? In my practice, the woman I meet most often has already cut carbs, tried a supplement a friend recommended, and still doesn’t know which driver she’s actually working with. The honest answer is that the evidence here is real but modest, and it works best alongside your prescribed care, not instead of it.
If weight is part of your picture, the research doesn’t point to weight loss lowering testosterone directly so much as it improving the metabolic health sitting underneath it, things like insulin sensitivity and cholesterol levels (Teede et al., 2023). That distinction matters: the goal is a body that manages insulin better, not a number on a scale, and there is no version of this conversation where the size of your body is a character flaw. Movement, especially strength training, supports that same insulin-sensitivity goal.
Two supplements come up often enough that they’re worth an honest look. Inositol has been studied in dozens of PCOS trials, and the most recent meta-analysis pooling them found the evidence on hirsutism and androgen levels limited and inconclusive; the modest metabolic-marker benefit it did find belonged specifically to a related compound, D-chiro-inositol, not the myo-inositol most commonly sold on its own (Fitz et al., 2024).
Spearmint tea has a small but real research base too: one 30-day trial found free and total testosterone dropped in the group drinking it, though the visible hair-growth score didn’t improve in that short a window (Grant, 2010). Neither of these is a proven treatment. Both are reasonable, low-risk things to raise with your care team if you’re curious.
Sleep and a settled nervous system belong on this list too, even though they’re less exciting than a supplement. A body that isn’t sleeping and isn’t getting out of survival mode has a harder time managing insulin and stress hormones, both of which feed back into androgen production. For a mom in Nolensville juggling a full week, this is often the piece that gets skipped first and matters most.
Alongside Your Prescriber, Not Instead
Combined oral contraceptives are the first-line prescription option your gynecologist or primary care provider may reach for to manage hyperandrogenism and irregular cycles, per current guidelines, and spironolactone is a medication that same prescriber may add when hair growth or acne needs more help than the pill provides on its own (Martin et al., 2018). Metformin is another standard option your prescriber may use when insulin resistance is part of the picture. These aren’t treatments we’re here to talk you out of.
What functional medicine adds is the workup that often happens before or alongside those prescriptions: figuring out which driver, or combination of drivers, is actually behind your numbers, so that whatever your prescriber recommends is aimed at the right target. Your care team should include your gynecologist or endocrinologist and us, not one instead of the other.
How We Approach Androgen Excess in Franklin
Here in Franklin, Dr. Amy Putrus-Schnell, DC CFMP starts with a root-cause question: which driver, or combination of drivers, is actually behind your specific pattern? That means looking at your androgen picture through DUTCH testing, DHEA-S included, alongside fasting insulin, together, rather than reacting to one flagged number in isolation.
The other half of the picture is your nervous system. A body that’s stuck in survival mode has a harder time regulating almost everything, hormones included, which is why nervous system regulation and root-cause lab work are the two pillars of our whole-body approach. Few clinics pair the two the way we do. Once your results are in, we sit down with you, your full history, and your actual symptoms, and build a plan from there, one that works alongside whatever your prescriber has already recommended, not around it.
Common Questions About High Testosterone in Women
What causes a woman’s testosterone to be too high?
PCOS is the most common cause by a wide margin. Insulin resistance, adrenal sources like elevated DHEA-S, and, rarely, a hormone-producing tumor can also raise testosterone. Working out which one applies to you starts with the right lab panel, not a guess.
What can decrease testosterone in females?
For women with PCOS or insulin resistance, prescribed options like combined oral contraceptives, spironolactone, and metformin have the strongest evidence behind them. Improving insulin sensitivity through nutrition and movement may support the pattern underneath, and inositol or spearmint tea show early, modest signals in small studies. None of these replace a workup with your provider.
What should I eat to reduce testosterone?
There’s no single food that lowers testosterone, and any claim that promises one deserves skepticism. What the evidence does support is that a way of eating that steadies blood sugar and supports insulin sensitivity, built around protein, fiber, and fewer refined carbohydrates, tends to help the metabolic pattern that often sits underneath elevated androgens.
Does vitamin D decrease testosterone in women?
This is a common question, and a reasonable one to bring to your provider. The research connecting vitamin D and androgen levels in women isn’t settled enough for us to make a specific claim here, so if it’s something you’re curious about, it’s worth raising directly at your visit rather than starting a supplement based on an online claim.
Can you have high testosterone without PCOS?
Yes. PCOS explains the large majority of cases, but insulin resistance on its own, adrenal sources like elevated DHEA-S or non-classic congenital adrenal hyperplasia, and rare tumors can all raise testosterone without meeting the criteria for a PCOS diagnosis. That’s exactly why the testing matters more than the label.
Getting Answers in Franklin
Maybe you’ve tried cutting foods on your own, or started a pill you weren’t sure about, and you still don’t have a clear picture of what’s driving your testosterone. That’s one of the most common conversations we have with women here in Franklin: something real is happening in your body, and you’re ready for someone to help you map it out.
Dr. Amy and her team would welcome the chance to sit down with you, make sense of what your numbers are actually telling you, and build a plan that works alongside the care you already have. Bring your questions to our Columbia Avenue office in Franklin, where a consultation means we sit down and go through your numbers with you properly.
