Low Testosterone in Women: Symptoms, Causes, and Treatment

When most people hear "low testosterone," they picture men. But women produce testosterone too — in their ovaries and adrenal glands — and it matters enormously for their health. In fact, testosterone is the most abundant biologically active hormone in women across most of their adult lives.

Despite this, low testosterone in women remains chronically underdiagnosed. Many women spend years being told their fatigue, low libido, and brain fog are "just stress" or "a normal part of aging," when the underlying issue may be a correctable hormonal deficiency.

What Is Testosterone's Role in Women?

Women produce testosterone in smaller amounts than men — typically between 15–70 ng/dL compared to 300–1,000 ng/dL in men — but this doesn't make it less important. Testosterone in women supports:

• Sexual desire and arousal — testosterone is the primary driver of libido in women
• Energy and motivation — it supports mitochondrial function and stamina
• Bone density — works alongside estrogen to prevent osteoporosis
• Muscle mass and strength — helps maintain lean body composition
• Mood and cognitive function — supports dopamine pathways involved in focus and emotional stability
• Skin health — contributes to collagen synthesis and wound healing

Testosterone levels in women peak in their 20s and then decline gradually. By menopause, levels are roughly half of what they were at their peak — and in women who undergo surgical menopause (oophorectomy), levels can drop 50% almost overnight.

Symptoms of Low Testosterone in Women

Because testosterone's effects are wide-ranging, the symptoms of deficiency are similarly broad. The most commonly reported include:

1. Reduced or Absent Libido

This is often the most distressing symptom for women. Low sexual desire — particularly when it represents a change from a woman's baseline — is strongly associated with low testosterone. Unlike low libido caused by relationship issues or psychological factors, testosterone-related low libido often presents as a complete absence of sexual thoughts or fantasy, not just decreased frequency.

2. Persistent Fatigue

Women with low testosterone frequently describe an energy that doesn't respond to adequate sleep. No matter how many hours they rest, they wake feeling unrefreshed and struggle to maintain energy throughout the day. This is distinct from the fatigue of anemia or thyroid dysfunction, though those should be ruled out first.

3. Brain Fog and Poor Concentration

Difficulty focusing, word-finding problems, and a sense of mental "cloudiness" are frequently reported. Research published in Menopause has linked androgen deficiency to reduced verbal memory and processing speed in women.

4. Mood Changes — Including Depression and Anxiety

Testosterone influences serotonin and dopamine activity. Women with low levels often report increased irritability, a flattening of mood, reduced motivation, and in some cases frank depression that doesn't fully respond to antidepressants alone.

5. Loss of Muscle Tone and Increased Body Fat

Even without changes in diet or exercise, women with low testosterone may notice muscle weakening and a shift toward increased abdominal fat. This is because testosterone supports lean muscle metabolism.

6. Bone Loss

Testosterone directly stimulates bone formation. Long-term deficiency increases osteoporosis risk, particularly in postmenopausal women whose estrogen levels are also low.

7. Thinning Hair

Paradoxically, both high and low testosterone can contribute to hair loss in women, depending on individual androgen sensitivity. Low levels may cause diffuse thinning across the scalp.

8. Vaginal Dryness and Discomfort

Along with estrogen, testosterone maintains the health of vaginal tissues. Deficiency contributes to dryness, discomfort during intercourse, and reduced sensitivity.

What Causes Low Testosterone in Women?

Several factors can suppress or reduce testosterone production in women:

Natural Aging and Menopause

The gradual decline of testosterone production from the ovaries is a normal part of aging. However, this decline accelerates around perimenopause and becomes more pronounced after menopause.

Surgical Menopause (Oophorectomy)

Women who have both ovaries removed lose the majority of their testosterone production immediately. This often results in more severe symptoms than natural menopause because the decline is abrupt rather than gradual.

Oral Contraceptives and Hormonal IUDs

Combined oral contraceptives (estrogen + progestin) increase sex hormone-binding globulin (SHBG), a protein that binds testosterone and makes it unavailable to tissues. Even when total testosterone appears normal on a blood test, free (biologically active) testosterone may be significantly reduced. This effect can persist for months or years after stopping oral contraceptives.

