What are the symptoms of high FAI?
High Free Androgen Index (FAI) indicates elevated active testosterone levels, causing symptoms like irregular periods, excess hair growth, acne, and hair loss in women. Men may experience aggression, mood changes, and cardiovascular issues.
Understanding Free Androgen Index (FAI)
The Free Androgen Index (FAI) is a calculated ratio that estimates the amount of biologically active testosterone circulating in your bloodstream. Unlike total testosterone measurements, FAI provides insight into how much testosterone is actually available for your body to use, making it a more accurate indicator of androgen activity.
FAI is calculated by dividing total testosterone by sex hormone-binding globulin (SHBG) and multiplying by 100. SHBG acts like a transport protein that binds to testosterone, making it inactive. When SHBG levels are low or testosterone levels are high, more free testosterone becomes available, resulting in an elevated FAI.
While testosterone is often considered a male hormone, it plays important roles in both men and women. However, when FAI levels rise above normal ranges, it can lead to a variety of symptoms that significantly impact quality of life. Understanding these symptoms is crucial for early detection and proper management of hormonal imbalances.
Severity of Hirsutism and Acne Symptoms by FAI Level
| FAI Level (Women) | Hirsutism Severity | Acne Presentation | Typical Areas Affected | |
|---|---|---|---|---|
| < 5 (Normal) | < 5 (Normal) | None to minimal | Occasional breakouts | T-zone only |
| 5-10 (Mildly elevated) | 5-10 (Mildly elevated) | Light facial hair | Persistent mild acne | Face, upper back |
| 10-20 (Moderately elevated) | 10-20 (Moderately elevated) | Noticeable facial/body hair | Moderate cystic acne | Face, chest, back |
| > 20 (Severely elevated) | > 20 (Severely elevated) | Extensive male-pattern hair | Severe nodular acne | Widespread |
Symptom severity can vary between individuals even at similar FAI levels due to genetic factors and androgen sensitivity.
Common Symptoms of High FAI in Women
Women are particularly sensitive to elevated androgen levels, and high FAI often manifests through multiple symptoms that can affect various body systems. These symptoms typically develop gradually and may worsen over time if left unaddressed.
Reproductive and Menstrual Changes
One of the most common indicators of high FAI in women is menstrual irregularity. This can include:
- Irregular or missed periods (oligomenorrhea or amenorrhea)
- Heavy or prolonged menstrual bleeding
- Difficulty conceiving or infertility
- Ovulation problems
- Development of ovarian cysts
These reproductive symptoms often occur because excess androgens interfere with normal ovarian function and the delicate balance of hormones needed for regular menstrual cycles.
Skin and Hair Manifestations
High FAI frequently causes visible changes to skin and hair that can be distressing for many women:
- Hirsutism (excessive hair growth in male-pattern areas like face, chest, and back)
- Severe acne, particularly along the jawline and chin
- Oily skin and enlarged pores
- Male-pattern baldness or thinning hair on the scalp
- Darkening of skin in body folds (acanthosis nigricans)
The severity of these symptoms can vary significantly between individuals and often correlates with the degree of FAI elevation.
Metabolic and Body Composition Effects
Elevated FAI can significantly impact metabolism and body composition in women:
- Weight gain, particularly around the midsection
- Difficulty losing weight despite diet and exercise
- Increased muscle mass
- Insulin resistance
- Changes in fat distribution patterns
Symptoms of High FAI in Men
While men naturally have higher testosterone levels than women, excessively high FAI can still cause problematic symptoms. These symptoms may be more subtle initially but can become significant over time.
Physical and Sexual Changes
- Increased muscle mass and strength
- Excessive body hair growth
- Premature balding or accelerated hair loss
- Acne outbreaks, especially on back and shoulders
- Enlarged prostate
- Changes in testicular size
- Altered sexual function (can be increased or decreased libido)
Behavioral and Mood Symptoms
High FAI in men often affects mood and behavior more noticeably than in women:
- Increased aggression or irritability
- Mood swings
- Impulsive behavior
- Sleep disturbances
- Difficulty concentrating
- Increased risk-taking behavior
Conditions Associated with High FAI
Several medical conditions are commonly associated with elevated FAI levels. Understanding these connections can help identify the underlying cause of symptoms.
Polycystic Ovary Syndrome (PCOS)
PCOS is the most common cause of high FAI in women of reproductive age. This hormonal disorder affects 5-10% of women and is characterized by elevated androgens, irregular periods, and often the presence of multiple small cysts on the ovaries. Women with PCOS typically have both high testosterone and low SHBG, resulting in significantly elevated FAI.
Other Associated Conditions
- Congenital adrenal hyperplasia
- Androgen-secreting tumors
- Cushing's syndrome
- Thyroid disorders
- Obesity and metabolic syndrome
- Use of anabolic steroids or certain medications
Upload your blood test results to track your progress
Seamlessly upload 3rd party biomarker & blood tests to track your whole health in 1 dashboard. Understand what each blood test means and how it fits into the bigger picture of your body and health.
