How to lower high testosterone in women

What causes high testosterone in women

By far the most common cause is polycystic ovary syndrome (PCOS), a condition in which the ovaries produce excess androgens, often alongside insulin resistance that further drives androgen production. That is why PCOS symptoms cluster: irregular or absent periods, acne, hirsutism (unwanted hair in a male-pattern distribution), and sometimes scalp hair thinning. Elevated androgens in PCOS are usually mild to moderate.

Less common causes need to be considered before assuming PCOS. Non-classic congenital adrenal hyperplasia (an enzyme difference that raises adrenal androgens) can look very similar and is screened for with a 17-hydroxyprogesterone level. Rarely, a markedly high testosterone level or the rapid onset of virilization — a deepening voice, significant muscle gain, or clitoral enlargement — prompts evaluation for an androgen-secreting ovarian or adrenal tumor. Thyroid disease, high prolactin, and Cushing syndrome are also checked when the picture fits. This is exactly why testing, rather than self-treatment, comes first.

First, get the diagnosis right

Because several conditions raise testosterone, the starting point is a workup, not a supplement or a borrowed prescription. A clinician typically measures total and free testosterone (drawn in the morning), often with DHEA-S, 17-hydroxyprogesterone, and other labs to sort out the cause, and interprets results alongside SHBG, since a low SHBG raises the free, active hormone even when the total looks normal. PCOS is diagnosed using the Rotterdam criteria and only after other causes are excluded.

This guide is educational and cannot diagnose you. What follows is a plain-language summary of the evidence-based options a clinician may discuss — not a recommendation to start any of them on your own. For the symptom overview and how the hormone is tested, see our

high testosterone in women overview.

Combined oral contraceptives: first-line for symptoms

For women who are not trying to conceive, the 2023 international evidence-based PCOS guideline recommends combined oral contraceptives (the estrogen-plus-progestin "pill") as first-line pharmacological treatment for hirsutism and menstrual irregularity. They work in two ways: they suppress the ovarian production of androgens, and the estrogen raises sex hormone-binding globulin, which mops up free testosterone so less of it is biologically active. Over several months this can improve acne, slow unwanted hair growth, and restore predictable cycles.

The pill is not for everyone — it is not used by those actively trying to conceive, and it carries its own considerations, so the choice of formulation belongs to a clinician who knows your history. The Endocrine Society hirsutism guideline similarly places oral contraceptives among first-line options for hirsutism in most premenopausal women.

Spironolactone: an anti-androgen for hair and skin symptoms

Spironolactone is an anti-androgen: it blocks androgen receptors and reduces androgen effects at the skin and hair follicle. Guidelines suggest adding it for hirsutism when a combined oral contraceptive alone has not given enough improvement after about six months, and it is frequently used together with the pill. That pairing is deliberate — spironolactone can harm the development of a male fetus, so reliable contraception is important during treatment, and the pill also helps prevent the irregular bleeding spironolactone can cause on its own.

It is prescribed off-label for this purpose and requires clinician supervision, including attention to potassium in some people. For how it works, typical dosing, and cautions, see our

spironolactone medication overview.

Metformin and inositol: the insulin angle

Because insulin resistance drives androgen production in many women with PCOS, medicines that improve insulin sensitivity are part of the toolkit. Metformin is used mainly for metabolic features and menstrual irregularity; a Cochrane review found it improves some metabolic and ovulatory outcomes in PCOS. Its effect on testosterone is indirect and generally modest — it is not primarily an androgen-lowering drug, and it is less effective than the pill for hair and skin symptoms. The 2023 guideline positions metformin especially where metabolic goals or cycle regulation are priorities.

Inositol (usually myo-inositol) is a widely marketed supplement for PCOS. Some studies report improvements in metabolic and ovulatory measures, but the 2023 international guideline concludes the evidence is still limited and considers inositol experimental rather than an established treatment. As a dietary supplement it is not evaluated by the FDA for efficacy. For the prescription side of the insulin approach, see our

metformin medication overview.

