Testosterone in Women: Everything to Know

Testosterone is the primary steroid hormone in men and is responsible for the development of many physical characteristics that are considered male. Produced in the ovaries, testicles, and adrenal glands, the hormone also supports important functions in female physiology.

In women, testosterone drives libido, sexual response, orgasm, and overall sexual satisfaction.⁽¹⁾ The hormone also affects mood, cognitive function, lean muscle mass, and bone health.⁽²⁾ Some research suggests that testosterone may also offer protection against breast cancer.⁽³⁾

Testosterone replacement therapy (TRT) is not only for men. While it may seem like an unlikely treatment for menopause, TRT can be used to help relieve symptoms related to fluctuating hormone levels during the menopause transition. This article will explain in detail how testosterone impacts female health and how women can naturally boost testosterone levels. 

Testosterone Levels in Women: Do women need testosterone? 

While women produce less testosterone than men, it’s still a necessary hormone for their health. Starting in their mid-30s, women experience a gradual decline in hormone production.

When testosterone levels fall, it can lead to a number of distressing symptoms. Unfortunately, women and their healthcare providers don’t always recognize that fatigue, aching bones, muscle weakness, weight gain, and brain fog may be caused by low levels of testosterone.⁽⁴⁾⁽⁵⁾

What are normal levels of testosterone in women?

After puberty, testosterone levels in men are about 20 times higher than in women.⁽⁶⁾ Blood tests show that normal testosterone levels in men range from 300 to 1,000 nanograms per deciliter (ng/dL). In contrast, a normal range for women is between 15 and 70 ng/dL.⁽⁷⁾⁽⁸⁾ However, testosterone blood tests can produce varied results from one day to the next and are not required for the treatment of menopause symptoms.

Low Testosterone in Women

Testosterone belongs to a group of steroid hormones called androgens. Levels of these hormones peak in a woman’s 20s but drop significantly during perimenopause and postmenopause. Instead of leveling off, testosterone accelerates its downward momentum every year.

By the time women reach their 60s, testosterone levels have decreased by about 50% compared to their levels in their 40s. In their 40s, women’s testosterone levels are already significantly lower than in their 20s.⁽⁹⁾

Symptoms of Low Testosterone in Women

The signs of low testosterone are frequently attributed to normal aging, and while that’s true, the symptoms can become persistent and may worsen. Women with low testosterone levels may experience these symptoms:^{(2)(5)(10)(11)}

• Decreased libido

• Pain during sex

• Diminished feelings of personal well-being 

• Tiredness or fatigue

• Mood changes

• Depression or anxiety

• Weight gain

• Cognitive problems 

• Loss of muscle mass

• Osteoporosis

• Vaginal dryness

What causes low testosterone in females?

Decreased testosterone levels in females can be influenced by a number of factors:

1. Menopause
During the menopause transition, levels of estrogen, progesterone, and testosterone decline. This can lead to symptoms like night sweats, hot flashes, low energy, anxiety, and fatigue. The average age at which women enter the menopause transition is between 45 and 55.⁽¹⁵⁾

2. Oophorectomy Procedure
Testosterone is secreted by the ovaries. Surgical removal of the ovaries induces immediate menopause, resulting in a 50% drop in androgen levels for postmenopausal women who undergo an oophorectomy.⁽¹⁶⁾

3. Medications
Low testosterone levels can be related to medication use. Statins, opioids, certain chemotherapy drugs, and combination birth control pills containing both estrogen and progesterone are among the medications that can lower testosterone levels as a side effect.^{(17)(18)(19)(20)}

4. Health Conditions
Obesity, obstructive sleep apnea (OSA), and overtraining syndrome are a few different health conditions that can cause testosterone to drop. Impaired functioning of the thyroid or pituitary gland can also affect testosterone levels. Additionally, a genetic condition called Turner syndrome can result in androgen deficiency. The condition involves a genetic abnormality in which females lack one X chromosome.^(8)(21)(22) 

Low Testosterone and Women’s Sexual Health

Declining levels of estrogen, progesterone, and testosterone during menopause can give rise to sexual health problems. These hormone imbalances may contribute to clitoral atrophy, characterized by a decrease in the size and sensitivity of the clitoris.⁽¹²⁾ However, one study conducted in Italy found that women experiencing sexual dysfunction who were treated with transdermal testosterone experienced enhanced blood flow to the clitoris. Some women received both testosterone and estrogen replacement therapy.⁽¹³⁾Low testosterone levels may also play a role in hypoactive sexual desire disorder (HSDD), which is marked by a lack of sexual desire. HSDD is reported to affect over 12% of women between the ages of 45 and 64 and more than 7% of women over the age of 65.^(13)(14)

High Testosterone in Women

People with hyperandrogenism have high levels of testosterone. A study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology examined more than 7,500 women in the United States and found that over 20% of premenopausal and postmenopausal women were diagnosed with hyperandrogenism.⁽²³⁾

Signs of High Testosterone in Women

Women with high levels of testosterone may experience the following symptoms:⁽⁸⁾

• Irregular menstrual periods

• Deepening of the voice

• Decrease in breast size

• Hair thinning

• Acne and oily skin

• Increased hair growth on the face, chest, buttocks, or inner thighs (hirsutism)

• Enlarged clitoris

What causes high testosterone in females?

