Androgens are a class of hormones that include testosterone and dehydroepiandrosterone (DHEA). While often associated with male development, these hormones are also produced in the female body by the ovaries and adrenal glands. They are precursors to other hormones like estrogen and are involved in numerous bodily processes beyond reproduction, making them an important part of female health.
The Role and Symptoms of Low Androgens
Androgens contribute to a woman’s overall health and well-being. These hormones help regulate sexual function, including libido and arousal, and are involved in the maturation of ovarian follicles. Beyond reproductive health, they help maintain lean muscle mass, bone density, mood, and energy levels, while also influencing metabolic regulation and cognitive abilities.
A deficiency in androgens can manifest through a range of symptoms. One of the most frequently reported is a noticeable decrease in sexual desire or libido, and women may also experience reduced sexual satisfaction and arousal. These changes can impact intimacy and overall quality of life.
Physically, persistent and unexplained fatigue is a common complaint. This can be accompanied by a loss of muscle mass and strength, even with regular physical activity. Some women may also notice changes such as thinning hair or an increased susceptibility to bone density loss.
The psychological effects can be subtle but impactful. Many women report a diminished sense of well-being, mood swings, or feelings of apathy. Cognitive issues, often described as “brain fog,” can also occur, affecting concentration and mental clarity.
Causes of Female Androgen Deficiency
Several factors can cause declining androgen levels in women. The most common reasons include:
- Natural aging, as hormone production peaks in a woman’s 20s and begins a gradual, lifelong decline. By menopause, androgen levels may be half of what they were at their peak.
- Surgical removal of the ovaries (oophorectomy), which leads to an abrupt and significant drop in androgen levels since the ovaries produce about half of the body’s supply.
- Medical conditions affecting the adrenal glands, another source of androgen production. Conditions such as adrenal insufficiency can lead to lower levels of hormones like DHEA.
- The use of specific medications. Oral contraceptives can increase the production of a protein that makes testosterone inactive, and glucocorticoids can suppress the body’s natural androgen production.
Diagnosing Androgen Deficiency
Diagnosing androgen deficiency in women is a complex process that does not rely on a single test. A healthcare provider begins with a thorough evaluation of a patient’s symptoms, such as low libido and fatigue, as they can overlap with other conditions like depression or thyroid issues.
To support the clinical findings, blood tests are used to measure hormone levels. These tests assess total testosterone and sometimes free testosterone, which is the portion not bound to proteins and is readily available for the body to use. The timing of these tests is important, as hormone levels can fluctuate throughout the menstrual cycle.
A significant challenge is the lack of a universally accepted definition of “low” testosterone in women. Unlike with men, there are no clear guidelines or standardized normal ranges, which can make interpreting blood test results difficult. A diagnosis often depends on the combination of symptoms and a physician’s clinical judgment after ruling out other causes.
Approaches to Management and Treatment
The primary medical intervention for androgen deficiency is testosterone therapy. For women, this therapy is administered in much lower doses than those used for men and is typically applied as a cream, gel, or through pellets inserted under the skin. The goal is to restore testosterone levels to a normal physiological range for women. Oral testosterone is not recommended due to potential negative effects on liver health and cholesterol.
Another option is supplementation with DHEA, a precursor hormone that the body can convert into testosterone. DHEA therapy can help increase circulating androgen levels and may improve energy and libido, particularly in women with adrenal insufficiency. Its use should be medically guided.
A notable aspect of testosterone therapy is that many countries lack government-approved products specifically for women. This leads to the “off-label” use of male formulations, where a doctor prescribes a product approved for men but at a carefully adjusted lower dose for a female patient.
Medical supervision is necessary throughout any treatment for androgen deficiency. Regular monitoring of hormone levels and clinical symptoms is necessary to ensure the dosage is correct and to watch for potential side effects like acne, unwanted hair growth, or voice deepening.