Last updated: October 23, 2026 · Each study and lab range below was checked at its source. PMIDs and links are listed at the end.
Quick answer
Androstenedione is a male-type hormone that your body turns into testosterone. Doctors often call it A4. Your ovaries make about half of it. Your adrenal glands make the rest. In PCOS, A4 is often high even when testosterone looks normal. In one study, 20 of 86 women with PCOS had high A4 but normal testosterone. A testosterone test alone would have missed them.
- The 2023 international PCOS guideline says doctors could test A4 and DHEAS if testosterone is not high.
- Ask for an LC-MS/MS test, taken in the morning, ideally off the pill for 3 months.
- Lab ranges differ. One US lab lists 30 to 200 ng/dL for adult women. Another lists 41 to 262 ng/dL.
- Insulin pushes the ovary to make more A4. Lowering insulin is the main lever food gives you.
Want meals built around lower insulin, without counting anything? Build your free meal plan.
What is androstenedione?
Androstenedione is a steroid hormone in the androgen family, the group that includes testosterone. Lab reports shorten it to A4, and this guide uses A4 from here on. A4 is weak by itself. Its job is to be a raw material. An enzyme called 17-beta-HSD turns it into testosterone. Another enzyme, aromatase, turns it into estrone, a form of estrogen.
Think of A4 as the stock in the back room. Testosterone is what ends up on the shelf. A high stock level tells you something about the factory, even when the shelf looks normal on test day.
Our PCOS glossary sums it up in one line. A4 is an androgen your body turns into testosterone. It comes from your ovaries and adrenal glands. And it can be high when testosterone reads normal. This guide covers the test, the 2023 guideline, the lab ranges and what food can and cannot do.
A note on names. PCOS is now also called PMOS (Polyendocrine Metabolic Ovarian Syndrome, the new name as of 12 May 2026). Androstenedione works the same way under either name. We say PCOS here because the studies and most lab reports still do.
Where does androstenedione come from in PCOS?
In women before menopause, the adrenal glands and the ovaries each make about half of the A4 in your blood, according to the NHS lab at University Hospitals Birmingham. After menopause the total drops, mostly because the ovaries make less.
The two sources run on different switches. The adrenal glands make A4 in response to ACTH, the stress-axis hormone from the brain. The ovaries make it in theca cells, the outer layer of each follicle, in response to LH. In PCOS, the ovary is usually the bigger problem. A 2016 review in Endocrine Reviews found that most PCOS cases show what the authors call functional ovarian hyperandrogenism. In plain words, the ovary makes too much androgen. Only about 3% had excess coming from the adrenal glands alone.
That split matters for testing. A4 reflects both sources. DHEAS, a related hormone, comes almost only from the adrenal glands. If you want the adrenal side in detail, our guide to adrenal PCOS and high DHEAS covers it.
How is androstenedione tested?
A4 is a plain blood test. The detail that matters most is the method the lab uses, and the second is when the blood is drawn.
Method: LC-MS/MS beats immunoassay
LC-MS/MS stands for liquid chromatography with tandem mass spectrometry. It sorts hormones by weight, so it can tell A4 apart from its look-alikes. An immunoassay uses antibodies, which can grab similar molecules by mistake. The 2023 international PCOS guideline says labs should use validated LC-MS/MS assays for total testosterone, and also for A4 and DHEAS if those are needed. Your lab report usually names the method next to the result. If it says "immunoassay", "ECLIA" or "RIA", that is worth knowing when you read the number.
Timing: morning, mid-cycle aside, off the pill
- A4 follows a daily rhythm and peaks in the morning, per the Birmingham NHS lab. A morning draw makes your results easier to compare over time.
- A4 runs highest near mid-cycle. The same lab asks for blood taken a week before or after your period.
- If your cycles are irregular or absent, you may not be able to time it. In the 2014 Birmingham study, most women with PCOS could not be tested in the early follicular phase for this reason.
- The combined pill makes androgen results hard to read. The 2023 guideline says that if testing is a must, the pill should be stopped for at least 3 months first, with other birth control used meanwhile.
- DHEA or A4 supplements raise the result, per the University of Michigan lab. Tell your doctor if you take either.
For the full panel and what each test adds, see PMOS lab tests, explained.
What is the normal androstenedione range for women?
There is no single normal range for androstenedione. Each lab sets its own, based on its own method and its own group of healthy women. Always read your result against the range printed on your own report.
