Low Testosterone in Women

In Diagnosis & Treatment, Online Doctor, Telemedicine by Dr. Clinton Osborn

People often think that women have estrogen, and men have testosterone, but little did we know that everybody can have both hormones in their body. It is true that woman has estrogen, but they also have a normal amount of testosterone in there as well. The proper level of testosterone can help maintain sex drive, produce new blood cells, boost energy levels, and stimulate other reproductive hormones. This is why it’s imperative to talk with a doctor and have a blood test to check your testosterone level to ensure that you have a healthy amount to avoid feeling fatigued, sluggish, and experience a lack of sex drive.

Because testosterone plays a huge role in our body, it’s essential that women should be more educated and aware of the function and importance of testosterone hormone. Luckily, we have all the information to keep you well-informed and to know when to see a doctor.

What is testosterone?

Testosterone is a primary male sex hormone, but they can also be found in females as well. It is a steroid hormone that stimulates male sexual characteristics and mainly produced in the testes. In the female, the testosterone hormone is found in the ovaries and the adrenal cortex. Testosterone hormones in females play an essential role in providing energy, strength, endurance, fitness, and maintaining as well as regulating the mood. With these important functionalities, women with testosterone deficiency would have to take supplements or medication to replenish the levels so that they would be able to avoid undesirable symptoms of fatigue, weight gain, depression, and other issues.

How does Testosterone affect women?

Testosterone belongs in the androgen hormone group and affects the sex drive, fertility, red blood cell production, muscle mass, and fat distribution. Testosterone is found in larger amounts in the male gender, but smaller levels in female genders. Keep in mind that the ovaries and adrenal glands produce a small amount of testosterone. According to the University of Rochester Medical Center, women on average should have a total of 15 to 70 ng/dL of testosterone in their blood. Anything below that will require further investigation by your healthcare provider.

What are the symptoms of low testosterone in women?

If you start having symptoms of fatigue, weight gain, low sex drive, infertility, sleep disturbance, menstrual irregularities, vaginal dryness, and much more, then it’s time to see your doctor for a check-up. Because these symptoms can often be found in other chronic illness, your doctor may have to rule out other medical problems such as anxiety, depression, chronic stress, menopause, and thyroid disease. That means, your doctor would have to do a blood test to check your hormone levels to rule out hypothyroidism by analyzing the thyroid stimulating hormone (TSH), T4, and T3 levels.

If they need to make sure that this is not menopause, then a blood test for estrogen level, FSH (Follicle Stimulating Hormone), and LH (luteinizing hormone) would need to be done as well. Your doctor will also interview you to make sure that you don’t have anxiety, stress, or Major Depressive Disorder. Once everything is ruled out, then a blood test for testosterone hormone can be initiated.

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What are the causes of low testosterone in women?

Women produce testosterone from the adrenal gland, ovaries, and peripheral tissues. If anything happens to any of these factors, it can affect the testosterone level in the body.

Here are some medical causes of low testosterone levels in women.


Oophorectomy involves a surgical procedure to take out the ovaries. When you take out the ovaries, you will lower the testosterone level because the ovaries are the main source that produces them. Oophorectomy utilizes a chemical that also removes the ovaries. This type of suppression can also lower the testosterone level as well.

Birth Control

When you take birth control pills, it increases the serum hormone binding globulin or SHBG in your blood. When your testosterone binds to SHBG, it becomes inactive. Keep in mind that only free or unbound testosterone is the active form that plays all those vital functional roles in your body, such as boosting our energy and increasing your libido. Once, testosterone is inactive, it loses its functional purpose. That can easily lead to testosterone deficiency in any woman who takes birth control.

However, this does not happen to everybody, but research has shown that hormonal contraception with symptoms of decreased libido tends to show low levels of free testosterone in the blood. Therefore, any woman who takes birth control pills and experiences vaginal dryness, lack of sexual interests, or other symptoms, should consider doing a blood test to check their levels.

Hypothalamic Amenorrhoea

Hypothalamic amenorrhea and is caused by abnormal hormone production that leads to a lack of menstrual cycle. The physiology of this problem starts in the hypothalamus region of the brain where the GnRH (gonadotropin-releasing hormone) is produced. GnRH functions to stimulate the anterior pituitary gland to release FSH and LH. Both FSH and LH will stimulate the ovaries to release estrogen and testosterone to the blood.

