Low Testosterone in Women-A Discussion 

Testosterone is the primary male sex hormone. It is also present in women. It is responsible for developing male reproductive tissues like the prostate and testicles and contributes to muscle and bone mass.  

Although testosterone is considered a male sex hormone, it is also present in people assigned female at birth. A person assigned female at birth experiences fluctuating levels of testosterone throughout the lifetime. At this time, there are no conclusive guidelines on normal testosterone levels in women and people assigned female at birth. It is important to check with an endocrinologist who is familiar with this hormone.  At Palmetto Endocrinology, we have extensive knowledge of the subject and will discuss your levels based on your unique health history. 

Low testosterone in women and people assigned female at birth could cause sluggishness, muscle weakness, irregular periods, and more. 

Signs of Low Testosterone in Women 

Too much or too little testosterone affects overall health and causes several possible symptoms. The body needs testosterone to produce new red blood cells, regulate hormone levels, and balance mood.  

Possible signs of low testosterone in people assigned female at birth include: 

• Fatigue 

• Weakness 

• Sluggishness  

• Depression 

• Anxiety 

• Chronic stress  

• Disturbed sleep  

• Lower sexual desire and satisfaction  

• Weight gain  

• Irregular menstrual cycle 

• Fertility problems  

• Vaginal dryness  

• Loss of bone density  

It is important to note that some people assigned female at birth do not experience any symptoms of low testosterone levels.  

Main Causes 

A person may experience low testosterone levels because of natural declines or a chronic health condition. Testosterone naturally decreases in women and people assigned female at birth over time. Other hormones, including estrogen, also naturally decline over time. 

Low testosterone levels may indicate a problem with the ovaries, adrenal glands, or pituitary gland. The ovaries produce testosterone, and as the ovaries lose function during menopause, testosterone levels decrease.  

Possible causes of low testosterone in women and people assigned female at birth include: 

• Adrenal insufficiency (Addison's disease): When the adrenal glands don't produce cortisol and aldosterone hormones 

• Hypopituitarism: A rare condition in which the pituitary glands don't produce enough hormones 

• Oophorectomy: History of surgical removal of the ovaries 

• Estrogen therapy  

• Menopause  

How Is It Diagnosed? 

At Palmetto Endocrinology we can measure your testosterone levels with a simple blood test. If you have developed possible symptoms of low testosterone, such as reduced libido, please make an appointment to see us. 

Many of the symptoms of low testosterone are considered vague and often caused by other conditions such as chronic stress or depression. Testosterone levels naturally fluctuate throughout the month in people who have not undergone menopause yet. We can recommend a time in your menstrual cycle to test your testosterone levels.   

Because there are no conclusive guidelines for normal testosterone levels in women and people assigned female at birth, we will consider both your lab values and symptoms when making a diagnosis. We will also perform a thorough physical exam.  

Treatment Options and Their Side Effects 

Treatment options are available for people with low testosterone levels. The goal of treatment is to improve symptoms and increase energy levels and sex drive.  

The U.S. Food and Drug Administration (FDA) has approved a few treatment options for people assigned female at birth with low testosterone levels. Possible treatment options include: 

• Estrogen medications: Some estrogen treatments, such as Estratest (esterified estrogens/methyltestosterone), also contain synthetic testosterone. This may be an effective treatment option for people who have gone through menopause.  

• Testosterone medications: Testosterone is available as injections, gel, skin patches, and pellets implanted beneath the skin.  

• DHEA supplements: Dehydroepiandrosterone (DHEA) is a steroid hormone produced by the adrenal glands. It is a precursor to testosterone, so taking a DHEA supplement may increase testosterone levels. However, more research is necessary. 

Possible side effects of testosterone supplements include: 

• Facial hair 

• Acne 

• Deepened voice 

• Hair loss  

• Enlarged clitoris  

• Fluid retention  

Alternative Therapies and Self-Care Methods 

Alternative treatments and lifestyle changes to raise testosterone levels may include: 

• Stress management: Chronic stress may lead to a decrease in testosterone levels. Proven stress management techniques include deep breathing, social support, physical activity, and meditation.  

• Sleep hygiene: Poor quality sleep contributes to low levels of certain hormones. Focus on getting better sleep by going to bed at the same time each night and winding down in the evenings without screens.  

• Nutritious diet: A balanced diet rich with nutrients, including vitamins, minerals, protein, fiber, and healthy fats, helps the body produce and balance hormones.  

• DHEA supplements: DHEA may cause the body to produce more testosterone. More research is necessary to determine if DHEA is a safe and effective treatment option.  

• Sex therapy: Sex therapy is an evidence-based therapy to treat sexual dysfunction, such as low libido or less sexual satisfaction.  

Summary  

Testosterone is a sex hormone that develops the male reproductive tissues and sperm. It is also important for the overall health of women and people assigned female at birth. The body needs testosterone to produce new red blood cells, support muscle health, and maintain bone mass.  

Low levels of testosterone in women and people assigned female at birth include fatigue, sluggishness, muscle weakness, sleep disturbances, irregular periods, and decreased sex drive. Make an appointment with us at Palmetto Endocrinology if you are concerned about your testosterone levels. 

Treatment options are available. Discuss the potential benefits and risks with us before starting testosterone therapy. 

Author

Joseph Mathews, MD, FACP, FACE, ECNU, CCD Joseph W. Mathews M.D., a board certified Endocrinologist and Medical Director of Palmetto Endocrinology, was born and raised in South Carolina. He earned his Bachelor of Science in Biology from the College of Charleston, Cum Laude. He then achieved his M.D. at the Medical University of South Carolina where he also completed his residency in Internal Medicine and a Fellowship in Endocrinology, Diabetes, and Metabolism. Dr. Mathews is also a Fellow of both the American College of Endocrinology and the American College of Physicians, holds an Endocrine Certification in Neck Ultrasound (ECNU) and is a Certified Clinical Densitometrist (CCD). He has extensive experience performing ultrasound guided fine needle aspiration biopsies. His practice includes a range of specializations including prescribing and fitting patients with insulin pumps. Dr. Mathews' practice has drawn patients from out of state to benefit from his expertise in thyroid disorders, diabetes, cortisol problems and their Endocrine disorders.