Get diet and lifestyle recommendations based on your blood results, health profile and health goals. You'll also receive a custom supplement recommendation for the precise nutrients your body craves.
Upload Past Blood Test Results
Click or drag file to upload
Once you upload your report, we'll extract the results for your review. Works with top labs including Quest Diagnostics, LabCorp, BioReference, EverlyWell, LetsGetChecked and hundreds of other labs.
Long-term Health Implications
Chronically elevated FAI levels can lead to serious health complications if left untreated. These long-term effects underscore the importance of early detection and management.
Cardiovascular risks are particularly concerning with high FAI. Elevated androgens can contribute to:
- Increased LDL (bad) cholesterol
- Decreased HDL (good) cholesterol
- Elevated blood pressure
- Increased risk of heart disease and stroke
- Development of atherosclerosis
Metabolic complications are also common, including an increased risk of developing type 2 diabetes, insulin resistance, and metabolic syndrome. Women with high FAI may face additional risks such as endometrial cancer due to irregular periods and unopposed estrogen exposure.
Testing and Diagnosis
Accurate diagnosis of high FAI requires comprehensive hormone testing. The calculation requires measuring both total testosterone and SHBG levels. Additional tests that may be helpful include:
- Free testosterone (direct measurement)
- DHEA-S (another androgen)
- LH and FSH (to assess pituitary function)
- Prolactin
- Thyroid function tests
- Fasting glucose and insulin
Normal FAI ranges vary by sex and age, but generally, values above 5 in women and above 100 in men may indicate elevated levels. However, interpretation should always be done in conjunction with clinical symptoms and other hormone levels.
Treatment Approaches
Treatment for high FAI depends on the underlying cause and the severity of symptoms. A comprehensive approach often yields the best results.
Lifestyle Modifications
For many people, lifestyle changes can significantly improve FAI levels:
- Weight loss (even 5-10% can improve symptoms)
- Regular exercise (both cardio and strength training)
- Anti-inflammatory diet rich in whole foods
- Stress management techniques
- Adequate sleep (7-9 hours nightly)
- Limiting alcohol and processed foods
Medical Treatments
When lifestyle changes aren't sufficient, medical interventions may be necessary:
- Oral contraceptives (for women) to regulate hormones
- Anti-androgen medications like spironolactone
- Metformin for insulin resistance
- Topical treatments for acne and hirsutism
- Fertility treatments if conception is desired
Taking Control of Your Hormonal Health
High FAI can significantly impact quality of life, but with proper diagnosis and treatment, symptoms can be effectively managed. The key is recognizing the signs early and taking proactive steps to address hormonal imbalances.
If you're experiencing symptoms of high FAI, don't wait to seek help. Early intervention can prevent long-term complications and improve your overall health and well-being. Regular monitoring of your hormone levels can help track progress and ensure treatment effectiveness.
Remember that hormonal health is complex and interconnected with many aspects of your overall health. Working with healthcare providers who understand these connections can help you develop a comprehensive treatment plan that addresses not just your FAI levels, but your complete hormonal picture. With the right approach, you can achieve hormonal balance and relief from symptoms.
References
- Rosenfield, R. L., & Ehrmann, D. A. (2016). The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocrine Reviews, 37(5), 467-520.[Link][PubMed][DOI]
- Deswal, R., Narwal, V., Dang, A., & Pundir, C. S. (2020). The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. Journal of Human Reproductive Sciences, 13(4), 261-271.[PubMed][DOI]
- Lizneva, D., Gavrilova-Jordan, L., Walker, W., & Azziz, R. (2016). Androgen excess: Investigations and management. Best Practice & Research Clinical Obstetrics & Gynaecology, 37, 98-118.[PubMed][DOI]
- Münzker, J., Hofer, D., Trummer, C., et al. (2015). Testosterone to dihydrotestosterone ratio as a new biomarker for an adverse metabolic phenotype in the polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 100(2), 653-660.[PubMed][DOI]
- Keevil, B. G., & Adaway, J. (2019). Assessment of free testosterone concentration. The Journal of Steroid Biochemistry and Molecular Biology, 190, 207-211.[PubMed][DOI]
- Teede, H. J., Misso, M. L., Costello, M. F., et al. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction, 33(9), 1602-1618.[PubMed][DOI]
Was this article helpful?
Frequently Asked Questions
How can I test my FAI at home?
What is the normal range for FAI?
Can high FAI be reversed naturally?
How long does it take to see improvements in FAI levels?
Is high FAI the same as having high testosterone?
This article is licensed under CC BY 4.0. You are free to share and adapt this material with attribution.
