Testosterone Levels in Women: What High and Low Mean

Testosterone is often thought of as a male hormone, but women make it too, in the ovaries and the adrenal glands. In much smaller amounts than in men, it contributes to sex drive, energy, and muscle and bone health. Too much can cause acne, unwanted hair growth and irregular periods, while levels naturally fall with age and after the ovaries are removed.

This guide explains what a high or low testosterone result means for women, how SHBG and the free androgen index fit in, the link with polycystic ovary syndrome (PCOS), and where testosterone treatment fits around the menopause.

Test it in Chiswick: our Testosterone blood test costs £49, with your result explained in person by a practitioner. No GP referral needed. Book this test or call 020 4515 0000. Prefer to test at home? A home finger-prick kit is also available, ask us when you enquire.

Quick answer

Many NHS laboratories give an adult female range for total testosterone with an upper limit of around 1.9 nmol/L, although some use a higher limit. A mildly raised result is most often linked to PCOS. A level above 5 nmol/L, or more than twice the upper limit, is a reason for specialist referral to rule out rarer causes. There is no agreed low cut-off for women: low sex drive around the menopause is assessed on symptoms, not a blood level. Always read the range on your report.

What your testosterone result means

• Low or at the lower end of the range: common after the menopause and after surgical removal of the ovaries. There is no agreed level that defines deficiency in women, so a low number on its own does not explain symptoms.
• Within range (often up to about 1.9 nmol/L): reassuring, but it does not rule out PCOS, because testosterone can be normal in PCOS while the free androgen index is raised.
• Above the range: most often seen with PCOS. It can also follow testosterone or anabolic steroid use, or occur with less common hormone conditions.
• Markedly raised (above 5 nmol/L, or more than twice the upper limit): NHS referral pathways advise specialist assessment to exclude an adrenal or ovarian cause.

Ranges vary by laboratory and testing method. Two NHS laboratories, for example, quote less than 1.9 nmol/L for adult women, while another NHS pathway uses an upper limit of 2.7 nmol/L for its assay. Your practitioner will always interpret your result against the range on your own report.

SHBG and the free androgen index

Most testosterone in the blood is bound to sex hormone binding globulin (SHBG) and is not active. When SHBG is low, more testosterone is free to act on the skin and hair follicles, even if total testosterone looks normal.

The free androgen index (FAI) combines the two: total testosterone divided by SHBG, multiplied by 100. A raised FAI suggests more active testosterone. FAI ranges vary widely: one NHS laboratory quotes 0.7 to 10.9% for women aged 18 to 46, while another quotes 0.18 to 7.07% for women aged 20 to 50. Results also need care when albumin is abnormal.

SHBG is often low in PCOS, reflecting raised insulin levels, and tends to be lower with excess weight. The combined contraceptive pill raises SHBG, which can lower the FAI, so tell us if you use hormonal contraception.

Our Testosterone Check (£59) measures total testosterone, SHBG, albumin, free testosterone and the FAI together, and is usually more useful for women than testosterone alone.

High testosterone and PCOS

PCOS, which the NHS now also calls polyendocrine metabolic ovarian syndrome (PMOS), is the most common reason for raised testosterone in women. NHS-listed symptoms include:

• Irregular periods or long gaps between periods
• Excess hair growth on the face or body, or thinning hair on the scalp
• Oily skin and acne
• Weight gain or difficulty losing weight
• Difficulty getting pregnant
• Thick, dark skin patches on the neck or armpits

In PCOS, NHS guidance notes that testosterone is normal or high, SHBG is normal or low, and the FAI is normal or raised. No single blood test diagnoses PCOS: a specialist looks at your periods, signs of excess androgens, blood tests and sometimes an ultrasound scan, and rules out other causes such as thyroid problems and raised prolactin. Our guide to blood tests for hair loss covers the hormone and nutrient checks that are useful when hair is thinning.

If testosterone is raised, NHS pathways suggest checking other adrenal hormones, such as DHEA-S and 17-hydroxyprogesterone, to look for less common causes like non-classic congenital adrenal hyperplasia.

Low testosterone, menopause and testosterone therapy

Testosterone falls gradually with age, and more sharply after the ovaries are removed. Some women notice lower sex drive, less pleasurable sex or low energy around the menopause.

NICE guideline NG23 on menopause recommends considering testosterone supplementation for people with low sexual desire associated with menopause if HRT alone is not effective. No testosterone product is licensed for women in the UK, so it is prescribed off-label, usually as a small dose of gel, alongside HRT.