However, if the GnRH level is low or if there is some abnormality in the hypothalamus region, then there would be a low level of FSH, LH, estrogen, and testosterone. This is a very common issue with young female athletes or someone who exercises too much. This is mainly because when you exercise or consume a low-calorie intake, it tends to suppress the GnRH hormone in the hypothalamus region. This is why a lot of female athletes or patients with eating disorders often have irregular menstrual cycles.

If this is left undiagnosed, it can potentially lead to serious medical problems such as osteoporosis, which is bone fractures due to inadequate calcium and vitamin D intake that can be affected by these hormone levels.

Early Menopause (Premature Ovarian Failure)

Usually, menopause occurs at age 50, but it can happen a little early or later. Menopause entails a low level of estrogen, which can lead to symptoms of hot flashes, fatigue, bone pain, depression, and other symptoms. Keep in mind that if you get menopause under the age of 40, it would be diagnosed with premature ovarian failure. The main problem with menopause is that the eggs don’t function the way that they used to, so they tend to create lower levels of testosterone and estrogen. When the body senses that there are decrease levels of estrogen and testosterone, it will activate the GnRH from the hypothalamus. The GnRH will activate the FSH and LH to stimulate the ovary.

Unfortunately, because the ovary is less functional in women with menopause or premature ovarian failure, it will not produce an adequate amount of hormone. Therefore, whenever your doctor does a blood test to check the hormone level, they will see a decrease in estrogen and testosterone level, but an increase in GnRH, LH, and FSH. These levels indicate a diagnosis of menopause or premature ovarian failure, which could be the reason why you would have testosterone deficiency.

Ovarian cysts and low test

An ovarian cyst is a fluid-like mass that can occur in the ovaries. Often times, these masses are benign and will go away on their own. Unfortunately, there are times that the cyst can grow and expand, therefore causing symptoms and destroying the function of the ovary. An ovarian cyst can lead to lower abdominal pain, nausea, vomiting, bloating, swelling, painful bowel movements, and painful intercourse. If the cyst burst, it can lead to shock, fever, and extreme pain. If you experience these intense symptoms, it’s best to see a doctor for an ultrasound to check if you would need surgery.

Another thing to keep in mind is that an expanding ovarian cyst can compromise the function and integrity of the ovaries. This can diminish hormone production which can lead to testosterone deficiency. Not all women would get this, but some would experience this issue. That is why a blood test in addition to the ultrasound is vital to make sure that your estrogen and testosterone hormones are at a proper level.

Diagnosing Low Testosterone in Women

The initial step of diagnosing testosterone deficiency is the interviewing process between the doctor and the patient. The goal is to note down all the symptoms and to rule out other underlying causes, such as major depressive disorder and anxiety. Once those are ruled out through physical examination and the interview, it’s time to do a thorough blood test. With the blood test, the doctor will review the thyroid hormone, estrogen, testosterone, FSH, and LH levels. This would help rule out menopause and hypothyroidism. Plus it will tell you if your testosterone level is too high or too low.

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Treatment for Low Testosterone in Women

Some hormone therapy contains both estrogen and testosterone replacement. This would be beneficial for menopausal patients. However, if you only have a testosterone deficiency, then it’s best to obtain testosterone medications. For cases with mildly low thyroid level, oral medication should be adequate. Your doctor can prescribe you the proper dosage or recommend supplements. However, if the level is extremely low, then a testosterone injection would be the best option. Your provider can administer testosterone injections or pellets to help raise your levels. Often times, patients rave that after injection, they experience a boost of energy and improved libido.

Even though testosterone treatment is highly effective, just like any medication, it does have some unfavorable side effects. Before initiating treatment, the doctor would warn you about side effects such as acne, hair loss, enlarged clitoris, facial hair, and developing a deeper voice. He or she might prescribe a lower dose of testosterone to see how your body reacts before increasing the amount, therefore reducing the severity of the side effects.

Alternative treatments

Aside from the prescription testosterone medication, there are also alternative lifestyle changes that can improve your testosterone levels as well. It’s best to do both the testosterone injection and these alternative treatments for maximum results.

