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Mar 11, 2021
5 min read

Low testosterone in women: symptoms and treatment options

Low testosterone levels can cause problems for women, including decreased sex drive, loss of muscle mass and bone density, and infertility. However, testosterone therapy is not recommended for women with low testosterone.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Low testosterone (often called low T) is a condition many men experience, but what about low testosterone in women? Is that something to be concerned about? While not as common as in men, some women do experience low T, which can cause a whole host of symptoms.

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What is testosterone?

Testosterone is more than just the primary male hormone (androgen). While men may have approximately 20–25 times higher testosterone levels than women, women need testosterone as well (Fabbri, 2016). 

Women make testosterone in special ovarian cells called theca cells. They also make testosterone in the adrenal glands, small specialized glands that sit on top of your kidneys. Adipose tissue, or body fat, is another source of testosterone. However, most of the testosterone that a woman makes gets converted to estradiol which becomes estrogen, the main female hormone (Udoff, 2020). 

Almost all testosterone in women is attached to sex hormone-binding globulin (SHBG), making it harder for your body to access. Free testosterone is unattached to proteins, and total testosterone is the total concentration of both protein-bound and free testosterone.

Why do women need testosterone?

Testosterone is an important part of a woman’s health and wellness, but the key is balance—low or high testosterone can lead to problems. Women require some level of testosterone for the following functions (Tyagi, 2017)

  • Sex drive (libido)
  • Maintaining muscle mass and bone density
  • Mood and energy levels
  • Fertility

Like men, levels of androgens in women decline with age, although levels generally stabilize in menopause. Medical conditions that affect the ovaries or adrenal glands may also lead to low testosterone levels in women (Udoff, 2020). 

What happens when testosterone levels are too low in women

An imbalance of testosterone can affect a woman’s well-being and sexual function. Symptoms of low T in women may include (Udoff, 2020):

  • Decreased sex drive
  • Decreased satisfaction with sex
  • Infertility
  • Irregular menstrual cycles
  • Vaginal dryness
  • Weaker bones and bone density loss (osteoporosis)

However, the relationship between testosterone levels and these symptoms is unclear. A 2014 Endocrine Society Task Force looked at the levels of testosterone in women with these symptoms. They did not find a correlation between particular testosterone levels and the presence of these symptoms. So while women need testosterone, the precise link between low testosterone levels and these potential side effects has not been proven, especially in otherwise normal, healthy women (Wierman, 2014). 

What causes low testosterone in women 

Several conditions can lead to low testosterone levels in women, including (Udoff, 2020):

  • Aging: testosterone levels decline naturally with age until a woman reaches menopause. In menopausal women, the ovaries continue to produce testosterone but not estrogen.
  • Bilateral oophorectomy: This is when you have both ovaries surgically removed. Since the ovaries still produce testosterone even after menopause, women who have had this surgery have even lower testosterone levels than postmenopausal women.
  • Primary adrenal insufficiency: If your adrenal glands are not working correctly, you may not make enough testosterone.
  • Pituitary gland dysfunction: In the normal testosterone production cycle, the pituitary (a gland at the base of your brain) releases a hormone called luteinizing hormone (LH), which tells your ovaries to produce testosterone. If your pituitary is not functioning normally, your ovaries may never get the signal to produce testosterone.
  • Anorexia nervosa: Anorexia nervosa is a condition where self-starvation leads to severe undernutrition. People with anorexia have very little body fat, a significant source of testosterone in women. This condition also affects the pituitary’s ability to produce LH normally, resulting in low testosterone levels (Misra, 2016). 
  • Medications: Oral contraceptive pills (usually containing estrogen and progesterone) stop the ovaries from making as much testosterone as usual. They also decrease the amount of free testosterone by increasing sex hormone-binding globulin (SHBG) levels. When the testosterone is bound to SHBG, it is not available for the body to use—so OCPs essentially take testosterone out of circulation. Glucocorticoid steroid medications also lower testosterone levels by decreasing adrenal gland function. 
  • Human immunodeficiency virus (HIV): Women with HIV may have low levels of testosterone.

Treatment options

Unlike in men, scientists still do not fully understand how low testosterone levels affect women or the best treatment approach. 

The 2014 Endocrine Society Task Force does not recommend treating low testosterone levels in women with hormone replacement therapy because there is not enough evidence to show that this type of treatment improves symptoms. In other words, women should not take testosterone or DHEA supplements to treat low testosterone levels because we don’t really know what levels of androgens are needed for normal functioning in women (Wierman, 2014).