Hypopituitarism

The pituitary gland signals the ovaries and adrenal glands to produce testosterone via luteinizing hormone (LH) and adrenocorticotropic hormone (ACTH). Pituitary dysfunction reduces these signals and can cause secondary testosterone deficiency.

Adrenal Insufficiency

The adrenal glands produce approximately 50% of a woman's testosterone (via DHEA). Adrenal disorders or chronic stress can reduce this output significantly.

Premature Ovarian Insufficiency (POI)

Women whose ovaries stop functioning before age 40 often have significantly low testosterone alongside low estrogen.

How Is Low Testosterone Diagnosed in Women?

Diagnosis involves blood testing, ideally performed in the morning when testosterone levels are at their daily peak. Key tests include:

• Total testosterone — overall amount in the blood
• Free testosterone — the biologically active fraction not bound to SHBG or albumin
• SHBG — high levels can render total testosterone functionally low
• DHEA-S — reflects adrenal androgen production

There is currently no universally agreed-upon lower "normal" limit for testosterone in women — this is partly why the condition is underdiagnosed. Most labs use male-derived reference ranges. The International Society for the Study of Women's Sexual Health (ISSWSH) recommends clinical diagnosis based on symptoms alongside laboratory values, not lab values alone.

Treatment Options for Low Testosterone in Women

Testosterone Therapy

The most direct treatment is testosterone replacement, which in women is typically prescribed at much lower doses than in men. Options include:

• Topical creams or gels — applied to the inner thigh or labia; provides steady absorption and is the most commonly prescribed form for women
• Pellet therapy — subcutaneous implants that release testosterone over 3–6 months; provides consistent levels but requires an in-office procedure
• Testosterone patches — not currently FDA-approved in the US for women, but Intrarosa (prasterone) is approved for dyspareunia and converts to testosterone locally

A 2019 systematic review in The Lancet Diabetes & Endocrinology found that testosterone therapy significantly improved sexual function in women, including desire, arousal, orgasm, and overall satisfaction, with a favorable safety profile when used at physiologic doses.

DHEA Supplementation

DHEA (dehydroepiandrosterone) is a precursor hormone that converts to testosterone in peripheral tissues. Intravaginal DHEA (brand: Intrarosa) is FDA-approved for dyspareunia in menopausal women. Oral DHEA supplements are available but have variable conversion and weaker evidence.

Lifestyle Modifications

While lifestyle changes alone rarely fully correct clinical testosterone deficiency, they can meaningfully support hormonal health:

• Resistance training — the most effective lifestyle intervention for supporting testosterone levels
• Sleep optimization — testosterone is produced primarily during deep sleep; inadequate sleep accelerates decline
• Stress management — chronic cortisol elevation suppresses androgen production
• Zinc and vitamin D — deficiencies in both are associated with lower testosterone; supplementation may modestly improve levels
• Body weight management — adipose tissue converts androgens to estrogen, reducing effective testosterone

Addressing Contributing Factors

If oral contraceptives are contributing to low testosterone, switching to a non-hormonal method or a low-SHBG option may help. If adrenal insufficiency is identified, appropriate adrenal support should be prioritized.

Is Testosterone Therapy Safe for Women?

When used at physiologic doses (i.e., doses that restore testosterone to the normal female range rather than supraphysiologic levels), testosterone therapy appears safe in short-to-medium-term studies. The primary concerns include:

• Virilization — acne, facial hair, voice deepening, clitoral enlargement. These are dose-dependent and largely reversible.
• Polycythemia — elevated red blood cell count; monitored via periodic blood work
• Cardiovascular effects — long-term data are limited; ongoing monitoring is recommended
• Breast cancer — current evidence does not suggest testosterone increases breast cancer risk at physiologic doses, but research is ongoing

The key is working with a knowledgeable provider who monitors levels and symptoms regularly, adjusting dosing as needed.

When to See a Doctor

If you're experiencing persistent fatigue, low libido, mood changes, or other symptoms described above — especially if they're affecting your quality of life — it's worth discussing testosterone testing with your physician. Don't accept "everything looks normal" without asking specifically about free testosterone and SHBG.

Telehealth providers like Truventa Medical can evaluate your symptoms, order appropriate lab work, and develop a personalized treatment plan — all without the wait of a traditional specialist appointment.