Low testosterone in women: Signs, causes, and treatments

What testosterone does in the female body

Testosterone is classified as an androgen (a “male-type” hormone), but women produce it too mainly in the
ovaries and adrenal glands. Even though women have far less testosterone than men, it still plays a major role
in health and wellbeing.

Key jobs of testosterone in women include:

• Sexual function: Helping regulate libido, arousal, and sexual satisfaction.
• Energy and motivation: Supporting overall vitality and drive.
• Muscle and bone health: Contributing to muscle mass and bone density, especially with aging.
• Mood and cognition: Influencing focus, memory, and emotional wellbeing.
• Hormonal balance: Working together with estrogen and progesterone to support cycles and fertility.

When testosterone levels drop significantly below what’s normal for your age and life stage, some women may
start to notice changes although not everyone with lower levels will have obvious symptoms.

Signs and symptoms of low testosterone in women

The symptoms of low testosterone in women are often subtle and nonspecific. Having one or two of these doesn’t
automatically mean your testosterone is low but a pattern of several symptoms that can’t be explained by
something else is worth discussing with a clinician.

Physical signs

• Persistent fatigue or sluggishness, even after rest
• Muscle weakness or loss of muscle tone
• Increased body fat or weight gain, especially around the midsection
• Decreased bone density or higher risk of fractures over time
• Thinning hair, sometimes including less pubic or underarm hair
• Sleep disturbances, such as trouble falling or staying asleep
• Hot flashes or night sweats in some women, particularly around menopause

Studies suggest that low androgens may contribute to decreased muscle mass and bone density, especially in
women with surgical menopause or pituitary or adrenal disorders.

Sexual symptoms

• Low libido or reduced interest in sex
• Difficulty becoming aroused
• Less intense or less frequent orgasms
• Vaginal dryness that can make sex uncomfortable
• Decreased sexual satisfaction overall

Androgen insufficiency is estimated to play a role in a substantial portion of female sexual dysfunction,
including reduced desire and arousal.

Emotional and cognitive symptoms

• Low mood, increased irritability, or a sense of “blah”
• Anxiety or feeling on edge
• Brain fog, memory lapses, or difficulty concentrating
• Reduced motivation or sense of wellbeing

These emotional and cognitive changes can easily be blamed on stress or life circumstances, but in some women
they may be part of a broader hormone picture that includes lower testosterone.

Remember: these symptoms are not unique to low testosterone. Thyroid disease, chronic stress, depression,
anemia, sleep apnea, and other conditions can look very similar. That’s why self-diagnosing based on a symptom
list (or a random ad) is risky. A thorough medical evaluation matters.

Common causes and risk factors

There isn’t just one cause of low testosterone in women. Often, it’s a combination of age, medical conditions,
medications, and overall health.

Natural hormonal changes

• Perimenopause and menopause: Testosterone levels gradually decline with age and often
  fall further during the transition to menopause and after the ovaries stop releasing eggs.
• Surgical menopause: Removal of the ovaries (oophorectomy) can sharply reduce both estrogen
  and testosterone levels, sometimes leading to more abrupt symptoms.

Underlying medical conditions

• Pituitary problems (hypopituitarism): The pituitary gland helps control hormone production
  in the ovaries and adrenal glands. When it’s not working properly, androgen levels can drop.
• Adrenal insufficiency: The adrenal glands also produce androgens, so adrenal disorders can
  contribute to low testosterone.
• Premature ovarian insufficiency or damage to the ovaries: This can be due to genetics,
  autoimmune disease, chemotherapy, radiation, or surgery.
• Chronic illnesses: Long-term illnesses, significant weight loss, eating disorders, or severe
  stress on the body can affect hormone production.

Medications that may lower testosterone

Certain medications can influence androgen levels or how your body processes them, including:

• Some hormonal contraceptives
• Chronic corticosteroid use
• Antiandrogen medications
• Oral estrogen therapy
• Long-term opioid use

Lifestyle and overall health factors

Hormones don’t exist in a vacuum. Factors like chronic stress, poor sleep, under-fueling (very low-calorie
diets), extreme endurance training, or long-term illness can influence how your body produces and responds to
testosterone. While these may not show up as “low testosterone” on a lab test every time, they often interact
with your hormone system and symptoms.

How low testosterone is diagnosed

Diagnosing low testosterone in women is not as simple as ordering a single test and calling it a day. In fact,
major endocrine guidelines warn against diagnosing “androgen deficiency” based only on lab numbers. Symptoms and
clinical context matter just as much, if not more.

