Testosterone is commonly known as the male sex hormone, but it is also found in women in small amounts, just as estrogen is found in small amounts in men. In women, the ovaries and adrenal gland produce half of your testosterone, and the rest is produced by converting other androgens, namely androstenedione and dehydroepiandrosterone (DHEA), to testosterone.
In women, testosterone either acts directly as an androgen or is converted to estrogen. It helps maintain strong bones, plays a role in reproductive function, and supports the female sex drive. Low testosterone levels in men and high testosterone levels in women are associated with infertility.
Testosterone can exert its effect directly or be converted to dihydrotestosterone (a more potent androgen) or estrogen before acting. Testosterone is converted to dihydrotestosterone in the skin, sweat glands, hair follicles, and genital skin. It is converted to estrogen in the brain, bone, fat tissue, skin, blood vessels, ovaries, and placenta.
Testosterone has the following effects in women:
Testosterone production in girls begins between the ages of 6 and 8. During puberty, testosterone levels fluctuate according to the menstrual cycle. Testosterone levels appear to vary throughout the day, with higher levels in the morning. Women have their peak testosterone levels in their 30s and 40s, followed by a steady decline with aging. This decline is not associated with menopause. Instead, it may be associated with decreased testosterone production in the ovaries and adrenal glands. Levels fall by roughly one-third.
About two-thirds of testosterone is bound to sex hormone-binding globulin (SHBG), with the remaining one-third bound to albumin. Small amounts of free testosterone are also present. When SHBG levels are low, testosterone is more quickly cleared from the blood. The inverse is also true. However, there is no strong correlation between blood testosterone levels and the effects of testosterone in your body tissues.
Normal testosterone levels in women:
The Australian Menopause Society recommends measuring total testosterone levels rather than free testosterone levels. This is because the purpose of measuring testosterone levels should not be to diagnose low levels but rather to avoid inadvertently giving testosterone to women with high levels before treatment.
Read More: Understanding High Testosterone Levels
In addition to a natural decline in testosterone levels with aging, low testosterone levels in women can be caused by an underactive pituitary gland, Addison’s disease, loss of ovarian function through disease or surgery, and a side-effect of some medications such as steroids or estrogen.
Low testosterone levels in women can lead to:
High testosterone levels in women can be caused by ovarian or adrenal gland cancer or by polycystic ovary syndrome (PCOS). In rare cases, testosterone production in the ovary may be excessive because of an abnormal sensitivity to luteinizing hormone. This condition is called hyperthecosis.
The most common cause of high testosterone levels in women is PCOS. Symptoms include:
Several societies, including the International Menopause Society and the Endocrine Society, have made recommendations regarding treating women with symptoms potentially due to abnormal testosterone levels. They acknowledge that clinicians have been recommending testosterone therapy in women for decades, despite the fact that there is no clear medical evidence in favor of doing so.
They advise against using testosterone therapy in premenopausal women. However, testosterone therapy should be considered in postmenopausal women, whether menopause occurred naturally or as a result of surgery, to restore normal levels.
Restoring natural testosterone levels is expected to increase sexual desire, arousal, orgasmic function, pleasure, and sexual responsiveness.
The Endocrine Societies do not recommend injectables, pellets, or testosterone formulations that produce higher than physiological testosterone levels.
As far as a recommendation to treat a decline in cognitive function or an increase in depression in postmenopausal women, researchers have found no evidence that testosterone supplementation improves either of these symptoms.
Read More: Cognitive Symptoms in Menopause
Small studies have suggested that testosterone therapy may help treat vaginal atrophy, especially in postmenopausal women with breast cancer. However, these studies are small in size.
The Endocrine Societies also believe that there is insufficient evidence to support the use of testosterone in women to increase or restore muscle strength or bone density.
The only studies that investigated whether testosterone supplementation improved bone density also included estrogen supplementation. Testosterone supplementation at normal physiologic doses (replacement) does not appear to affect lean body mass, total body fat, or muscle strength. More research is needed to assess any potential benefits of testosterone replacement on the musculoskeletal system.
The Endocrine Societies recommend against the use of testosterone therapy to treat:
The only medical indication for testosterone replacement therapy is in postmenopausal women who have low sexual desire due to hypoactive sexual desire disorder. This diagnosis is made after a complete medical assessment, not based on low testosterone levels.
Unfortunately, testosterone metabolism in women is extremely complex. There is little correlation between blood testosterone levels and the effect of testosterone in body tissues.
Testosterone levels should be measured in postmenopausal women experiencing sexual dysfunction due to HSDD. The goal of testing is to identify women who may have abnormally high testosterone levels. If women receive testosterone therapy for low sexual desire associated with hypoactive sexual desire disorder and there is no benefit within six months, therapy should be stopped.
Learn more about testosterone therapy options and their side effects: The problems with testosterone replacement therapies
Diagnosing low testosterone levels as a cause of mood disorders, weight gain, and fatigue is difficult because there have not been enough clinical studies that show a clear link between a drop in testosterone hormone levels and the symptoms women are experiencing. Thus, the Endocrine Society advises against treating any of these symptoms with testosterone replacement. However, there are some lifestyle modifications you can make to improve your overall health and support normal hormone function.
Read More: 7 Ways to Naturally Regulate Your Hormones
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While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.