Hyperandrogenism is usually related to an underlying health condition or medication use. Here are some of the most common causes of high testosterone levels in females:

1. Polycystic Ovary Syndrome (PCOS)
PCOS is a frequently underdiagnosed condition characterized by elevated levels of testosterone and irregular periods. The ovaries may also become enlarged, and small cysts may develop. Influenced by genetic factors, PCOS is the most common hormonal disorder affecting women of reproductive age.⁽²⁴⁾

2. Congenital Adrenal Hyperplasia
Congenital adrenal hyperplasia is a genetic condition that causes an imbalance of hormones, including an overproduction of testosterone. The cause of the condition is typically a genetic mutation in which a person lacks a specific enzyme necessary for healthy adrenal gland function.^(8)(25)

3. Tumors of the Ovaries or Adrenal Glands
Ovarian tumors can cause the organ to produce an excess of testosterone, a condition known as ovarian overproduction of androgens. Androgen-secreting tumors can also develop in the adrenal glands, leading to elevated testosterone levels. Women with these tumors may develop male characteristics.^(26)(27) 

4. Obesity
While weight gain has been associated with low testosterone, some studies suggest a link between abdominal obesity in females and increased androgen levels. In contrast, obesity in men is typically linked to drops in testosterone.^(28)(29)(30)

5. Medications and Supplements
Some medications can increase women’s testosterone levels, such as certain antiepileptic drugs.⁽³¹⁾ The same may be true for certain supplements. A study published in the Journal of Sex & Marital Therapy demonstrated that postmenopausal women with low levels of zinc who received supplementation experienced increased testosterone levels and improvements in sexual function.^(8)(32)

Testosterone Tests for Women

Since testosterone test results can vary on a daily basis, blood work is not necessarily required for treatment necessity. However, if recommended by a doctor, several different tests exist to analyze a person’s testosterone levels. While not exclusive to women, the following four blood tests can be used if an individual displays signs of high or low testosterone.⁽³³⁾ 

• Total testosterone tests are most frequently used to measure two different types of testosterone: the amount of the hormone attached to proteins in the body and the levels of testosterone that are unattached to proteins, known as free testosterone.

• Free testosterone tests are typically used as a diagnostic tool. This blood test only measures the amount of testosterone in the body that is not attached to proteins.

• Bioavailable testosterone tests are used less frequently to analyze an individual’s free testosterone levels as well as how much testosterone is attached to albumin in the blood.

• A sex hormone binding globulin (SHBG) test may be recommended in the event that a person displays signs of abnormal testosterone levels but receives a normal total testosterone test result. An SHBG test can reveal how much testosterone is available for use in the body.

How to Increase Testosterone in Women

It’s normal for women to experience decreases in hormone production during the menopause transition. Although these natural changes can’t be avoided, there are ways for women to increase low testosterone levels. 

• Hormone replacement therapy (HRT): Hormone replacement therapy (HRT) may involve supplementation with dehydroepiandrosterone (DHEA), a hormone precursor naturally produced in the body that gets converted into testosterone.

• Regular physical activity: Vigorous exercise has been shown to temporarily increase women’s testosterone levels.⁽³⁵⁾

• Dietary modifications: Eating more beans, fatty fish, fruits, and vegetables may stimulate testosterone production.⁽³⁶⁾

• Vitamin D supplementation: Low testosterone has been associated with vitamin D deficiency. People with decreased testosterone who are deficient in vitamin D may benefit from supplementation.⁽³⁶⁾

• Amino acids: While research is limited, getting plenty of amino acids like L-arginine, whether through foods or supplements, may boost testosterone levels.⁽³⁷⁾ 

• Sleep hygiene: Sleep deprivation affects all hormones, including testosterone. Sleeping seven to eight hours every night can help maintain hormonal balance.

• Stress management: Stress increases cortisol levels, which can block testosterone production.⁽³⁸⁾

• Sexual thoughts or activity: Some research indicates that having sex can raise women’s testosterone levels. Fantasizing about sex may have similar effects, though these effects may be reduced by the use of hormonal contraceptives.⁽³⁹⁾

• Reducing alcohol consumption: While most research has been conducted on men, increased alcohol intake has been linked to drops in testosterone. Minimizing alcohol consumption may help keep hormone levels balanced.⁽⁴⁰⁾

Just as estrogen and progesterone are essential to women’s health, so is testosterone. The hormone plays a role in increasing muscle mass, which supports weight management and prevents the accumulation of fat in the belly and back that often occurs as women age. Increased muscle mass also boosts metabolism.

Women with low testosterone may experience dips in energy or fatigue. Testosterone stimulates red blood cell production and helps stabilize iron levels.⁽⁴¹⁾ Red blood cells and iron work together to carry oxygen to the cells, and when cells don’t receive enough oxygen, fatigue can set in.

Restoring testosterone to normal levels can help reverse these trends. HRT can help relieve testosterone-related symptoms in women, leading to improvements in mood, confidence, and overall health.