Androstenedione Test

If you are a woman experiencing unwanted hair growth, stubborn acne, thinning hair, or irregular periods, your body may be producing too many androgens. Androstenedione (4-androstene-3,17-dione) is one of the most informative markers for detecting that excess. It is the only circulating androgen that runs higher in premenopausal women than in men, and measuring it can reveal hormonal overproduction that testosterone alone might miss.

Androstenedione sits at a crossroads in your hormone production pathway. Your body uses it as raw material to make either testosterone or estrone (a form of estrogen). Both your ovaries and your adrenal glands produce it in roughly equal amounts, which makes it a useful general signal of androgen excess but less helpful for pinpointing exactly where the excess is coming from. Its direct androgenic potency is only about 10% of testosterone's, but elevated levels indicate your hormone-producing glands are working harder than expected.

Professional guidelines recommend measuring androstenedione in anyone being evaluated for suspected androgen excess. This is especially valuable when your testosterone and free testosterone levels come back in the normal range but your symptoms suggest otherwise. In one study, 26% of women with excess hair growth who had a normal free androgen index still showed androstenedione values above normal, making it a meaningfully useful marker for uncovering hidden hormonal imbalance.

What Your Level Means

Your androstenedione level fluctuates with your menstrual cycle and declines with age. Concentrations are significantly higher during the middle and second half of your cycle compared to the early days of your period. This means the timing of your blood draw matters. For the most consistent and comparable result, testing during the early follicular phase (the first few days of your period) is ideal.

What matters most is not just whether your number falls outside the reference range, but how high it is and which other androgens are elevated alongside it. The pattern of elevation is what guides your next steps.

Patterns That Point to a Cause

Your body's androgens come from two main factories: the ovaries and the adrenal glands. Different conditions tend to raise different androgens in recognizable patterns. Understanding these patterns is the key to making sense of your result.

Two adrenal-specific androgens, DHEA and DHEA-S (dehydroepiandrosterone and its sulfated form), are produced almost exclusively by the adrenal glands. If those are elevated alongside your androstenedione, the adrenals are likely the main driver. If your testosterone is elevated but DHEA and DHEA-S are normal, the ovaries are the more likely source. Androstenedione itself, because both glands make it, can be elevated in either scenario.

A study of 1,205 women with androgen excess found distinct signatures depending on the underlying cause. These patterns are worth understanding because they directly shape what additional testing or imaging you might need.

Sources: Elhassan et al. (1,205 women cohort study)

What this means for you: if you are postmenopausal and your androstenedione is severely elevated, that finding warrants prompt imaging of your adrenal glands. If you are premenopausal with a markedly high androstenedione, a genetic condition called congenital adrenal hyperplasia (where your adrenal glands lack an enzyme needed to make cortisol and overproduce androgens instead) is the most common explanation and can be confirmed with additional hormone testing.

Androstenedione and PCOS

Polycystic ovary syndrome is by far the most common cause of androgen excess in premenopausal women. Current international guidelines recommend starting with total testosterone and free testosterone as first-line tests for PCOS. If those come back normal but you still have symptoms, androstenedione and DHEA-S are recommended as second-line markers.

Beyond confirming the diagnosis, your androstenedione level may say something about your metabolic risk. Research shows that androstenedione is strongly and inversely associated with insulin sensitivity, meaning higher levels tend to track with greater insulin resistance. The likelihood of blood sugar problems increases as your androgen profile becomes more severe. In other words, a higher androstenedione does not just reflect a hormonal issue; it may signal that your metabolism is under strain as well.

If your androstenedione is elevated in the context of PCOS, it is worth discussing metabolic screening with your clinician, including fasting glucose, insulin, and hemoglobin A1c, even if you do not have obvious metabolic symptoms.

Getting an Accurate Result

The testing method matters more for androstenedione than for many routine labs. Immunoassay-based tests, which are still common, tend to read higher than the true value because the antibodies used in the test can cross-react with similar molecules in your blood. The most accurate method is LC-MS/MS, sometimes called mass spectrometry. If you are ordering this test yourself, look for a lab that specifies LC-MS/MS methodology, or ask before ordering.

Timing also matters. Because androstenedione rises in the middle and latter parts of your menstrual cycle, drawing your blood in the first few days of your period gives the most stable baseline. If you are postmenopausal or do not have regular cycles, timing is less of a concern, but morning draws are generally preferred for hormone testing.

No single androstenedione value can confirm or rule out a specific diagnosis on its own. There is no absolute androgen level that is diagnostic of a tumor, just as there is no minimum level that excludes one. The value of this test lies in combining it with other androgens, your symptoms, and your clinical picture to build a clear hormonal map.

Questions This Biomarker Can Answer

• Is my body producing excess androgens even though my testosterone level looks normal?
• Are my symptoms of excess hair growth, acne, or hair loss driven by a measurable hormonal imbalance?
• Does the pattern of my androgen elevation point toward my ovaries, my adrenal glands, or both as the source?
• Could my androgen excess be caused by congenital adrenal hyperplasia rather than PCOS?
• Is my androgen profile severe enough to warrant imaging or further investigation for a hormone-producing tumor?