The Task Force made an exception in postmenopausal women with hypoactive sexual desire disorder (HSDD) (Wierman, 2014). HSDD is a sexual dysfunction that affects 10% of adult women. It causes women to experience a lack of motivation to participate in sex due to a decreased sexual desire or inability to maintain interest throughout the sexual activity—this can be quite distressing to some women (Goldstein, 2017). 

Short-term therapy with testosterone has improved HSDD symptoms in some postmenopausal women. Interestingly, testosterone levels on blood tests after hormone replacement therapy didn’t seem to match up with an improvement in symptoms. Testosterone replacement is not recommended for premenopausal women with HSDD (Wierman, 2014). But even for postmenopausal women, we should note that this short-term testosterone therapy was given in the setting of a study and that testosterone replacement for women is not approved by the FDA. 

Another concern regarding treating women who have low testosterone with testosterone replacement therapy is the limited data regarding this therapy’s safety for women. Women may experience side effects from testosterone replacement, including hair loss, acne, excess facial hair, and a deepening of the voice. 

Studies looking at the relationship between androgen therapy and breast cancer development have had varying results, especially in postmenopausal women. Lastly, scientists are still unclear about how testosterone replacement therapy affects a woman’s risk of cardiovascular disease (Udoff, 2020). 

Testosterone therapy is not FDA-approved for use in women. Women should avoid using testosterone formulations that are made for men to treat their symptoms, especially without seeking medical advice. If you and your healthcare provider decide on testosterone therapy, you will need to have your levels checked routinely, as well as watch out for signs of too much testosterone (e.g., acne, hair growth, etc.) (Faubion, 2015).

Lifestyle changes that may help you improve some of the symptoms of low testosterone include:

Speak with your healthcare provider

The balance of hormone levels is crucial for your health and wellness. If your testosterone levels are out of whack, you may experience side effects. Talk to your healthcare provider if you are concerned about your testosterone levels. 

References

  1. Fabbri, E., An, Y., Gonzalez-Freire, M., Zoli, M., Maggio, M., & Studenski, S. et al. (2016). Bioavailable Testosterone Linearly Declines Over A Wide Age Spectrum in Men and Women From The Baltimore Longitudinal Study of Aging. The Journals Of Gerontology Series A: Biological Sciences And Medical Sciences, 71(9), 1202-1209. doi: 10.1093/gerona/glw021. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26921861/ 
  2. Faubion, S.S. & Rullo, J.E. (2015). Sexual Dysfunction in Women: A Practical Approach. American Family Physician, 92(4): 281-288. Retrieved from https://www.aafp.org/afp/2015/0815/p281.html
  3. Goldstein, I., Kim, N. N., Clayton, A. H., DeRogatis, L. R., Giraldi, A., Parish, S. J., et al. (2017). Hypoactive Sexual Desire Disorder: International Society for the Study of Women’s Sexual Health (ISSWSH) Expert Consensus Panel Review. Mayo Clinic Proceedings, 92(1), 114–128. doi:10.1016/j.mayocp.2016.09.018 https://pubmed.ncbi.nlm.nih.gov/27916394/
  4. Misra, M. & Klibanski, A. (2016). Anorexia Nervosa and Its Associated Endocrinopathy in Young People. Hormone Research in Paediatrics, 85(3), 147–157. doi:10.1159/000443735. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26863308/
  5. Tyagi, V., Scordo, M., Yoon, R. S., Liporace, F. A., & Greene, L. W. (2017). Revisiting the role of testosterone: Are we missing something?. Reviews in Urology, 19(1), 16–24. https://doi.org/10.3909/riu0716 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434832/
  6. Udoff, L. C. (2020, May). Overview of androgen deficiency and therapy in women. UpToDate. Crowley, W.F., Barbieri, R.L, Martin, K.A. (Eds.). Retrieved on Mar. 4, 2021 from https://www.uptodate.com/contents/overview-of-androgen-deficiency-and-therapy-in-women
  7. Wierman, M. E., Arlt, W., Basson, R., Davis, S. R., Miller, K. K., Murad, M. H., et al. (2014). Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism, 99(10), 3489–3510. doi:10.1210/jc.2014-2260. Retrieved from  https://academic.oup.com/jcem/article/99/10/3489/2836272 https://pubmed.ncbi.nlm.nih.gov/25279570/