Androstenedione: what it is, what it tells you and when it’s tested

Androstenedione is an androgen, a hormone from the testosterone family. The adrenal glands make it, as do the ovaries in women and the testicles in men. On its own it does little: your body turns it into testosterone and oestrogens.

When it’s tested

Doctors mostly order it for women with excess hair, acne or irregular periods, when testosterone does not explain everything. It is also used to follow people with a rare adrenal condition, congenital adrenal hyperplasia.

It is not a test for people who feel well. Even with symptoms, the first test is testosterone: androstenedione comes after, because it is less reliable for a diagnosis.

That is why Rosa does not test it. Instead it looks at things that often matter in the same problems: insulin and blood sugar, which are often off in polycystic ovary syndrome, and TSH, because your thyroid shifts your cycle too.

What it tells you, and what it does not

If it is high, there are more androgens than usual. In women the most common cause is polycystic ovary syndrome.

It does not say on its own where they come from, the ovaries or the adrenal glands. For that your doctor reads it with other hormones.

If it is normal, it does not rule out too many androgens: sometimes only testosterone is high.

That is why it is read together with other tests:

• Testosterone: It is the first test for androgens
• DHEA-S: An androgen that comes almost only from the adrenal glands
• Insulin: It is often high in polycystic ovary syndrome
• TSH: Your thyroid can make periods irregular too

Normal androstenedione levels

The lab decides what is normal, and it changes with sex, age and the method. Some reports use ng/mL, others nmol/L: always check the unit.

It is higher in the morning and falls during the day. That is why the test is usually done in the morning. If you have it rechecked over time, do it at the same time of day.

There is no single number for everyone. The range on your own report counts, read with testosterone and your symptoms.

If your androstenedione is high or low

• High androstenedione: In women it is often polycystic ovary syndrome. Less often the adrenal glands are involved. If it is very high or the symptoms came on fast, it should be seen soon.
• Low androstenedione: Usually not a problem. It falls with age and after menopause.

What can skew the result

A few things shift it without any disease. It helps to tell your doctor.

• The time of the test: It is higher in the morning. An afternoon test can give a lower result.
• The pill: It lowers androgens and can hide an excess. Do not stop it on your own: ask your gynaecologist.
• Supplements and hormones: Products with DHEA or other hormones raise it. Tell your doctor before the test.
• Steroid medicines: People who take them for an adrenal condition should have the test at the same time relative to their dose.

When to worry

Talk to your doctor if:

• You have excess hair, acne that does not clear or irregular periods.
• It is above the range on your report.
• You are struggling to get pregnant: talk to your gynaecologist too.
• You are a woman and over a few months your voice has deepened, you have much more hair, hair loss at the temples or an enlarged clitoris: see your doctor soon.

Frequently asked questions

What does high androstenedione mean in women? There are more androgens than usual. It is often polycystic ovary syndrome. Your doctor reads it with testosterone, your symptoms and sometimes an ultrasound.

What is the link between androstenedione and PCOS? In polycystic ovary syndrome, androgens are often high. The first test is testosterone. Androstenedione is looked at if testosterone is normal.

What are normal androstenedione levels? They depend on the lab, your sex and your age. The range on your own report counts, with the test done in the morning.

Is high androstenedione dangerous? Usually not, but the cause needs to be found. If it is very high, or the symptoms came on within a few months, your doctor looks for rarer causes, such as an adrenal problem.

Does Rosa test androstenedione? No. Rosa measures insulin, blood sugar and TSH, which help when periods are irregular. If your doctor wants androstenedione, they order it separately.

Sources

• Teede and colleagues, recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism, 2023. PMID 37580314
• Martin and colleagues, evaluation and treatment of hirsutism in premenopausal women: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 2018. PMID 29522147
• Speiser and colleagues, congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 2018. PMID 30272171