Testosterone, SHBG and DHEA-S in women: what the androgen tests show.
Women make testosterone too, at roughly a tenth of male levels, and it matters for skin, hair, energy, mood and libido. A women's androgen test measures total testosterone, SHBG (the protein that binds it) and calculates the free androgen index, with DHEA-S showing the adrenal share. High results are informative; low results are harder to interpret.
Why androgens matter in women
Androgens are the group of hormones that includes testosterone. In women they are produced in the ovaries and the adrenal glands, and some is made in tissues such as fat and skin from precursors like DHEA-S. Levels peak in the twenties and drift down slowly with age; they do not drop sharply at menopause the way oestradiol does, because the adrenal share continues.
Androgens influence hair follicles and oil glands, which is why the most visible signs of excess are acne, oily skin and hair growing in a male pattern. They also contribute to muscle and bone, energy, mood and sexual desire, which is why "low testosterone" gets raised as a possible cause of tiredness and low libido. The tests below tell a doctor whether androgen activity is actually raised. Whether it is meaningfully low is a much harder question, and this article is honest about that.
Total testosterone, SHBG and the free androgen index: how they fit together
Total testosterone measures all the testosterone in the blood, bound and unbound. In women the numbers are small, and at the low end of the range many laboratory methods struggle to measure them accurately. That is the first reason a total result alone can mislead.
SHBG, sex hormone binding globulin, is a protein made in the liver that carries testosterone and oestradiol in the blood. Hormone that is bound to SHBG is not available to tissues. So two women with the same total testosterone can have very different amounts of active hormone if one has high SHBG and the other low. SHBG rises with oestrogen (including the combined pill), thyroid over-activity and age, and falls with insulin resistance, excess weight and thyroid under-activity.
The free androgen index (FAI) puts the two together to estimate the active fraction:
This is why a women's androgen test should always include SHBG. The FAI is the reading doctors lean on when the question is androgen excess, and it is the reason a "normal" total testosterone does not close the question on its own.
DHEA-S and the adrenal contribution
DHEA-S (dehydroepiandrosterone sulphate) is made almost entirely by the adrenal glands. It is a weak androgen in itself, but it is converted into testosterone in other tissues, so it represents the adrenal share of a woman's androgen supply. Levels are highest in the twenties and fall steadily with age, so the reference range depends on how old you are.
Doctors measure it for two reasons. First, when androgen signs are present but testosterone and FAI are unremarkable, a raised DHEA-S points towards the adrenal glands rather than the ovaries. Second, a very high DHEA-S is one of the findings that prompts a doctor to look for less common adrenal causes rather than PCOS. It is stable across the day and the cycle, so it can be collected any time.
Typical ranges, and why women's ranges are narrow
These are typical adult ranges to give you a sense of scale. They vary between laboratories and assay methods more than most blood tests do, and your doctor reads them against the range printed on your own report.
| Marker | Typical adult female range | What it usually means |
|---|---|---|
| Total testosterone | Roughly 0.3 to 2.0 nmol/L (some labs quote up to about 2.5) | Above range with symptoms suggests androgen excess; low-end readings are hard to measure precisely. |
| SHBG | Roughly 20 to 120 nmol/L, wide | Low SHBG raises the active fraction and is common with insulin resistance; high SHBG is common on the pill. |
| Free androgen index | Below about 5 to 7, depending on the laboratory | The main marker for androgen excess; read with symptoms and cycle history. |
| DHEA-S | Age-dependent; roughly 2 to 11 µmol/L in younger adults, lower with age | Raised suggests an adrenal contribution; very high prompts further assessment. |
Ranges vary by laboratory; your report shows the range your lab uses. Typical ranges on this page are drawn from Pathology Tests Explained (RCPA) and the sources listed below.
The ranges are narrow for a simple reason: women's testosterone is measured in tenths of a nanomole, in the part of the scale where assays designed mainly for men are least precise. Small differences in method produce different reference intervals, and a result near the lower limit may be indistinguishable from a normal one. Timing matters too: testosterone is highest in the morning, so morning collection is standard, and the combined pill raises SHBG and lowers the FAI, so results on the pill are read with that in mind (the contraception and hormone tests article explains which methods affect which markers).