Here is how four published ranges compare. US labs report in ng/dL. UK and European labs report in nmol/L. One nmol/L is about 28.6 ng/dL, based on the weight of the molecule.
| Source | Method | Adult female range |
|---|---|---|
| University of Michigan lab (US) | LC-MS/MS | 30 to 200 ng/dL (age 18+) |
| Labcorp (US) | LC-MS/MS | 41 to 262 ng/dL (age 15 to 60); 17 to 99 ng/dL (age 61 to 80) |
| University Hospitals Birmingham NHS (UK) | Not stated | 0.9 to 7.5 nmol/L before menopause; 0.4 to 2.9 nmol/L after |
| O'Reilly 2014 study (UK) | LC-MS/MS | 1.4 to 7.4 nmol/L, women before menopause |
Notice the top of the US ranges: 200 at one lab, 262 at another. A result of 230 ng/dL would be flagged high at the first and normal at the second. That is why you compare your number to your own lab's range, and why a repeat test should go to the same lab.
Does androstenedione help diagnose PCOS?
Measuring A4 next to testosterone finds androgen excess that testosterone alone misses. That matters because high androgens are one of the three features used to diagnose PCOS.
The clearest data come from a 2014 study at the University of Birmingham, published in the Journal of Clinical Endocrinology and Metabolism. Researchers measured androgens by LC-MS/MS in 86 women with PCOS:
- 56 had high A4 and high testosterone.
- 20 had high A4 with normal testosterone.
- 10 had neither raised.
- None had high testosterone with normal A4.
So A4 was raised in 88% of the group and testosterone in 65%. Of the 30 women with normal testosterone, 20 still had high A4. The authors called serum A4 "a more sensitive indicator of PCOS-related androgen excess" than total testosterone.
What the 2023 guideline says
The 2023 International Evidence-based Guideline for PCOS, backed by ASRM, the Endocrine Society, ESE and ESHRE, puts A4 in second place. Its wording: "If testosterone or free testosterone is not elevated, healthcare professionals could consider measuring androstenedione and dehydroepiandrosterone sulfate (DHEAS), noting their poorer specificity and greater age associated decrease in DHEAS."
Three things follow from that sentence. Total and free testosterone come first. A4 is an option, not a must. And "poorer specificity" means a high A4 is less sure to mean PCOS than a high testosterone, so other causes still need ruling out. For the full diagnostic path, read how PMOS is diagnosed.
What does high androstenedione with normal testosterone mean?
High A4 with normal testosterone usually means your body is making extra androgen raw material that has not yet shown up as high testosterone in the blood. In the Birmingham study, this was the case for about 1 in 4 women with PCOS.
It is not a harmless middle ground. The same study tracked blood sugar control with a glucose tolerance test:
| Androgen pattern (PCOS group) | Women | Had abnormal blood sugar |
|---|---|---|
| Normal A4, normal testosterone | 10 | 0% |
| High A4, normal testosterone | 20 | about 1 in 7 |
| High A4, high testosterone | 56 | 25% |
A4 also tracked insulin sensitivity more closely than testosterone did. When the researchers put both hormones in one model, only A4 was tied to insulin sensitivity. The study was small, so treat it as a strong signal, not a verdict. The practical point: if your A4 is high, it is worth checking how your body handles insulin. Our guide to testing insulin resistance beyond glucose lists the tests to ask for.
When high A4 needs a closer look. The 2023 guideline says that when androgens are far above the lab range, doctors should look for other causes. These include tumours of the ovary or adrenal gland, congenital adrenal hyperplasia and Cushing's syndrome. Fast-onset symptoms matter most: a deepening voice, quickly spreading hair growth or a change in body shape over months. If that is you, see a doctor soon rather than changing your diet first.
How does insulin raise androstenedione in PCOS?
Insulin works with LH to push the theca cells in your ovary to make more androgen, including A4. The 2016 Endocrine Reviews paper describes the ovary as still responsive to high insulin, even when muscle and liver have become resistant to it. That gap is the trap: your body makes more insulin to clear glucose, and the ovary reacts to every extra unit.
The proof that this runs both ways came from a 1996 trial in the New England Journal of Medicine. Researchers lowered insulin with metformin in 11 women with PCOS for 4 to 8 weeks. Their insulin response to glucose fell by almost half. Free testosterone fell from 12 to 7 pmol/L, and SHBG, the protein that binds testosterone, nearly tripled. The enzyme that builds androgens in the ovary also became less active. Nothing changed in the placebo group.