Lifestyle and insulin sensitivity

The 2023 guideline treats lifestyle — nutrition, physical activity, sleep, and behavioral support — as the foundation of PCOS care for everyone, whether or not medication is added. Improving insulin sensitivity can lower androgen levels over time, and for women who carry excess weight, even a modest weight reduction can help restore more regular cycles and reduce androgen-driven symptoms. The point is not rapid weight loss but sustainable changes that improve how the body handles insulin.

Two honest caveats: not everyone with PCOS has excess weight (lean PCOS is real), and lifestyle change alone is often not enough to control hirsutism, which is why it is usually combined with the options above. Framing this as "just lose weight" is neither accurate nor kind — it is one lever among several, and it works best alongside a plan built with a clinician.

What the 2023 guideline says, in short

Put together, the evidence-based hierarchy looks like this: lifestyle is foundational for everyone; combined oral contraceptives are first-line for hirsutism and irregular cycles in those not trying to conceive; spironolactone is added for hirsutism when the pill is not enough after about six months; metformin is chosen mainly for metabolic features and cycle regulation; and inositol remains experimental. None of this is a substitute for a diagnosis, and the best combination depends on your goals — especially whether you want to prevent pregnancy or conceive, since that changes the options entirely.

The workup and prescription belong to a clinician

High testosterone has several possible causes, and the medicines that manage it — the pill, spironolactone, and metformin — are prescription-only, chosen based on your diagnosis and whether you want contraception or fertility. This page is informational and does not diagnose you or recommend a dose. A licensed clinician can order the right tests and build a plan. If you want to compare PCOS-focused telehealth options, the pick below is a starting point.

Related reading

• High testosterone in women: symptoms and testing
• Testosterone for women (the opposite question)
• Spironolactone: how it works and cautions
• Metformin: uses and side effects

Frequently asked questions

What causes high testosterone in women?

The most common cause is polycystic ovary syndrome (PCOS), often with insulin resistance driving androgen production. Less common causes include non-classic congenital adrenal hyperplasia and, rarely, an androgen-secreting ovarian or adrenal tumor, which is suspected when levels are very high or virilization comes on quickly. A clinician tests to identify the cause before treating.

How do you lower high testosterone in women?

There is no safe over-the-counter method. The 2023 international PCOS guideline lists combined oral contraceptives as first-line for high-androgen symptoms in those not trying to conceive, with spironolactone commonly added for hirsutism. Metformin targets insulin resistance, and lifestyle changes that improve insulin sensitivity can help. The right plan depends on the cause and your goals and is set by a clinician.

Does the birth control pill lower testosterone?

Combined oral contraceptives lower the effect of testosterone in two ways: they suppress ovarian androgen production and raise sex hormone-binding globulin, which reduces free, active testosterone. Over several months this can improve acne, slow unwanted hair growth, and regulate periods. They are first-line for these symptoms in PCOS for women not trying to conceive, but the choice belongs to a clinician.

Does metformin lower testosterone in PCOS?

Metformin improves insulin sensitivity and is used mainly for metabolic features and menstrual irregularity in PCOS. Its effect on testosterone is indirect and generally modest, and it is less effective than the pill for hair and skin symptoms. A Cochrane review found metformin improves some metabolic and ovulatory outcomes. It is a prescription medicine decided on with a clinician.

Does inositol help lower testosterone?

Inositol (usually myo-inositol) is a popular supplement for PCOS, and some studies report improvements in metabolic and ovulatory measures. However, the 2023 international guideline considers the evidence limited and treats inositol as experimental rather than established. As a dietary supplement it is not evaluated by the FDA for efficacy. Discuss it with a clinician rather than relying on it as a treatment.

Primary medical sources

1. guidelineTeede HJ, et al. "Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome." J Clin Endocrinol Metab 2023;108(10):2447-2469.
2. guidelineMartin KA, et al. "Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline." J Clin Endocrinol Metab 2018;103(4):1233-1257.
3. PubMedTang T, et al. "Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility." Cochrane Database Syst Rev 2012;5:CD003053.
4. ACOGACOG. "Polycystic Ovary Syndrome (PCOS)" — patient FAQ on diagnosis and management.