The Role of Testosterone in Fertility and PCOS

Testosterone in Fertility - Testosterone is commonly considered a male hormone and is associated with male reproductive health. However, did you know that it also plays a crucial role in female fertility?

While men require optimal testosterone levels for sperm production, women need small amounts of this hormone for normal ovarian function, hormonal balance, and overall reproductive health. However, an imbalance in testosterone levels can contribute to fertility issues, particularly in conditions like polycystic ovary syndrome (PCOS). Understanding the role of testosterone in fertility can help you address any concerns and improve reproductive outcomes.

Testosterone is an androgen hormone produced in ovaries and adrenal glands in women. It contributes to reproductive health by:

• Supporting the development of eggs

• Regulating the production of other essential reproductive hormones, such as oestrogen and progesterone in women

• Influencing libido and sexual function

• Maintaining muscle and bone health, which indirectly supports reproductive wellness

In women, an optimal balance of testosterone is required for regular ovulation and healthy menstrual cycles. When testosterone levels are too high this can lead to irregular ovulation and conditions such as PCOS.

PCOS is a common hormonal disorder affecting reproductive-age women. It is characterised by elevated levels of androgens, including testosterone, which can disrupt ovulation and cause various symptoms that impact fertility. These symptoms may include:

• Irregular or absent menstrual cycles

• Unwanted bodily hair growth (hirsutism)

• Acne and oily skin

• Weight gain and difficulty losing weight, particularly around the abdomen (however not all women will have difficulty managing their weight with PCOS)

• Thinning of hair on the scalp

• Cystic ovaries identified on scan

• Elevated Anti-Mullerian hormone (AMH) levels

• Insulin resistance

The high testosterone levels in PCOS interfere with the normal development and release of eggs from the ovaries, making conception more challenging. Additionally, insulin resistance, a common feature of PCOS, can further exacerbate hormonal imbalances, leading to increased testosterone production and worsening symptoms.

However, it is important to be aware that your blood testosterone levels can still be normal despite exhibiting symptoms such as acne, irregular cycles and weight gain etc. 

Because of this, to be diagnosed with PCOS, women should be assessed on the Rotterdam Criteria (this criteria was updated in 2024 to include AMH blood testing or an ultrasound scan). If you are concerned you may have PCOS speak with your health care provider for investigations and further information.

Balancing testosterone levels is crucial for both male and female fertility. Here are some strategies to optimise hormonal health:

• Healthy Diet : Consuming a diet rich in whole foods, lean proteins, healthy fats, and fibre can help regulate insulin levels and support hormone balance.

• Regular Exercise : Strength training and cardiovascular exercise can improve insulin sensitivity, reduce excess androgens in women with PCOS, and boost testosterone in men.

• Weight Management : Maintaining a healthy weight can help regulate hormonal fluctuations and improve ovulatory function in women with PCOS.

• Medications : In cases of PCOS, doctors may prescribe medications such as metformin to improve insulin sensitivity. If you are not ovulating, you may require ovulation induction medication to help you conceive.

• Stress Reduction : High stress levels can contribute to hormonal imbalances, so incorporating relaxation techniques such as meditation, yoga, or mindfulness can be beneficial.

Testosterone in fertility - Testosterone plays a critical role in fertility for women. While balanced testosterone levels support reproductive function, high levels can lead to fertility challenges. Conditions such as PCOS highlight the impact of elevated testosterone on female fertility, making it essential to address hormonal health for improved reproductive outcomes. 

By adopting a holistic approach that includes lifestyle changes, medical interventions, and stress management, you can optimise your testosterone levels and enhance your chances of conception.

If you are concerned about your testosterone levels or worried you may have PCOS, we recommend that you check the following blood levels:

You can also book a consultation with one of our Women’s Health Specialist Nurses to discuss your results and next steps on understanding your hormonal health.