That trial measured testosterone and the enzyme, not A4 itself. It still shows the direction: less insulin, less ovarian androgen. If your A4 is high and you also have signs of insulin resistance, the insulin side is where food can act. Our page on breakfasts for insulin resistance shows one place to start.
You do not need another plan. You need a system. A printed plan works until the week you are tired or the fridge is empty. PCOS Meal Planner builds every meal around a protein floor and steady carbs, and it adjusts to the foods you like and the time you have. Build your free plan.
Can diet lower androstenedione?
Not directly, as far as current trials show. No good trial has shown a food that lowers A4 on its own. The evidence for food runs through insulin, and it is measured mostly on testosterone and the free androgen index (FAI), not A4.
Here is what the trials do support:
- A 2019 Cochrane review of lifestyle programs in PCOS found they probably lower FAI. The pooled drop was 1.11 points across 6 trials and 204 women. The authors rated the evidence low quality.
- A 2013 trial moved calories earlier in the day for 60 lean women with PCOS over 90 days. Daily calories stayed the same. In the big-breakfast group, insulin fell by 54% and free testosterone by 50%.
- The 1996 metformin trial above shows that lowering insulin lowers ovarian androgen output. Food lowers insulin by a smaller amount than a drug.
In practice, that points to meals that keep insulin lower without a crash diet: 25 to 30 grams of protein at breakfast, fibre with every carb, and more of your food earlier in the day. Two simple builds are a Greek yogurt bowl with almond butter and flaxseed or a black bean and egg breakfast bowl. None of this needs weight loss to start, and none of it needs you to eat less than you need.
Be wary of products that claim to "block androgens". The trial evidence for food runs through insulin. If you want to know whether changes are working, a repeat A4 at the same lab after about 3 months is a fair check. The 2023 guideline also notes that repeat androgen tests have a limited role once you are diagnosed, so ask whether a retest would change what you do.
Myths about androstenedione and PCOS
Myth: If your testosterone is normal, your androgens are normal.
Reality: In a 2014 study of 86 women with PCOS, 20 of the 30 with normal testosterone had high androstenedione.
Myth: Androstenedione only comes from the adrenal glands.
Reality: Before menopause, the ovaries and adrenal glands each make about half. In PCOS, the ovary is usually the main source of excess.
Myth: There is one normal range for androstenedione.
Reality: One US lab tops out at 200 ng/dL for adult women. Another tops out at 262. Read your result against your own lab's range.
Myth: A high androstenedione result proves PCOS.
Reality: The 2023 guideline notes its "poorer specificity". Other causes, such as congenital adrenal hyperplasia or a tumour, still need ruling out.
Myth: A special food can block androstenedione.
Reality: No trial shows a food that lowers A4 directly. The evidence runs through insulin: lower insulin, less push on the ovary to make androgens.
Frequently asked questions
What is androstenedione in PCOS?
Androstenedione, or A4, is an androgen. Your body turns it into testosterone or into estrone. Your ovaries and adrenal glands each make about half. In PCOS, A4 is often high. It is high more often than testosterone is. In one study, A4 was high in 88% of women with PCOS. Testosterone was high in 65%. So A4 can show extra androgen that a testosterone test misses.
What is a normal androstenedione level for a woman?
It depends on the lab. The University of Michigan lab lists 30 to 200 ng/dL for adult women. Labcorp lists 41 to 262 ng/dL for ages 15 to 60. A UK NHS lab lists 0.9 to 7.5 nmol/L before menopause. Read your number against the range on your own report. Use the same lab for any repeat test.
Can you have PCOS with normal testosterone but high androstenedione?
Yes. In a 2014 study of 86 women with PCOS, 20 had high A4 and normal testosterone. That was about 1 in 4. The 2023 guideline says doctors could test A4 and DHEAS when testosterone is not high. A high A4 can count as a sign of androgen excess. Other causes still need to be ruled out.
When should I get my androstenedione tested?
Get it done in the morning. A4 peaks early in the day. If you have periods, aim for a week before or after one. A4 runs high near mid-cycle. If your cycles are irregular, test when you can. If you take the combined pill, the 2023 guideline says to stop it for 3 months first, if testing is a must. Use other birth control during that time.
