What Are Androgens?

Androgens are a group of hormones most people associate exclusively with men — but they play a vital and often underappreciated role in women's health too. Testosterone, DHEA (dehydroepiandrosterone), DHEA-S, and androstenedione are the primary androgens circulating in a woman's body. They contribute to libido, bone density, muscle tone, mood, and even skin health. In the right amounts, they are genuinely good for you.

The problem arises when androgen levels rise above the normal physiological range for women, a state known as androgen excess or hyperandrogenism. This is one of the most common hormonal imbalances I see in women of reproductive age, and it is frequently at the root of symptoms that get dismissed, misdiagnosed, or chalked up to stress or "just getting older."

Understanding what's actually driving elevated androgens is the first step to doing something meaningful about them — and the good news is, there is a lot you can do.

Signs of Elevated Androgens

The symptoms of androgen excess tend to cluster in recognisable patterns, though not every woman will experience all of them. The most common signs include:

It's worth noting that lab tests don't always tell the full story. Some women have symptoms consistent with androgen excess but "normal" lab values — this is because what's measured in a standard blood panel doesn't always reflect tissue-level androgen activity. A skilled clinician will look at the clinical picture alongside the numbers.

What Drives Androgen Excess

Androgen excess rarely appears out of nowhere. It is almost always a downstream consequence of something else going on in the body — most commonly, polycystic ovary syndrome (PCOS), insulin resistance, adrenal dysfunction, or a combination of these.

PCOS is the most prevalent cause of hyperandrogenism in women, affecting an estimated 10–15% of women of reproductive age. In PCOS, the ovaries produce elevated androgens due to a disruption in the normal hormonal signalling that governs follicle development and ovulation. But PCOS itself has several distinct subtypes — and understanding which type you have matters enormously for how you address it.

Other causes include congenital adrenal hyperplasia (a genetic condition affecting cortisol production), androgen-secreting tumours (rare), and hyperprolactinaemia. In practice, however, the vast majority of cases come back to insulin resistance and adrenal stress.

The Insulin-Androgen Connection

If I had to name one driver of androgen excess that I see most frequently in my work, it would be insulin resistance. This connection is so central that it reshapes how we need to think about treatment entirely.

Here's what's happening: when cells become resistant to insulin, the pancreas secretes more of it to compensate. High circulating insulin stimulates the ovaries and adrenal glands to produce more androgens. Simultaneously, elevated insulin suppresses the production of sex hormone-binding globulin (SHBG) — the protein that binds testosterone in the bloodstream and keeps it inactive. Less SHBG means more free, biologically active testosterone, amplifying the androgenic effects even if total testosterone levels look only mildly elevated on a lab test.

You don't need a formal diagnosis of diabetes or pre-diabetes to have meaningful insulin resistance. Many women with androgen excess have blood sugar that looks "normal" on standard tests but is driven by a diet high in refined carbohydrates, chronic sleep deprivation, elevated cortisol, or sedentary behaviour.

Key insight: improving insulin sensitivity is often the single most impactful intervention for reducing androgen excess — and it works regardless of whether you have a formal PCOS diagnosis.

The Adrenal Contribution

The adrenal glands sit above the kidneys and are responsible for producing cortisol, adrenaline, and yes — androgens, particularly DHEA and DHEA-S. Under conditions of chronic stress, the adrenal glands can become dysregulated and produce excess androgens as a kind of hormonal side effect of an overworked stress response.

This is sometimes called adrenal androgen excess, and it tends to show up in women who are high-achieving, chronically stressed, under-sleeping, and running on caffeine and willpower. Labs will show elevated DHEA-S specifically, while testosterone and other markers may be in a normal range.

The adrenal piece is important because the interventions differ somewhat from ovarian androgen excess. Pouring more dietary interventions at an adrenal driver without addressing the nervous system and stress load often yields disappointing results.

What You Can Do

Addressing androgen excess requires working on the root cause rather than suppressing symptoms. The conventional approach — the birth control pill — works by artificially lowering LH (which reduces ovarian androgen production) and raising SHBG. It can quiet the symptoms while you're on it, but it does nothing to address underlying insulin resistance or adrenal dysfunction. When women come off the pill, the symptoms often return — sometimes worse.

Here is what the evidence supports for reducing androgen excess naturally:

I want to be clear: androgen excess can range from mild and manageable to severe and requiring medical intervention. If you're experiencing significant symptoms, getting a thorough hormonal panel — including total testosterone, free testosterone, DHEA-S, SHBG, fasting insulin, and fasting glucose — is an important first step. Work with a clinician who will look at the full picture, not just whether your numbers fall within the standard lab range.

The body is not broken. Androgen excess is a signal — one worth listening to. When you understand what's driving it, you have real options.

This article is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and treatment of any health condition.