Low Testosterone in Women: Symptoms, Causes, and How to Address It

Testosterone is typically thought of as a male hormone — but it’s an essential hormone for women too, and one that declines significantly with age. Women produce testosterone in their ovaries and adrenal glands, and adequate levels are critical for energy, libido, muscle strength, bone density, cognitive function, and mood. When testosterone falls below optimal levels, the symptoms can be significant and are frequently overlooked or misattributed to stress, menopause, or depression.

Despite this, low testosterone in women is rarely tested or discussed in standard medical care. This guide covers what testosterone does in women’s bodies, how to recognize a deficiency, what testing looks like, and what treatment options are available.

What Does Testosterone Do in Women?

In women, testosterone serves multiple important functions that are often not appreciated outside of specialized care:

• Sexual desire and arousal — testosterone is the primary driver of libido in women, even more so than estrogen
• Energy and motivation — adequate testosterone supports drive, ambition, and overall energy levels
• Muscle mass and strength — testosterone helps maintain and build lean muscle
• Bone density — works alongside estrogen to preserve bone mineral density
• Mood and cognitive function — testosterone supports confidence, focus, and cognitive clarity
• Cardiovascular health — has favorable effects on arterial function and cardiac muscle
• Clitoral sensitivity and genital tissue health

When Does Testosterone Decline in Women?

Testosterone in women peaks in the early 20s and then begins a gradual decline. By the time a woman reaches her 40s, testosterone levels are typically about half of what they were at peak. The decline accelerates around menopause, particularly surgical menopause (removal of the ovaries), which removes the primary production site and causes an immediate, dramatic testosterone drop.

Factors that can accelerate testosterone decline or suppression in women include:

• Oral contraceptives — the pill raises sex hormone binding globulin (SHBG), which binds testosterone and makes it unavailable; many women notice libido and energy changes while on hormonal birth control
• Chronic stress — the adrenal glands prioritize cortisol production over sex hormone production under chronic stress (pregnenolone steal)
• Oophorectomy (surgical removal of ovaries)
• Premature ovarian insufficiency
• Hypopituitarism
• Chronic illness
• Severe caloric restriction or eating disorders

Symptoms of Low Testosterone in Women

The symptoms of low testosterone in women are frequently non-specific, which is why they’re often attributed to stress, aging, depression, or menopause without investigating the hormonal root cause:

• Low or absent libido — the most classic and commonly reported symptom; reduced sexual desire and diminished arousal or genital sensation
• Persistent fatigue — especially the kind that sleep doesn’t fully resolve
• Decreased motivation and drive — feeling flat, uninspired, or less competitive than you used to be
• Difficulty building or maintaining muscle — even with consistent exercise
• Increased body fat — particularly around the midsection
• Depressed mood, irritability, or anxiety
• Reduced cognitive sharpness — concentration difficulties, word-finding problems
• Loss of pubic and axillary (underarm) hair
• Vaginal dryness and discomfort (can overlap with low estrogen)
• Decreased bone density
• Reduced sense of wellbeing and vitality

Testing for Low Testosterone in Women

Proper testing for testosterone in women includes:

• Total testosterone — the overall amount; note that standard lab reference ranges for women are derived from a broad population and may not reflect optimal levels
• Free testosterone — the unbound, biologically active portion; this is often more clinically relevant than total testosterone
• Sex Hormone Binding Globulin (SHBG) — high SHBG binds up testosterone and reduces free levels even when total testosterone appears adequate
• DHEA-S — a precursor hormone from the adrenal glands that converts to testosterone; an indicator of adrenal androgen production

Important nuance: standard reference ranges for testosterone in women are wide and sometimes not particularly helpful for identifying suboptimal levels. A knowledgeable provider interprets these results in the context of symptoms, not just absolute numbers.

Treatment Options for Low Testosterone in Women

Testosterone Replacement Therapy

Testosterone replacement therapy for women is one of the most under-prescribed and under-discussed interventions in women’s health — despite a substantial evidence base for its benefits on sexual function, energy, mood, and bone density.

In women, testosterone is typically used at much lower doses than in men. Delivery methods include:

• Topical cream or gel — applied to skin; the most common form in functional medicine practice due to ease of dose adjustment
• Subcutaneous pellets — small pellets inserted under the skin every 3-6 months; provide stable levels
• Compounded transdermal preparations — customized to the patient’s specific dosing needs

When used appropriately at physiological doses, testosterone therapy in women has a favorable safety profile. The most common side effects at supraphysiological doses (acne, unwanted hair growth, voice changes) are dose-dependent and avoidable with careful management. Monitoring is important: labs should be checked periodically to ensure levels remain physiological.

Addressing Underlying Contributors

If high SHBG is binding up testosterone, addressing the cause (often oral contraceptive use, thyroid dysfunction, or high estrogen relative to testosterone) can meaningfully improve free testosterone levels without direct supplementation. Managing chronic stress — which diverts precursor hormones away from sex hormone production — is also an important piece of the puzzle.

Lifestyle Support

Resistance training is the most effective lifestyle intervention for supporting healthy testosterone levels. Adequate sleep (7-9 hours per night) is critical — testosterone is primarily produced during sleep. Reducing chronic stress, ensuring sufficient zinc and vitamin D, and maintaining healthy body composition all support the hormonal environment.

Getting Evaluated for Low Testosterone in Norfolk, Nebraska

Low testosterone in women is a real, measurable, and treatable condition — one that is frequently dismissed or simply not tested. If the symptoms described above sound familiar, a comprehensive hormone evaluation can determine whether testosterone (and other related hormones) are contributing.

At Fundamental Wellness in Norfolk, Nebraska, we include sex hormone testing as part of our comprehensive functional medicine evaluation. We look at the full picture — testosterone, estrogen, progesterone, adrenal hormones, thyroid, and metabolic health — to understand where your hormone levels are relative to optimal, not just “not abnormal.” From there, we build a personalized plan that addresses what you actually need.

You don’t have to settle for feeling less energetic, less motivated, or less yourself. Hormones matter — and you deserve a provider who takes all of them seriously.