Clinical evaluation

A healthcare professional will usually start with:

• A detailed medical history (symptoms, menstrual history, surgeries, medications, stress, lifestyle)
• A physical exam, including signs of hormone imbalance or other conditions
• Screening for other common causes like thyroid disease, anemia, depression, or sleep disorders

Blood tests

If low testosterone is suspected, a clinician may order blood tests that can include:

• Total testosterone (and sometimes free testosterone)
• Sex hormone–binding globulin (SHBG)
• Other hormones, such as estradiol, FSH, LH, DHEA-S, thyroid hormones, and prolactin

In premenopausal women, blood is often drawn in the morning and timed to a certain part of the menstrual cycle
because hormone levels fluctuate. Even then, levels are naturally low, and assays aren’t always standardized, so
interpreting results is challenging. That’s why guidelines do not recommend routine testosterone testing in all
women with vague symptoms.

One more caution: direct-to-consumer hormone tests and online “diagnosis” tools may oversimplify complex
hormone issues. It’s safer to review your symptoms and any lab results with a qualified health professional.

Evidence-based treatments for low testosterone in women

Once in a while, social media makes it sound like every tired, stressed, low-libido woman simply needs a dash of
testosterone and all will be well. Reality is more complicated.

Medical organizations are quite cautious about testosterone therapy in women. The best evidence so far supports
a narrow use: treating postmenopausal women with low sexual desire that causes distress (called hypoactive
sexual desire disorder or HSDD), after other possible causes have been addressed.

Testosterone therapy: what we know

Research shows that carefully dosed testosterone therapy can modestly improve sexual desire and satisfaction in
some postmenopausal women with HSDD. This is usually done using low-dose transdermal formulations (such as gels
or patches) adjusted to keep levels within the normal female range.

Important points to understand:

• No FDA-approved female-specific products (yet): In the United States, there are currently no
  testosterone products officially approved specifically for women, so treatment is often “off-label” using
  carefully modified male products or compounded formulations.
• Dose matters a lot: Too much testosterone can cause acne, unwanted facial or body hair,
  scalp hair thinning, voice deepening, and changes in cholesterol.
• Monitoring is key: Clinicians typically check symptoms, side effects, and blood levels
  regularly, aiming for the physiologic female range and using the lowest effective dose for the shortest
  necessary time.
• Long-term safety is still being studied: We still lack robust long-term data on heart health,
  breast cancer risk, and other outcomes in women on testosterone therapy, which is why guidelines remain
  conservative.

Non-hormonal strategies and lifestyle changes

Not every woman with symptoms needs or wants hormone therapy. Many will benefit from a broader plan that
addresses the different pieces contributing to low energy or low libido:

• Review current medications: If medications such as certain contraceptives, opioids, or
  steroids might be playing a role, your clinician may consider adjusting them when appropriate.
• Address mental health: Anxiety, depression, and relationship stress can absolutely affect
  desire and energy. Therapy, couples counseling, or sex therapy may help.
• Sleep and stress management: Chronic sleep deprivation and high stress throw off many
  hormones, not just testosterone. Simple changes (regular sleep time, limiting screens at night, stress
  reduction techniques) can make a bigger difference than they sound like.
• Movement and resistance training: Strength training helps build muscle, support bone health,
  and improve mood all of which can enhance overall wellbeing and possibly help with some symptoms linked to
  low androgens.
• Relationship and sexual education: For low libido and sexual dissatisfaction, a combination
  of education, communication, and sometimes counseling is often part of a comprehensive treatment plan.

Supplements and “hormone boosters”

Over-the-counter “testosterone boosters” and herbal blends marketed to women can be tempting, especially if they
promise instant energy, better sex, and a flat stomach by next Tuesday. The reality:

• Most haven’t been well studied in women.
• Some can interfere with other medications or lab tests.
• A few may actually contain unlisted hormones or drugs.

Always talk with a healthcare professional before starting supplements for hormone health. “Natural” doesn’t
automatically mean safe or effective.

Everyday steps to support hormone and overall health

You can’t fully “biohack” your testosterone levels with lifestyle alone, but simple habits support your entire
hormone network and may soften some of the symptoms associated with low androgens.

• Prioritize sleep: Aim for 7–9 hours of high-quality sleep. Hormone production and regulation
  rely heavily on your sleep–wake rhythm.
• Eat enough and eat regularly: Extremely restrictive dieting can disrupt hormone production.
  A balanced pattern of protein, healthy fats, and complex carbs supports energy and muscle health.
• Lift something heavier than your phone: Resistance training two to three times per week can
  help maintain muscle mass, bone density, and metabolic health.
• Manage stress in realistic ways: You don’t need a perfect wellness routine, but small,
  repeatable practices (short walks, brief breathing exercises, journaling, or setting boundaries) can reduce
  chronic stress loads.
• Track your symptoms: Keeping a simple symptom journal (energy, mood, sleep, libido, cycle
  changes) can help you and your provider see patterns over time.

These steps won’t replace medical care for significant hormone deficiencies, but they can make any treatment
plan more effective and help you feel more in control of your health.

