Low Testosterone in Women: Symptoms, Testing and Treatment

Low testosterone in women most often shows up as a low sex drive that is new and bothersome, sometimes with fatigue, low mood or less motivation. Women make testosterone in the ovaries and adrenal glands, and levels fall gradually with age and sharply after the ovaries are removed. The only well-proven reason to treat low testosterone in women is low sexual desire that causes distress after menopause, according to a 2019 global consensus statement. Testosterone for women is prescribed off-label at much lower doses than men use, and levels are checked with blood tests to keep them in the normal female range.

Why women need testosterone

Testosterone is often called a male hormone, but women make it too, and in larger amounts than estrogen during the reproductive years. It plays a role in:

• Sexual desire, arousal and satisfaction
• Muscle mass and strength
• Bone health
• Energy and a sense of well-being

The ovaries make about half of a woman’s testosterone and the adrenal glands and body tissues make the rest.

What causes low testosterone in women?

• Age. Testosterone declines gradually from the 20s onward. A woman in her 40s has roughly half the testosterone she had in her 20s. Natural menopause does not cause a sudden drop.
• Removal of the ovaries. Surgical menopause (oophorectomy) cuts testosterone production sharply and suddenly.
• Oral estrogen and birth control pills. These raise sex hormone binding globulin (SHBG), which binds testosterone and leaves less of it free to act.
• Adrenal or pituitary problems, such as adrenal insufficiency or hypopituitarism.
• Chemotherapy or radiation affecting the ovaries.
• Some medications, including corticosteroids and opioids.

Fatigue, low mood and brain fog are common in midlife for many reasons, including poor sleep, thyroid problems, low iron, depression, perimenopause and stress. That is why symptoms alone are not enough to diagnose low testosterone.

Low testosterone or something else?

Before treating low libido with testosterone, a good evaluation looks at:

• Vaginal dryness and painful sex, which often respond to vaginal estrogen
• Relationship stress, depression and anxiety
• Medications that lower libido, such as some antidepressants
• Sleep, thyroid function and iron levels
• Perimenopause and menopause symptoms such as hot flashes and night sweats

How is low testosterone tested in women?

Blood tests usually include:

• Total testosterone, ideally a morning draw
• SHBG, to estimate how much testosterone is free and active
• Often estradiol, FSH, thyroid tests and a complete blood count, depending on your symptoms

Female testosterone levels are low and lab ranges vary, so a single number does not diagnose a “deficiency.” Labs are most useful before treatment, as a baseline, and during treatment, to make sure levels stay in the normal premenopausal range. See our guide to hormone testing for women.

Testosterone therapy for women

What the evidence says

A 2019 Global Consensus Position Statement on the Use of Testosterone Therapy for Women, endorsed by menopause and endocrine societies around the world, concluded that testosterone can improve sexual desire, arousal, orgasm and satisfaction in postmenopausal women with hypoactive sexual desire disorder (HSDD). It found not enough evidence to use testosterone for mood, energy, cognition, bone or muscle alone.

Forms of testosterone

There is no testosterone product approved by the FDA for women in the United States, so providers prescribe it off-label. Common options include:

• Creams or gels applied to the skin, either compounded at a female dose or a small, measured fraction of a male product
• Pellets placed under the skin every few months, which require careful dosing and lab checks
• Injections, used less often in women

Testosterone is often added to estrogen and progesterone therapy rather than used alone.

Side effects

At female doses, side effects are usually mild. The most common are:

• Acne or oily skin
• More hair growth where testosterone is applied, or on the face

At doses that are too high, women can develop scalp hair thinning, a deeper voice or clitoral enlargement, and some of these changes may not reverse. That is why regular follow-up and blood levels matter.

Testosterone is not used during pregnancy or breastfeeding, and women with hormone-sensitive cancers need a careful discussion with their oncologist first.

How long until it works

Most women who respond notice a difference in sexual desire within 3 to 6 months. If there is no benefit after 6 months, the consensus statement recommends stopping.

Testosterone for women in Owasso

At Pathway Health & Beauty, Tia Christ, APRN-CNP, evaluates women with low libido and low energy as part of a full hormone and health review, with labs before and during treatment. Learn more about testosterone for women, hormone replacement for women and hormone pellets. Call or text 918-973-4575 for a free discovery call.