Testosterone is often characterized as a male hormone, yet it is significant and active in the female body, produced primarily by the ovaries and adrenal glands. While women naturally maintain much lower levels than men, this androgen plays a fundamental role in overall health and well-being. When a woman’s testosterone levels drop below the optimal range, debilitating symptoms can occur, which are frequently misattributed to other conditions or dismissed as aging. Understanding the specific signs of this hormonal imbalance is the first step toward regaining physical and psychological health.
How Testosterone Functions in the Female Body
Testosterone serves multiple functions beyond the reproductive system, maintaining body composition and metabolic health. It supports the maintenance of muscle mass, contributing to strength and physical energy levels. The hormone also plays a protective role in skeletal integrity by helping to sustain bone density, which is important as women age.
This androgen is linked to energy metabolism, influencing how the body processes and utilizes energy from food sources. Adequate levels contribute to a balanced mood and a sense of well-being, regulating emotional responses and cognitive function. Within the reproductive system, testosterone is a precursor to estrogen and a driver of sexual desire and response.
Recognizing the Physical and Psychological Signs
The physical manifestations of low testosterone can impact a woman’s daily life, beginning with a pervasive feeling of exhaustion that sleep does not resolve. This chronic fatigue is often accompanied by a decrease in muscle strength and tone, making regular activities feel more strenuous. A reduction in lean muscle mass can lead to unexplained weight gain, particularly around the midsection.
Physical changes can also extend to the skin and hair, resulting in thinning hair on the scalp and dry, brittle skin. Low testosterone is associated with a decrease in bone mineral density, which increases the risk of developing osteoporosis and fragility fractures.
The psychological and cognitive effects of low testosterone are equally disruptive, often presenting as a pervasive mental dullness commonly referred to as “brain fog.” Women may struggle with difficulty concentrating, a reduced attention span, and problems with short-term memory recall. This cognitive impairment can affect performance in both professional and personal settings.
Emotional symptoms frequently include a persistent low mood, irritability, and a lack of motivation. These mood changes are not always severe enough to meet the criteria for clinical depression but represent a distinct departure from a woman’s typical emotional state.
The impact on sexual health is one of the most commonly recognized symptoms, manifesting as a loss of libido or reduced sexual desire. This decrease in interest is often paired with a diminished ability to achieve orgasm and a reduction in the intensity of sexual pleasure. Low androgen levels can also contribute to vaginal dryness, which makes intercourse uncomfortable or painful.
Common Factors That Lead to Low Levels
Testosterone levels in women naturally begin a gradual decline starting in their late twenties and early thirties, accelerating significantly during the transition into menopause. As the ovaries decrease their production of reproductive hormones, both estrogen and testosterone diminish. The surgical removal of the ovaries (oophorectomy) causes an immediate and dramatic drop in testosterone production, often resulting in more acute symptoms than natural aging.
Certain medical conditions that affect the endocrine system can also be the root cause of low testosterone. Adrenal insufficiency, such as Addison’s disease, impairs the adrenal glands’ ability to produce androgens. Similarly, disorders affecting the pituitary gland, such as hypopituitarism, can disrupt the signaling necessary for the ovaries and adrenal glands to manufacture hormones.
The use of specific medications represents another factor in lowering available testosterone. Oral estrogen therapy, often prescribed for menopausal symptoms, can increase the production of Sex Hormone Binding Globulin (SHBG) in the liver. Since SHBG binds to testosterone, it makes the hormone biologically inactive, reducing the amount of free, usable testosterone in the body. Hormonal contraceptives and long-term use of corticosteroids can have a similar effect.
Medical Testing and Treatment Approaches
A woman who suspects low testosterone should consult with a specialist, such as an endocrinologist or gynecologist, to begin diagnosis. Diagnosis typically involves blood tests to measure total testosterone and, more importantly, free testosterone, which is the fraction available for the body’s tissues to use. Because testosterone levels fluctuate throughout the day and the menstrual cycle, the timing of the blood draw is a consideration, especially for premenopausal women.
Many commercially available laboratory assays are not sensitive enough to accurately measure the low concentrations of testosterone typical in women, making diagnosis challenging. Physicians must also rule out other conditions with overlapping symptoms, such as thyroid disorders, depression, and chronic fatigue syndrome, before confirming a deficiency. Testing for Sex Hormone Binding Globulin (SHBG) is routinely performed to help interpret the results of total testosterone.
If a deficiency is confirmed, treatment often involves Testosterone Replacement Therapy (TRT), which aims to restore levels to the mid-to-high normal range for premenopausal women. The preferred delivery methods are transdermal preparations, such as gels or creams, which allow for a consistent and physiological release of the hormone into the bloodstream. Pellets inserted under the skin are another option, though they do not allow for the same precise dose adjustment as topical formulations.
Treatment must be closely monitored by a healthcare provider, typically every three to six months, to assess symptom improvement and check for potential side effects. Due to the risk of androgenic side effects, such as acne or increased facial hair growth, the lowest effective dose is used and adjusted slowly. While no testosterone product is specifically approved by the U.S. Food and Drug Administration for female use, its application for women with Hypoactive Sexual Desire Disorder (HSDD) is supported by many professional medical societies.