Which androstenedione test is most accurate?
LC-MS/MS is the most accurate. It sorts hormones by weight, so it can tell A4 apart from look-alike hormones. Immunoassays use antibodies, which can pick up the wrong molecule. The 2023 guideline says labs should use LC-MS/MS for A4 and DHEAS when those are tested. Your report usually names the method.
Is high androstenedione linked to insulin resistance?
Yes. Insulin pushes the ovary to make more androgen. In the 2014 study, A4 tracked insulin sensitivity more closely than testosterone did. Women with high A4 and high testosterone had the most blood sugar problems: 25% of them. Women with neither raised had none. If your A4 is high, ask for an insulin test too.
How can I lower androstenedione naturally?
No food has been shown to lower A4 directly. The best evidence runs through insulin. Lower insulin means less push on the ovary. A 2019 Cochrane review found that diet and exercise programs probably lower the free androgen index a little. Start with protein at breakfast and fibre with your carbs. Eat more of your food earlier in the day.
What is the difference between androstenedione and DHEAS?
DHEAS comes almost only from the adrenal glands. A4 comes from both the adrenal glands and the ovaries. So DHEAS points to the adrenal side. A4 covers both. The 2023 guideline puts both tests second, after testosterone. It also notes that DHEAS falls with age, so your age matters when you read it.
What to do with your androstenedione result
- Find the range on your report. Write down your number, the lab's range and the method. That takes two minutes.
- Check the conditions. Was it a morning draw? Were you on the pill or taking DHEA? If so, the result may not reflect your baseline.
- If A4 is high and testosterone is normal, say so. Ask your doctor whether it counts as androgen excess under the 2023 guideline.
- Ask for an insulin check. A fasting insulin or a glucose tolerance test with insulin shows whether insulin is pushing your ovaries.
- Change breakfast first. Protein and fibre in the morning is the cheapest place to lower insulin.
Turn a lab result into dinner. Tell PCOS Meal Planner what you like and what you avoid. It builds a week of meals aimed at lower insulin and writes the shopping list. Start free.
Sources
- O'Reilly MW, Taylor AE, Crabtree NJ, et al. Hyperandrogenemia predicts metabolic phenotype in polycystic ovary syndrome: the utility of serum androstenedione. Journal of Clinical Endocrinology and Metabolism. 2014;99(3):1027-1036. PMID 24423344
- Teede HJ, Tay CT, Laven J, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Human Reproduction. 2023;38(9):1655-1679. doi:10.1093/humrep/dead156. Also in European Journal of Endocrinology, PMID 37580861
- Rosenfield RL, Ehrmann DA. The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine Reviews. 2016;37(5):467-520. PMID 27459230
- Nestler JE, Jakubowicz DJ. Decreases in ovarian cytochrome P450c17 alpha activity and serum free testosterone after reduction of insulin secretion in polycystic ovary syndrome. New England Journal of Medicine. 1996;335(9):617-623. PMID 8687515
- Lim SS, Hutchison SK, Van Ryswyk E, et al. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews. 2019;3:CD007506. PMID 30921477
- Jakubowicz D, Barnea M, Wainstein J, Froy O. Effects of caloric intake timing on insulin resistance and hyperandrogenism in lean women with polycystic ovary syndrome. Clinical Science. 2013;125(9):423-432. PMID 23688334
- University Hospitals Birmingham NHS Foundation Trust. Androstenedione, pathology test guide. uhb.nhs.uk
- Michigan Medicine Laboratories. Androstenedione, serum. mlabs.umich.edu
- Labcorp. Androstenedione, LC/MS (test 004705). labcorp.com
How this article was made
We started from the one-line entry in our own glossary and checked every claim against its source. The 2023 guideline wording is quoted from the published recommendations, not from a summary. The study counts come from the full text of the 2014 Birmingham paper. Lab ranges were read from each lab's own test page in October 2026, and they can change.
Two limits are worth naming. The key A4 study had 86 women with PCOS, from one center. And no trial we found tested a diet against A4 as its main outcome, which is why the food advice here runs through insulin.
The bottom line on androstenedione and PCOS: if your testosterone is normal but your symptoms say otherwise, ask whether A4 was tested, and by which method.
This guide is general information, not medical advice. Lab results need a doctor to read them in context. Do not stop hormonal birth control to get tested without a plan for other contraception.
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