Low Testosterone in Women
What is low testosterone in women?
Testosterone is a type of androgen hormone (or sex hormone) in your body. Hormones are chemical messengers that tell your body how to work and what to do. Everyone makes testosterone, but men and people assigned male at birth (AMAB) make the most testosterone. Women and people assigned female at birth (AFAB) also need testosterone, but at a much lower level.
Testosterone levels gradually begin to decrease as you enter your 30s. But you can experience low testosterone levels at any time in your life. Healthcare providers measure testosterone levels with a blood test.
Your ovaries, adrenal glands and other tissues and cells produce testosterone. Too little or too much testosterone can affect your overall health and impact the levels of other sex hormones in your body. The side effects of testosterone on women and people AFAB aren’t fully understood. Many treatment methods for low testosterone are unregulated and not widely studied. Only you and your healthcare provider can decide what’s best for you based on your symptoms and bloodwork.
How does testosterone affect a woman’s body?
Testosterone plays a role in a woman’s:
- Libido (sex drive or desire for sex).
- Bone and muscle health.
- Mood and energy.
- Menstrual cycle and fertility.
Symptoms and Causes
What are the symptoms of low testosterone in women?
A blood test is the only way to know if your testosterone levels are low. However, there are some common signs of low testosterone to watch for, like:
- Low sex drive (hypogonadism).
- Lack of energy and feeling tired.
- Loss of strength and muscle tone.
- Infertility or trouble conceiving.
- Irregular menstrual cycle.
- Vaginal dryness.
- Depression or anxiety.
- Thinning hair.
- Dry, brittle skin.
- Trouble sleeping.
Talk to a healthcare provider if you struggle with any of these symptoms. They can evaluate you and assess if testosterone levels may be responsible.
What causes low testosterone in women?
Getting older (entering menopause) is one of the largest causes of low testosterone. By the time a person reaches menopause, their testosterone levels may have decreased by half of what they once were.
People who’ve had their ovaries removed (oophorectomy) will also have low testosterone levels because their ovaries are responsible for about half of all testosterone production.
Other than age and having your ovaries removed, other causes for low testosterone include:
- Turner syndrome (a genetic condition where your ovaries don’t develop).
- Tumor on your pituitary gland.
- Ovarian insufficiency.
- Adrenal insufficiency (Addison’s disease).
- Malnutrition (like from anorexia or extreme malnourishment).
- Hyperprolactinemia (too much of the hormone prolactin).
- Hypothalamic amenorrhea (loss of your menstrual period from extreme stress, weight loss or exercise).
- Premature menopause (menopause before 40 years old).
Medications that can lower testosterone levels include:
- Hormonal contraceptives.
- Antiandrogen medications.
- Oral estrogen therapy.
Some people may also have something in their genetic makeup (their DNA) that interferes with their body’s ability to produce or process DHEA and DHEA-S. These are two compounds that convert to testosterone.
Diagnosis and Tests
How is low testosterone diagnosed?
First, your healthcare provider does a physical examination and talks to you about your symptoms and medical history. They may order blood work to check hormone levels. Many providers hesitate to diagnose low testosterone because research on the link between testosterone levels and specific symptoms isn’t well known. Low testosterone is often hard to diagnose because its symptoms mimic other conditions like depression, thyroid issues or low iron (anemia).
Measuring testosterone levels involves a blood test. Your blood test results can vary depending on when the test is taken. This is because hormone levels fluctuate throughout your menstrual cycle and even between morning and evening. If you’re still getting a period, there’s a specific window in your cycle that’s best for measuring testosterone in your blood.
What should a woman’s testosterone level be?
It depends on your age. Testosterone levels decline with age throughout a person’s life, starting in their 30s. For example, low testosterone in a 30-year-old is a different value than low testosterone in a 50-year-old. Healthcare providers don’t have a standard value for “normal” testosterone levels in women and people AFAB.
Management and Treatment
How is low testosterone treated?
Treatment for low testosterone can be controversial because low testosterone in women and people AFAB hasn’t been well-studied. The U.S. Food and Drug Administration (FDA) hasn’t approved any testosterone treatments currently. As there isn’t a standard for treatment, providers treat low testosterone in women the same way they’d treat it in men. This can be problematic because women and people AFAB require significantly less testosterone (a much lower dose of medication) than men and people AMAB.
Testosterone can come in many forms, like:
Taking DHEA pills can also be an option. As DHEA is a precursor to testosterone, taking a supplement may help your body create testosterone. DHEA is available without a prescription but isn’t regulated by the FDA.
You should discuss the risks of each treatment method with your healthcare provider before deciding. Many well-respected medical societies and healthcare experts advise against treating low testosterone in women unless specific criteria are met.
What are the risks of hormone therapy for low testosterone?
If you decide to take testosterone supplements, you’ll need close monitoring for side effects. Some of these are:
- Male-pattern baldness.
- Excess hair growth.
- Deep voice.
- Enlarged clitoris.
When should I see my healthcare provider?
Contact a healthcare provider if you think you have symptoms of low testosterone. While the causes and effects of low testosterone aren’t completely known, your healthcare provider can run tests to help figure out what’s causing your symptoms.
A note from Cleveland Clinic
Testosterone is a hormone typically associated with men, but women also need testosterone. Low testosterone may cause several symptoms. If your levels are low, it could affect other hormones in your body and cause you to feel disinterested in sex or be extra tired or weak. Testosterone also affects your menstrual cycle. Your healthcare provider can evaluate you and perform any necessary bloodwork. Some treatments for low testosterone exist, but they aren’t approved by the FDA and come with risks. Don’t start testosterone therapy unless you’ve talked to your provider and carefully weighed your options.
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