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Friday, March 31, 2023
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    Managing testosterone overload in women

    Datuk Dr Nor Ashikin Mokhtar

    ANN/THE STAR – Testosterone is primarily a male hormone, but it is also present in women.

    Weight gain, acne and hair loss are symptoms of hormonal changes, including high testosterone.

    Doctors may inform patients of high testosterone levels, but they may not always offer much advice on how to lower your testosterone levels to help you feel better.

    So, what are the reasons women have high testosterone and how can you lower it?

    It’s important to understand what is happening in your body so that you can return to normal.

    In most cases (95 per cent of the time), high testosterone is caused by something else, like another hormonal imbalance.

    Tackling the root issue will help improve your high testosterone levels.


    Understanding symptoms is very critical in diagnosing high testosterone, as each individual varies in terms of what is considered too much for their body.

    There are plenty of women who have “normal” testosterone levels, but have all the symptoms of too much testosterone, because what is considered the average normal is actually high for them individually.

    While the testosterone levels in these patients may appear relatively “normal”, they will still benefit greatly from treatment to help manage their symptoms.

    Some common symptoms of high testosterone levels in women include:

    Imbalances of other hormones, including the ratio of oestrogen and progesterone, other androgens like dehydroepiandrosterone (DHEA), and thyroid hormone.

    Changes in mood, including depression, irritability or anger.

    Weight gain (especially if it is unexpected), or inability to lose weight.

    Acne, changes in complexion or very oily skin (deep cystic acne, usually at the jawline, is common with high androgen levels).

    Hair loss (especially if thyroid function and other hormones are normal and if the hair loss is “male-patterned”).

    Many of these symptoms tend to be non-specific, hence there will be some overlap with other hormone imbalances in your body.

    For example, weight gain and hair loss are also signs of thyroid problems, but not male-patterned baldness.

    Additionally, thyroid issues can cause acne, but such acne usually isn’t cystic or located on the jawline.

    If you use these specific clues, you might be able to accurately guess where your hormonal problems are coming from.

    However, due to the overlap of symptoms, it is always best to consult your doctor and get the relevant hormone levels tested.


    Managing high levels of hormones can be challenging because it requires digging into the root cause.

    Anything that increases certain hormones can also increase your total testosterone (even if it is taken as a supplement!).

    As a result, when evaluating testosterone levels, it’s a good idea to also check serum DHEA levels, in addition to cortisol levels.

    The following are common causes of high testosterone, but do note that there are also other causes not in this list.

    Imbalance in oestrogen and progesterone

    Hormones in your body interact with one another. When one hormone is imbalanced, it will ultimately impact other hormones in the body.

    Despite the lack of clarity about the exact mechanism, there is definitely a correlation between testosterone, and progesterone and oestrogen.

    Treatment: Check for oestrogen and progesterone imbalances through blood serum levels.
    Maintain optimal thyroid function as hypothyroidism can cause low progesterone levels and oestrogen dominance.

    To ensure optimal oestrogen excretion and metabolism, make sure your liver is functioning properly, and that your B vitamins and nutrients are methylated.

    Consider supplements to help with oestrogen metabolism. These include vitamin B12 (preferably methylcobalamin), 5-MTHF (methyltetrahydrofolate), DIM (diindolylmethane) or indole-3-carbinol, milk thistle, MSM (methylsulphonylmethane) and bio-identical progesterone (20-40mg transdermally on days 14-28 of your menstrual cycle).

    Resistance to insulin

    Insulin resistance usually causes low testosterone in men, but it can cause high testosterone in women.

    If you have both high testosterone and high insulin levels, then insulin is definitely contributing to your hormone imbalance.

    Check your HbA1c and fasting insulin levels, in addition to free and total testosterone levels.

    Treatment: Consider insulin-sensitising medications such as SGLT-2 (sodium-glucose co-transporter 2) inhibitors, metformin, GLP-1 (glycogen-like peptide 1) agonists and alpha-amylase inhibitors.

    Increase thyroid function and insulin sensitivity by using T3 hormone supplements.

    Consider supplements such as berberine (1,000-2,000mg per day), alpha lipoic acid (600-1,200mg per day), magnesium, chromium and glucomannnan, which have been shown to reduce blood sugar and insulin levels.

    Insulin resistance is common among women with weight-loss resistance (and problems losing weight).

    Do not ignore this hormone and make sure you get properly evaluated if you have insulin resistance.

    Weight gain

    Women with excess fat also have higher levels of testosterone as fat cells increase androgens in the body. Additionally, these cells increase insulin resistance, resulting in further androgen excess (high testosterone).

    To normalise testosterone levels, you must lose weight in addition to the other therapies above.

    Treatment: You might want to consider diets like nutritional ketosis if you want to decrease carbohydrates (especially refined carbohydrates such as sugar, bread, pasta, etc).

    A prolonged or intermittent fasting programme may be beneficial.

    Lack of exercise

    Consider exercise as an additional way to prevent your body from developing high levels of testosterone.

    Lack of exercise does not cause high testosterone levels directly, but exercise does help prevent high levels. By sensitising your cells to insulin, exercise lowers insulin levels.

    Exercising may help balance testosterone to boost muscle mass and libido.

    Treatment: Strength-training or high-intensity interval training (HIIT) can increase insulin sensitivity.

    High levels of leptin

    When you don’t receive the signal to burn fat, your brain does the opposite instead.
    Fat cells produce leptin, a hormone that controls appetite and metabolism.

    Leptin levels are high in women with polycystic ovary syndrome (PCOS), and insulin resistance further worsens testosterone levels in women with leptin resistance.

    Therefore, high insulin levels lead to elevated testosterone levels in women with PCOS.

    Treatment: Consider leptin-sensitising medications like exenatide and liraglutide.

    While there are no specific supplements to treat leptin resistance that have been shown to work consistently, you can try the insulin-sensitising supplements listed above, as well as fish oil, zinc and leucine.

    Cut down your carbohydrate and fructose consumption as both make leptin levels worse.

    Treat underlying thyroid resistance and insulin resistance if present.

    Adrenal disease

    There are several precursors to testosterone, including DHEA, pregnenolone, progesterone and androstenedione, which are produced by the adrenal glands in this condition.

    Treatment: Add consumption of salt like Himalayan pink salt or Celtic sea salt.

    Manage stress levels with relaxation techniques like yoga, meditation, spiritual contemplation or prayer, time outside or in nature, and so on.

    Reduce caffeine and alcohol consumption

    Avoid other stimulates like amphetamine-based medications (amphetamine, methylphenidate hydrochloride, phentermine, etc).

    Get eight hours of sleep per night, and avoid high-energy tasks late at night, as well as taking naps during the day.

    Consider the following supplements: vitamin B6, adrenal glandulars, adrenal adaptogens, vitamin C, and low doses of melatonin.


    High testosterone levels can be treated, but the underlying cause must be addressed.

    You should be able to reduce your symptoms dramatically if you diagnose and treat the underlying cause properly.

    The most common causes of high testosterone are insulin resistance, leptin resistance, oestrogen/progesterone imbalances, adrenal dysfunction and poor diet/lifestyle.

    If you are serious about treating your high testosterone levels, find a doctor who knows how to balance hormones and is willing to dig into the cause of your problem.

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