Guy’s and St Thomas’ NHS Foundation Trust explains that low sex drive is usually diagnosed from symptoms and history, and blood tests are not always needed. Where testosterone is prescribed, NHS services commonly check a baseline level with SHBG, then recheck after starting treatment to keep levels within the female range. Low sex drive has many possible causes, including stress, low mood, relationship factors, vaginal dryness and some medicines. Our guide to blood tests for low libido explains which other checks can help.

What to do with your result

• Mildly raised: discuss your periods, skin and hair symptoms with our practitioner. A wider hormone panel or a GP review for PCOS may be the next step.
• Markedly raised: see your GP promptly for referral to a specialist.
• Low with symptoms around the menopause: talk to your GP or a menopause specialist about HRT first, and whether testosterone may be added.
• On testosterone therapy: follow your prescriber’s monitoring plan.

When to see your GP

Book a GP appointment if you have:

• Missed three periods in a row, or periods that have become irregular
• Missed periods along with unwanted facial hair, weight change or skin changes
• Not conceived after a year of trying, or sooner if you are 36 or over
• A testosterone result above 5 nmol/L or more than twice the upper limit

Get help quickly: ask for an urgent GP appointment, or call NHS 111, if you notice signs of virilisation developing over weeks or months, such as rapidly increasing body or facial hair, a deepening voice, or enlargement of the clitoris. NHS pathways treat these as red flags that need prompt specialist assessment.

Who should consider a testosterone test

• Women with irregular periods, acne or excess hair growth
• Women with thinning scalp hair
• Women with suspected PCOS or difficulty conceiving
• Women using, or considering, testosterone therapy around the menopause

If you also want to look at your cycle hormones, our Hormone Health Check (£69) adds FSH, LH, oestradiol, progesterone and prolactin to testosterone, SHBG and the FAI.

Preparing for your test

• Time of day: NHS laboratories recommend an early morning sample, as testosterone varies through the day.
• Your cycle: note the first day of your last period. If you are having a wider panel, your practitioner may suggest a particular day of your cycle.
• Medicines: tell us about hormonal contraception, HRT or testosterone gel. If you use gel, avoid applying it near the area where the sample will be taken.
• Biotin: if you take high-dose biotin, NHS laboratories advise leaving at least 8 hours between your last dose and the sample.

How often to retest

A mildly raised result is worth repeating with SHBG to confirm it. If you start testosterone therapy, NHS services typically recheck within about 6 to 12 weeks, again at around 6 months, then yearly once levels are stable. For PCOS, your GP or specialist will advise on ongoing checks.

Frequently asked questions

Is a testosterone level of 2.5 nmol/L high for a woman?

It is above the upper limit used by many NHS laboratories, so it is usually considered mildly raised, although some laboratories use a higher limit. The usual next steps are a repeat with SHBG and FAI, and a review of your periods and symptoms. It is below the 5 nmol/L level that prompts specialist referral.

Can a blood test diagnose PCOS?

Not on its own. Blood tests show whether androgens are raised and rule out other causes, but PCOS is diagnosed by combining your symptoms, blood results and sometimes an ultrasound scan.

Can high testosterone cause hair loss in women?

Yes. Raised androgens can cause thinning hair on the scalp, often alongside excess hair elsewhere. Iron, thyroid and other causes are also worth checking.

Should I have my testosterone checked for low libido during the menopause?

A blood test is not needed to diagnose low libido, but a baseline level is useful if testosterone treatment is being considered, and it guides monitoring once treatment starts.

Does the contraceptive pill affect testosterone results?

It can. The combined pill raises SHBG, which can lower the FAI and mask raised androgens. Tell your practitioner what you take so your result is read correctly.

Testosterone testing in Chiswick

You can have your blood taken at Omnia Lifestyle, 8 to 9 Bedford Corner, The Avenue, Chiswick, London W4 1LZ. We are a short walk from Turnham Green station on the District line (Piccadilly line trains stop there early in the morning and late in the evening only), and buses 94, E3 and 272 stop nearby. Limited parking is available on request when you book. Your sample is analysed at the Randox accredited laboratory, you do not need a GP referral, and a practitioner explains your result with you in person. Most results are ready within a few working days, and a GP feedback report is available on request.

Book our Testosterone test or the Testosterone Check, explore our women’s health blood tests, or compare every blood test and price. For related reading, see our guides to SHBG levels and blood tests for hair loss.

This article is general information, not medical advice. Discuss your results with your GP or practitioner.