Androgens are often called "male hormones," but everyone produces them. In PCOS, the issue isn't having androgens — it's having elevated levels that cause distressing symptoms.

The main androgens tested in PCOS:

• Total testosterone: The most commonly measured. Elevated in about 75% of people with PCOS. • Free testosterone: The "active" form not bound to proteins. Often a more sensitive marker than total testosterone. • DHEA-S: Produced primarily by the adrenal glands. If DHEA-S is the only elevated androgen, adrenal PCOS may be the primary driver.

What elevated androgens do:

• Skin: Acne, especially along the jawline and chin (hormonal pattern) • Hair growth: Excess hair on face, chest, abdomen, back (hirsutism) — affects 60-80% of people with PCOS • Hair loss: Thinning at the crown and temples (androgenic alopecia) — affects about 40% • Mood: Can contribute to irritability and mood changes • Ovulation: Disrupts the hormonal cascade needed for regular ovulation

The term "male hormones" is misleading and contributes to shame. Androgens are a normal part of everyone's biology. In PCOS, the body simply produces more than the typical range, often driven by insulin resistance.

Treatments that lower androgens (spironolactone, birth control) or address the insulin resistance driving their overproduction (metformin, inositol) can improve symptoms significantly — but timelines are typically 3-6 months.