The Androgen Feedback Loop
High insulin levels stimulate the ovarian theca cells to produce excess androgens. Simultaneously, insulin inhibits the production of Sex Hormone-Binding Globulin (SHBG) in the liver, leaving more testosterone "free" and active in the bloodstream.
1
The SHBG Connection
Low SHBG is often the hidden reason why your Total Testosterone looks normal but your Free Testosterone is high.
2
Hirsutism Link
Free testosterone is the specific fraction responsible for unwanted hair growth and cystic acne.
Optimal Free Testosterone Benchmarks
Functional Range (Hormonal Health Focused) 1.0 - 5.0 pg/mL
Standard Lab Range 0.1 - 6.4 pg/mL
Common Questions
Can I have PCOS with normal testosterone?
Yes, if your SHBG is low, your total levels might look fine while your active (Free) levels are high enough to cause symptoms.