Sex therapy

When you have sex, your testosterone level increases to maximize endurance and libido. That is why you should find a boyfriend, husband, or partner that can satisfy your cravings. In addition, sex releases endorphins, which dilates your blood pressure, decrease the stress hormones and promote blood flow. All of this can help maintain adequate levels of testosterone in your blood.

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Stress management

When you are stressed, your body releases sympathetic hormones such as epinephrine and norepinephrine. This fight or flight response can constrict blood vessels and signaled the body to suppress any sex hormone. That means you will experience low estrogen and testosterone level during a stressful time. This actually makes sense because you will not stop to have sex if someone is chasing after you with a knife. However, with proper stress management regime such as yoga and meditation, it can help decrease the release of the sympathetic hormones and cortisol, so your testosterone levels will be well-regulated.

Healthier diet

When you eat unhealthy food, you accumulate fat in your body. The fat can be aromatized and converted to estrogen. High estrogen levels from peripheral fat can signal the body to decrease the GnRH levels from the hypothalamus, therefore, reduce FSH and LH. This will ultimately decrease testosterone production. However, with a healthy diet of fruits, vegetables, white meat, lean meat, protein, and fish, you will experience a proper level of testosterone. With low amounts of fat in your body, The hypothalamus will receive the signal to create more hormones such as estrogen and testosterone to improve your sex life, energy, and well-being.

Keep in mind that low-calorie intake and eating disorders can have a detrimental effect on your hormone levels. If you have an eating disorder, it can decrease your testosterone level because it can negatively affect the GnRH signal in the hypothalamus. That is why it’s essential to have adequate caloric intake as well as a healthy diet regime.


Your body has an amazing ability to adapt and function in any situation. This magical ability has a lot to do with the bodies feedback mechanism. When your body needs extra power and strength, they will activate your testosterone levels. If it needs something peaceful and feminine, then estrogen is what they will be looking for. For example, when you lift weights or do cardio, your body will signal the ovaries to create more testosterone to improve your strength and endurance.

Exercise can also reduce body fat, therefore decreasing peripheral estrogen levels and increasing testosterone. When you exercise, your body will release endorphins to reduce stress, promote better sleep, and reduce blood pressure. All these factors can contribute to proper hormone regulation. Keep in mind that obsessive and insane amount of exercise can have the opposite effect by lowering your testosterone level. Therefore, it’s best to have a balance so you don’t overdo it.


When you go to a drugstore, and purchase over-the-counter testosterone supplements, it can definitely help boost your energy level, stamina, and libido. The significant part is that the supplements often contain natural ingredients so you will be less likely to get the nasty side effects that you would get from injections. However, supplements are not as strong as testosterone injection, so using them alone may not be enough to replenish your testosterone levels.

The best strategy would be to utilize both testosterone injections from your doctor and supplements at the same time. If anything, you can show the doctor the supplement that you plan to take so they can analyze the dosage, and create a more effective treatment plan. For example, the doctor may prescribe a lower dosage of testosterone injection, and advise that you take the supplement at the same time. That way, you would not have to deal with a severe side effects case on your hand.

Proper sleep

On average, adults should sleep around 7 to 10 hours a day to produce an adequate amount of testosterone. The lack of sleep can lead to stress, anxiety, depression, and hormone irregularity. This could ultimately cause a testosterone deficiency. Research has shown that adults who get only five hours of sleep per night will have a 15% reduction in testosterone levels. If you get 7 to 10 hours of sleep, your testosterone levels will increase by 15%.

Take home message

Testosterone hormones still remain a mystery to many doctors and researchers. Fortunately, they are making a lot of breakthrough discoveries with clinical trials to learn more about the hormone. One of the most important things to keep in mind is that testosterone tends to change as we age, and can drop drastically as you reach menopause.

If you experience any symptoms of testosterone deficiency, it’s best to visit your doctor for a blood test to find the underlying cause and to know the severity of your testosterone levels. You should never take testosterone therapy without your doctor’s recommendation. After all, high testosterone levels can lead to symptoms of acne, aggression, anger, nervousness, insomnia, and much more. Therefore, with the proper medical consultation, you will be able to obtain the appropriate treatment plan to keep your testosterone levels well-regulated.

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