Do Women Have Testosterone?

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.

What Does Testosterone Do in Women?

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:

Maintains libido and sex drive
Maintains bone health
Modulates aspects of brain function
Reduces pain sensation
Modulates mood
Stimulates red blood cell production
Supports fertility

Testosterone Levels 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:

Total testosterone: between 15-70 ng/dL
Free testosterone: between 1.0-8.5 pg/dL

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.

Low Testosterone in Women

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:

Low sexual desire, arousal, and responsiveness
A decline in bone density
Fatigue
Decreased motivation

Too Much Testosterone in Women

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:

Balding and increased body hair (hirsutism)
Acne
Missed periods
Infertility
Ovarian cysts
Male pattern or frontal balding
Weight gain
Blood clots
Sleep apnea
Enlarged clitoris

Testosterone Therapy for Women

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.

Symptoms Testosterone is Not Medically Indicated to Treat

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.

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:

Low libido in premenopausal women
Infertility
Cognitive function
Mood disorders
Metabolic syndrome
Osteoporosis
Fatigue
Weight gain

Recommendations for Testosterone Therapy in Women

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

Natural and Alternative Remedies

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.

Exercise improves insulin resistance, helps maintain a healthy weight, and lowers the risk of cardiovascular disease.
Resistance training may improve muscle strength associated with decreasing testosterone levels. Along with aerobic exercise, it decreases stress, the tendency to gain weight as we age, and improves heart and lung function.
Get eight hours of restorative sleep. Hormone release is tied to the circadian rhythm. Maintaining a regular sleep cycle can help support the regular release of hormones.
Try meditation or yoga to manage stress. Cortisol, the stress hormone, can affect the levels of other hormones.
Consume a healthy diet full of antioxidants and healthy sources of proteins and fats.

Disclaimer

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.

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