Sarah sat on the edge of her bed, the morning light barely filtering through the curtains. Another day, and that familiar, heavy blanket of tiredness was already settling in. “It’s not just tired,” she’d told me in the clinic, “it’s… an absence. Like my get-up-and-go just got up and went.” And her spark, that easy laugh her husband missed? That felt distant too. It’s a story I hear, in different ways, from women who just don’t feel like themselves anymore. Sometimes, we find ourselves exploring the possibility of low testosterone in women.
So, what exactly is testosterone? Most folks think of it as a ‘male’ hormone, and yes, men do have a lot more of it. But it’s an androgen, or sex hormone, that everyone’s body makes – women included! We just need it in smaller amounts. Your ovaries, adrenal glands (those little glands on top of your kidneys), and even other cells chip in to produce it.
Think of hormones like tiny messengers zipping around, telling your body what to do. Testosterone in women plays a part in your:
- Sex drive (your libido)
- Keeping your bones and muscles healthy
- Your mood and energy levels
- Even your menstrual cycle and fertility.
Now, here’s the tricky bit. What ‘low’ means isn’t always clear-cut, and honestly, we’re still learning a lot about how testosterone works in women. Levels naturally start to dip as we head into our 30s and beyond. But sometimes, they can be lower than expected for your age, and that’s when we might start looking closer.
What Might You Notice with Low Testosterone in Women?
If your testosterone levels are on the lower side, you might experience a few things. It’s different for everyone, of course. But some common feelings or changes I hear about include:
- A real dip in your sex drive – just not interested like you used to be.
- Feeling constantly tired or lacking energy, even after a good night’s sleep.
- Maybe noticing a bit of muscle weakness or finding it harder to stay strong.
- If you’re trying to conceive, sometimes infertility can be a clue.
- Your periods might become irregular.
- Some women mention vaginal dryness, which can be uncomfortable.
- Changes in mood, like feeling down (depression) or more worried (anxiety).
- Your hair might seem thinner.
- Skin feeling drier than usual.
- Trouble sleeping through the night.
It’s a bit of a mixed bag, isn’t it? And many of these can be due to other things too, which is why it’s good to chat if something feels off.
Why Might Testosterone Levels Dip?
So, what can cause these levels to drop? Well, one of the biggest reasons is simply getting older, especially as you approach and go through menopause. By that time, your testosterone can be about half of what it was.
If a woman has had her ovaries removed (an oophorectomy), that’s another significant factor, since the ovaries make a good chunk of your testosterone.
But there are other reasons too. Things like:
- Turner syndrome, a genetic condition affecting ovarian development.
- A tumor on the pituitary gland (the master hormone controller in your brain).
- Treatments like chemotherapy or radiation.
- Ovarian insufficiency, where the ovaries aren’t working as they should.
- Adrenal insufficiency (you might have heard of Addison’s disease).
- Malnutrition, perhaps from conditions like anorexia or just not getting enough nutrients.
- Hyperprolactinemia, which is when you have too much of a hormone called prolactin.
- Something called hypothalamic amenorrhea – this can happen when extreme stress, significant weight loss, or very intense exercise makes your periods stop.
- Premature menopause, meaning menopause before you hit 40.
Certain medications can also play a role. We’re talking about things like some hormonal contraceptives, corticosteroids, antiandrogen medications (drugs that block testosterone), oral estrogen therapy, and even opioids.
And, less commonly, some people just have a genetic setup that makes it harder for their body to make or use DHEA and DHEA-S. These are substances that your body can convert into testosterone.
Figuring It Out and What We Can Do
If you come to me with some of these symptoms, the first thing we’ll do is just talk. I’ll want to hear your story, understand what you’re experiencing, and go over your medical history. Then, we’ll do a physical check-up.
To get a clearer picture of your hormone levels, we usually rely on a blood test. Now, measuring testosterone in women can be a bit finicky. Your hormone levels can swing up and down throughout your menstrual cycle, and even change from morning to evening. So, if you’re still having periods, there’s often a specific time in your cycle that’s best for this test.
Honestly, diagnosing low testosterone in women can be challenging. Why? Because those symptoms we talked about? They can also point to other things like thyroid issues, depression, or even low iron (anemia). Plus, there isn’t one single ‘normal’ testosterone number for all women – it really depends on your age, as levels naturally decline.
What About Treatment?
This is where the conversation gets even more nuanced. Treatment for low testosterone in women is… well, it’s a bit controversial. The truth is, it hasn’t been studied as much in women as it has in men. The U.S. Food and Drug Administration (FDA) hasn’t actually approved any specific testosterone treatments for women.
Often, if treatment is considered, it’s similar to how it’s done for men, but that can be tricky because women need much, much lower doses.
If we do explore treatment, testosterone can come in a few forms:
- Injections
- Tiny pellets placed under the skin
- Creams or gels
- Patches
- Pills or capsules
Some women also consider taking DHEA supplements. Remember how DHEA is a building block for testosterone? The idea is that taking DHEA might help your body make more. But, DHEA is sold over-the-counter and isn’t regulated by the FDA, so quality can vary.
Important Considerations and Risks
It’s really important to know that many respected medical groups and doctors are cautious about treating low testosterone in women unless very specific conditions are met. If you do decide to try testosterone therapy, we’d need to monitor you very closely for side effects. These could include:
- Acne breakouts
- Hair thinning in a male-pattern baldness way
- Excess hair growth on the face or body
- A deepening of your voice
- An enlarged clitoris
This isn’t to scare you, but to be open and honest. We’ll discuss all the potential pros and cons for you specifically. It’s always a shared decision.
Take-Home Message: Key Things to Remember About Low Testosterone in Women
Okay, that was a lot of information! If you’re feeling a bit overwhelmed, here are the main things I’d like you to take away:
- Testosterone is normal for women: We all have it, just in smaller amounts than men. It’s important for sex drive, bone/muscle health, mood, and energy.
- Symptoms can be vague: Things like fatigue, low libido, or mood changes can be due to low testosterone in women, but also many other things.
- Diagnosis isn’t always straightforward: A blood test helps, but interpreting the results needs care, as ‘normal’ varies and levels fluctuate.
- Treatment is a careful discussion: There are options, but they aren’t FDA-approved for women and come with potential risks we need to weigh together.
- Talk to your doctor: If you’re not feeling yourself and suspect your hormones might be involved, please reach out. We can explore it together.
You’re not alone in wondering about these changes. We’re here to listen and help you find answers and feel more like yourself again. Take care.