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How are testosterone and PCOS linked to female infertility?

How are testosterone and PCOS linked to female infertility?

Catherine Poslusny | June 15, 2021 | Getting Pregnant
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Polycystic ovary syndrome (PCOS) is one of the most common causes of female infertility. In fact, about 1 out of every 10 women of childbearing age are affected by this hormonal condition, though many may not realize it. Confirming a PCOS diagnosis typically requires connecting a series of dots, or symptoms, that don’t always appear related (think: weight gain, acne, and irregular periods). Many women with PCOS don’t learn that they have it until they have trouble getting pregnant and turn to their doctor for answers. The good news is having PCOS does not mean that you can’t get pregnant. While there is no cure for PCOS currently, PCOS is treatable by managing the symptoms (1).

There’s a lot that physicians and medical researchers are still trying to figure out about PCOS. However, current research shows that the syndrome is linked to increased levels of male hormones, including testosterone, which may lead to infertility (1). In this post, we’ll go into the relationship between PCOS and testosterone, how it can affect your fertility, and what you can do about it.

How is PCOS related to testosterone levels?

Doctors may not know what causes PCOS, but they do know that it’s linked to elevated levels of androgens (aka male hormones, including testosterone) and insulin (a hormone that helps your body transform glucose from food into energy). Along with hormonal imbalances, PCOS may be accompanied by weight gain or difficulty losing weight, cysts in the ovaries, acne, and changes in hair growth (1, 2).

Many women with PCOS have elevated insulin levels because their body isn’t responsive to the effects of insulin. This condition is called insulin resistance, and it’s common in women with PCOS, especially those who are overweight, have a family history of diabetes, or don’t get enough physical activity. When cells don’t respond to insulin as they should, the body starts to make more to try to correct the problem. This leads to an excess of insulin in the blood, which causes the ovaries to over-produce testosterone. Hyperandrogenism, or an abundance of male hormones, is one of the main symptoms of PCOS (1, 2, 3).

What are the symptoms of high testosterone in women?

When diagnosing PCOS, doctors usually look for a combination of clues that may indicate above-average levels of androgens in the body. Right now, there isn’t a definitive test that can diagnose PCOS. Sometimes elevated testosterone levels can show up in a blood test, but that’s not always the case.

Common symptoms linked to high testosterone and PCOS include acne, oily skin, deepening of the voice, hair loss on the scalp, and excess hair growth on the face, chest, and abdomen (this condition is called hirsutism). Other symptoms that help doctors diagnose PCOS include irregular periods, skipped periods, and infertility. (2, 4, 5).

Testosterone and female fertility

Testosterone may be a male sex hormone, but that doesn’t mean that men are the only ones who produce it. Your ovaries and adrenal glands actually create testosterone right alongside estrogen, though in much smaller quantities. These two hormones help maintain your reproductive health, including how well your ovaries function. They may also play a role in regulating bone health and libido (1, 3, 5).

When your body produces too much testosterone, as is often the case for women with PCOS, it may lead to various health effects, including infertility. During each menstrual cycle, follicles in the ovaries start growing in preparation for ovulation (when a follicle releases a mature egg). High testosterone levels may hamper this follicle growth and prevent your body from ovulating. This is one reason that women with PCOS tend to have irregular periods or no periods at all. And, of course, you can’t get pregnant if you don’t ovulate (1, 3).

Treating infertility caused by high testosterone and PCOS 

If left untreated, PCOS may make it difficult for you to conceive on your own. Fortunately, you have many options to increase your chances of getting pregnant. Potential treatments range from lifestyle changes to medications to surgery. When you’re not trying to conceive, hormonal birth control may be prescribed to treat the hormonal imbalances caused by PCOS (6). However, you’re probably here because you’re trying to get pregnant, so we’ll dig into alternative treatment options. Keep in mind, though, that everyone’s situation is different, and you should talk to your doctor to figure out which route is right for you.

Lifestyle changes

If you are overweight or obese, one of your doctor’s first recommendations will probably be for you to try to get to a healthier weight. This may include making changes to your diet and increasing your physical activity. Some women start to see improvements in their testosterone levels after losing as little as 5 to 10% of their overall body weight (6, 7).

Pharmaceutical options

Hormonal medications are another option to help women with high testosterone levels to ovulate more consistently. Clomiphene, or clomiphene citrate, is the most commonly prescribed infertility treatment for women with PCOS. Gonadotropin injections containing follicle-stimulating hormone (FSH) may also be used to induce ovulation in women with PCOS. Both clomiphene and gonadotropins are linked to higher chances of multiple births (8, 9). 

Metformin, an insulin-sensitizing drug, is sometimes prescribed by itself or in combination with other treatments for PCOS. By helping the body respond to insulin, this medication may help lower insulin levels, leading to lower testosterone production and improved ovarian function (8). 


If medication and lifestyle changes aren’t successful, your doctor may recommend ovarian drilling, a laparoscopic surgery in which a doctor makes a small perforation in an ovary, which decreases androgen production and may improve ovulation (8, 10).

If none of the above treatments work, you may talk to your doctor about other options, such as intrauterine insemination (IUI) and in vitro fertilization (IVF)

PCOS can be a frustrating condition to deal with, especially since there’s still so much left to learn about it. Fortunately, one thing we do know about the syndrome is that it doesn’t have to keep you from conceiving. When you talk to your doctor about your fertility, including your PCOS and testosterone levels, they can help you find the right treatment options and increase your chances of getting pregnant.

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