Androgens

What they are

Androgens are a family of steroid hormones. The main ones measured in a PCOS workup are:

• Total testosterone — the best known, produced by the ovaries and adrenal glands, and in small amounts by peripheral conversion
• DHEAS (dehydroepiandrosterone sulphate) — a marker of adrenal activity, less variable than testosterone
• Androstenedione — a hormonal precursor produced by the ovaries and adrenal glands

These hormones are present in all people regardless of sex, and play normal physiological roles: bone growth, libido, red blood cell production, among others.

Why they matter in PCOS

Hyperandrogenism — an excess of androgens — is one of the three diagnostic criteria for PCOS according to the Rotterdam criteria (2003). It can be:

• Clinical: visible symptoms linked to androgen action on target tissues — acne (particularly along the jawline and lower face), hirsutism (excess hair growth in androgen-dependent areas: face, abdomen, back, thighs), androgenic alopecia (hair thinning at the crown or top of the scalp)
• Biochemical: elevated blood test levels, even without visible symptoms

In PCOS, androgen excess comes mainly from the ovaries (stimulated by elevated LH) and sometimes from the adrenal glands. Insulin resistance, which is common in PCOS, also amplifies ovarian androgen production.

What can affect the results

Androgen levels vary with the stage of the cycle, the time of day (testosterone is higher in the morning), and the laboratory used. Certain medications — particularly hormonal contraceptives — significantly alter results. A single measurement is generally not sufficient to draw conclusions.

Free testosterone (not bound to SHBG) is biologically active, but its direct measurement is less reliable. The free androgen index (calculated) is often used instead, or total testosterone is interpreted alongside SHBG values.

Key takeaways

• A family of hormones present in all people
• Excess (hyperandrogenism) is one of the 3 diagnostic criteria for PCOS
• Can manifest as acne, hirsutism, or hair loss
• Levels vary with cycle stage, time of day, and medications
• Always interpret in the full clinical context