High androgens: PCOS, acne and hair changes
Raised androgen activity, shown by a high FAI or total testosterone, is one of the three features doctors use when assessing PCOS, alongside irregular ovulation and the appearance of the ovaries on ultrasound. It is also one recognised cause of persistent adult acne along the jaw and chin, coarse hair on the face, chest or abdomen, and thinning at the crown, although many women with those signs have levels inside the range, because the skin can be unusually sensitive to ordinary amounts of androgen. Signs of androgen excess on the skin count as evidence even when the blood level is within range, which is one more reason the result is read with your history rather than in isolation.
A high result is not a diagnosis by itself. Your doctor considers how high, whether DHEA-S is also raised, how quickly the signs appeared and what your cycles are doing. Very high levels or signs that develop rapidly prompt a search for less common causes. The PCOS and your hormones article explains the full picture, and the PCOS panel adds the metabolic markers (fasting glucose, HbA1c, lipids) that doctors assess alongside androgens.
Low testosterone in women: what a test can and cannot settle
This is where honesty matters. There is no agreed blood level that defines testosterone deficiency in women. The Australasian Menopause Society and international position statements are clear that a low result does not diagnose a problem, and that symptoms such as low libido, low energy and low mood have many causes, including thyroid disease, low iron, sleep, mood disorders, relationship factors and medications.
So what can a test settle? It can show whether a level is clearly at the very low end, for example after the ovaries have been removed, and it can exclude a high level as the explanation for symptoms. What it cannot do is tell you that a result in the lower half of the range explains how you feel. If low libido or energy is your concern, the more productive tests are usually thyroid, iron and the cycle hormones, read together, with androgens as one part of the picture. Where a doctor has prescribed testosterone for a woman, blood tests are used for monitoring; the women's testosterone therapy check exists for that purpose only, for women whose doctor has prescribed it.
The KnowLuna panels that include these
Total testosterone, SHBG, free androgen index and DHEA-S are included in the female hormone panel, alongside FSH, LH, oestradiol, progesterone, prolactin and cortisol, so the androgen picture is read next to the cycle hormones. The PCOS panel includes the same androgen markers plus the metabolic set, collected fasting. Symptom-led options include the hormonal acne check and the female hair loss check. Every option for this stage is on the cycles and hormones hub.
Common questions
How do I test my testosterone levels as a woman?
With a morning blood sample collected at a pathology centre, requested by a doctor. Ask for total testosterone and SHBG together so the free androgen index can be calculated, and DHEA-S if acne or hair changes are part of the picture. Results are read against your laboratory's female reference range and alongside your symptoms and cycle history.
What is a normal testosterone level for a woman?
Typically somewhere around 0.3 to 2.0 nmol/L for total testosterone, with a free androgen index below about 5 to 7, but the exact interval depends on the laboratory and assay. Because women's levels sit at the bottom of the scale, small method differences matter, and your report's own range is the one your doctor uses. Ranges vary by laboratory.
What is a normal DHEA-S level for a woman?
It depends on age. DHEA-S peaks in the twenties, roughly in the range of 2 to 11 µmol/L, and falls steadily through the decades, so a laboratory quotes an age-specific range. A raised result suggests an adrenal contribution to androgen signs; a very high result prompts a doctor to look further. Ranges vary by laboratory.
How do I know if my testosterone is high?
Usually from the signs first: persistent adult acne along the jaw, coarse hair on the face or body, thinning at the crown, and irregular cycles. A blood test then shows whether the free androgen index or total testosterone is above range, and DHEA-S shows whether the adrenal glands contribute. A doctor puts the level and the signs together; neither alone is enough.
Is a testosterone test covered by Medicare in Australia?
When a GP or specialist requests it for a recognised clinical reason, such as investigating acne, hair changes or suspected PCOS, the pathology is usually rebated and often bulk-billed at the collection centre. Medicare does not fund testing for reassurance or a baseline. Consumer-initiated tests, including KnowLuna's panels, are self-pay.
Sources and further reading
- Pathology Tests Explained (RCPA): testosterone
- Pathology Tests Explained (RCPA): sex hormone binding globulin (SHBG)
- Pathology Tests Explained (RCPA): DHEA-S
- Monash University: International Evidence-based Guideline for the Assessment and Management of PCOS 2023
- Davis SR et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women (2019)
- Australasian Menopause Society: Testosterone and women
General information only, not medical advice. If your symptoms are severe or sudden, see a doctor promptly. This page does not replace a consultation with a doctor who knows your history; read our medical disclaimer.