Androgens are a group of sex hormones present in both males and females. While often associated with male characteristics, these hormones, including testosterone and dehydroepiandrosterone sulfate (DHEA-S), are naturally produced in women by the ovaries, adrenal glands, and through peripheral conversion in fat cells. Androgens have over 200 cellular actions in women and are present in higher concentrations than estrogens. These hormones are involved in numerous bodily functions beyond reproduction, influencing overall health and well-being.
Role of Androgens in Female Health
Androgens play a multifaceted role in female health, extending beyond their function as precursors for estrogen synthesis. Testosterone, a primary androgen, contributes to maintaining sexual desire and arousal. This hormone is also involved in muscle protein synthesis, supporting muscle mass and strength, which can decline if androgen levels are low.
Dehydroepiandrosterone (DHEA) and DHEA-S are other significant androgens that contribute to bone health by supporting estrogen levels, which are important for maintaining bone density. These hormones also influence energy levels and overall vitality. Androgens interact with neurotransmitters like serotonin and dopamine, impacting mood stability and cognitive functions such as memory and concentration.
Recognizing the Signs
Low androgen levels in females can manifest through a variety of symptoms that impact daily life. A common sign is a diminished sexual desire or libido, along with reduced sexual satisfaction. Women may also experience persistent fatigue and decreased motivation.
Physical changes can include a reduction in pubic hair and a decrease in muscle strength and mass. Mood disturbances include a lowered sense of well-being, irritability, and depressive symptoms. Some women may also notice difficulty concentrating, disturbed sleep patterns, and increased susceptibility to bone loss.
Underlying Causes
Low androgen levels in females can stem from various factors, both natural and medical. A natural decline in androgen production occurs with age, with levels peaking in a woman’s 20s and gradually decreasing thereafter. By the time a woman reaches menopause, blood androgen levels can be about half of their peak.
Medical conditions can also contribute to low androgens. Adrenal insufficiency can lead to androgen deficiency. Hypopituitarism and the surgical removal of ovaries (bilateral oophorectomy) can also cause a significant reduction in androgen levels.
Certain medications can affect androgen levels. Long-term use of oral estrogen therapy, including some oral contraceptives, can indirectly lower free testosterone levels by increasing sex hormone-binding globulin (SHBG), a protein that binds to androgens and makes them inactive. Chronic stress can also play a role by influencing hormone regulation.
Diagnosis and Management
Diagnosing low androgen levels in females involves a review of medical history and a physical examination. Since symptoms can be vague and overlap with other conditions like depression or thyroid disease, a healthcare provider will often rule out these possibilities first. Blood tests are used to measure androgen levels, including total testosterone, free testosterone, and DHEA-S.
While blood tests provide valuable information, there are currently no universally accepted guidelines for “low” testosterone levels in females, and results can vary by laboratory. For women who are still menstruating, the timing of the blood test may be adjusted as androgen levels can fluctuate throughout the menstrual cycle.
Management strategies for low androgens are varied and tailored to the individual. Lifestyle adjustments are often recommended, including a balanced diet and regular physical activity to support hormonal balance. Stress reduction techniques are also beneficial, as chronic stress can disrupt hormone levels.
Addressing any underlying medical conditions, such as adrenal or pituitary disorders, is a primary step. Hormone therapies may be considered under medical supervision. Testosterone therapy, though not widely FDA-approved for women, has been used to address hypoactive sexual desire disorder in postmenopausal women. DHEA supplementation is another option, with vaginal DHEA approved for treating painful intercourse. These hormonal interventions require careful consideration of potential risks and benefits, and monitoring for side effects like acne or unwanted hair growth.