Lived experiences and practical insights

While research and guidelines are critical, the day-to-day reality of living with low testosterone can’t always
be captured in lab values or clinical terms. The following composite stories are based on common experiences
reported by women not on any one real person but they illustrate what this journey can feel like.

Case 1: “I thought I was just burnt out”

Imagine a 39-year-old woman juggling a full-time job, kids, and aging parents. She notices that her energy is
constantly in the basement. Workouts feel harder. Her interest in sex has quietly faded, and she chalks it up to
stress and being “too busy.” Over time, she starts to feel guilty like something is wrong with her or her
relationship.

When she finally talks to her clinician, they dig deeper: sleep patterns, work stress, medications, mental
health, menstrual changes. After ruling out thyroid issues and iron deficiency, her provider notes that her
symptoms could be related to a combination of early perimenopause, chronic stress, and possibly low androgens.
The solution isn’t a magic injection; it’s a mix of better sleep, therapy for burnout, and, only after careful
evaluation, a discussion about whether low-dose hormone therapy makes sense.

Case 2: “Surgical menopause hit like a freight train”

Picture a woman in her mid-40s who has her ovaries removed due to a high genetic cancer risk. Overnight, her
estrogen and testosterone levels plummet. She notices hot flashes, night sweats, brain fog, and a sudden loss of
sexual desire. Her body feels foreign.

In this case, her care team explains that she’s experiencing surgical menopause, which often comes with a more
abrupt hormone shift than natural menopause. They talk through options: estrogen therapy, lifestyle changes, and
when her low sexual desire becomes distressing a careful trial of low-dose testosterone under close
monitoring. Alongside this, she joins a support group and realizes she isn’t “failing at coping”; her hormones,
life stress, and emotions are all part of the same story.

Case 3: “I was promised a miracle by an ad”

Another common experience: a woman sees an advertisement claiming that a “hormone optimization clinic” can fix
her energy, libido, and weight with one-size-fits-all testosterone pellets. She’s tired of feeling exhausted and
dismissed, so she signs up.

At first, she feels a boost more energy, higher sex drive. But soon, she develops acne, increased facial hair,
and mood swings. Her levels were never closely checked, and the dose wasn’t adjusted. Eventually, she ends up
back in a traditional clinic, where she has a frank discussion about safe dosing, realistic expectations, and
guideline-based care.

What these stories have in common

Across these scenarios, several themes show up again and again:

• Symptoms are real, even when labs are confusing: Many women feel dismissed when their blood
  tests look “normal.” A good clinician listens to your experience and looks at the whole picture.
• Quick fixes are rarely the full answer: Testosterone may help in specific situations, but
  it’s not a universal cure for stress, relationship issues, or burnout.
• Collaboration works better than passive care: Women who track symptoms, ask questions, and
  speak up about side effects tend to get more tailored, safer treatment plans.
• Emotional impact matters: Changes in libido, energy, or mood can affect self-esteem and
  relationships. It’s okay to seek counseling or couples therapy as part of your care.

Perhaps the biggest takeaway from these experiences is this: if you suspect low testosterone or another hormone
imbalance, you’re not “being dramatic” or “just getting older.” Your concerns are valid. Bringing them to a
qualified healthcare professional and being honest about your symptoms, your goals, and your worries is a
powerful first step.

And if a clinic promises to solve all your problems with one unmonitored hormone shot or pellet? That’s your cue
to ask many more questions… or to walk away.

When to seek medical help

You should consider talking with a healthcare professional if you notice:

• Persistent low energy that doesn’t improve with rest
• Markedly reduced libido that bothers you or affects your relationship
• Unexplained mood changes, brain fog, or sleep problems
• New or worsening vaginal dryness, pain with sex, or decreased sexual satisfaction
• History of surgical menopause or hormone-related conditions plus new symptoms

A clinician can help rule out other causes, determine whether low testosterone or broader hormonal changes are
playing a role, and discuss safe, evidence-based options. Online information (including this article) is helpful
for understanding your body but it’s not a substitute for personalized medical advice.

Conclusion

Low testosterone in women is real, but often misunderstood. Testosterone is not just a “male hormone” it
supports libido, mood, muscle and bone health, and overall wellbeing in women too. When levels drop, some women
may feel more tired, less interested in sex, and less like themselves.

The good news: you don’t have to navigate this alone, and you don’t need to choose between “suffering in
silence” and “jumping into risky treatments.” With a thoughtful evaluation, a realistic look at lifestyle
factors, and in specific cases carefully monitored hormone therapy, many women find meaningful improvement.

If your inner voice is saying, “Something feels off,” it’s worth listening. Bring your questions, your symptom
list, and your curiosity to a trusted healthcare professional. Your hormones don’t define you, but understanding
them can absolutely help you feel more like yourself again.