Do the ovaries provide significant testosterone and androstenedione in women and does ovarian aging reduce that output?

Clinical evidence

• Ovarian contribution to androgens: Classical endocrine physiology demonstrates that the ovaries are a primary source of unconjugated testosterone and androstenedione in women. Direct ovarian secretion from theca and stromal cells accounts for approximately 25% to 30% of circulating testosterone in premenopausal women, while ovarian secretion of the precursor androstenedione provides substrates for peripheral conversion to testosterone.
• Impact of ovarian aging: Longitudinal cohort studies, including the Study of Women’s Health Across the Nation (SWAN) and the Penn Ovarian Aging Study (POAS), show that while peripheral total testosterone levels remain relatively stable or decline only modestly during the perimenopause transition, absolute ovarian-specific androgen output (testosterone and androstenedione) declines gradually as follicular depletion progresses.

Mechanistic explanations

• Relative androgen excess: During perimenopause, the depletion of ovarian follicles causes a rapid and steep drop in estradiol levels. Because absolute ovarian testosterone output declines at a much slower and more gradual rate, the testosterone-to-estradiol ($T/E_2$) ratio increases significantly, creating a state of relative androgen excess despite the overall reduction in absolute ovarian synthesis.
• Postmenopausal ovarian stroma activity: Even after the loss of follicular activity, the postmenopausal ovarian stroma remains gonadotropin-responsive and steroidogenically active. Under the influence of elevated luteinizing hormone (LH) levels, the stroma continues to synthesize and secrete modest amounts of testosterone and androstenedione.

Practical considerations

• Metabolic and cardiovascular risk: The rising $T/E_2$ ratio that accompanies ovarian aging is clinically relevant, as relative androgen excess is associated with adverse metabolic shifts, including increased visceral adiposity, lipid profile deterioration, and an elevated risk of developing metabolic syndrome during midlife.

Bottom line

In women, the ovaries are a major source of testosterone and androstenedione. Although ovarian aging gradually reduces absolute ovarian androgen output, the much steeper decline in estrogen production shifts the hormonal balance toward relative androgen excess, which has important implications for midlife metabolic and cardiovascular health.