JASMA

When you hear the word “testosterone,” you might picture gym bros flexing in the mirror or late-night ads aimed at men.
But here’s the twist: women need testosterone, too. In fact, it quietly supports your energy, mood, libido, muscles, and even your bones.
So when levels dip too low, you might feel “off” in ways that are hard to explaintired, foggy, less interested in sex, or just not like yourself.

Low testosterone in women is real, but it’s also a bit misunderstood. There’s no single “perfect number,”
and symptoms often overlap with menopause, stress, thyroid issues, or depression. Still, knowing the common signs and causes can help you
have a smarter, more focused conversation with your healthcare providerinstead of just saying, “I’m exhausted and cranky all the time, help.”

What Does Testosterone Do in Women?

Testosterone is an androgen (a “male” sex hormone) that women also produce in smaller amounts.
It’s made mostly in the ovaries and adrenal glands and circulates throughout your body doing a lot more than people give it credit for.

Key roles of testosterone in women

• Sexual desire and arousal: Supports libido, sexual thoughts, and responsiveness.
• Energy and stamina: Helps you feel more awake and motivated rather than dragging through the day.
• Muscle mass and strength: Assists in building and maintaining lean muscle.
• Bone health: Works together with estrogen to support bone density and reduce fracture risk.
• Mood and sense of well-being: Influences motivation, confidence, and overall quality of life.
• Cognition: May play a part in focus, memory, and mental clarity.

When testosterone levels slide below what’s normal for you, these body systems don’t necessarily “break,”
but they may run less smoothlylike using your phone on 5% battery all day.

What Is Low Testosterone in Women?

Here’s the tricky part: there’s no universal lab number that magically defines “low testosterone” in women.
Normal ranges vary by age, lab methods, and even the time of day. Many experts focus less on the number and more on a combination of:

• Clear, persistent symptoms (like low libido, fatigue, or loss of well-being), and
• Consistently low blood levels on accurate testing performed at the right time and using reliable assays.

Some clinicians use terms like “androgen deficiency” or “female androgen insufficiency” rather than just “low T.”
Whatever the label, the key question is: Are your symptoms meaningfully linked to low testosterone, and what can be safely done about it?

Common Symptoms and Signs of Low Testosterone in Women

Low testosterone can show up differently from one woman to another. Some have multiple symptoms; others feel very little despite low levels on blood tests.
Still, there are patterns doctors look for.

Sexual symptoms

• Decreased sexual desire or interest in sex
• Fewer sexual thoughts or fantasies
• Difficulty becoming aroused
• Reduced sensitivity or difficulty reaching orgasm
• Less satisfaction from sexual activity

These symptoms can overlap with other conditions like depression, relationship stress, chronic illness, or pain during sex,
so testosterone is only one piece of the puzzlenot the whole picture.

Physical and emotional symptoms

• Ongoing fatigue or low energy, even with good sleep
• Muscle weakness or feeling less strong than usual
• Reduced exercise tolerance or slower workout recovery
• Increased body fat or weight gain, especially with muscle loss
• Decreased bone density over time (leading to osteopenia or osteoporosis)
• Mood changes: low mood, irritability, anxiety, or “flat” motivation
• Brain fog, trouble concentrating, or feeling less mentally sharp
• Sleep disturbances, such as insomnia or restless sleep

Reproductive and hormonal clues

• Irregular or absent menstrual cycles (often along with other hormone changes)
• Lower fertility or trouble conceiving related to broader hormonal imbalance
• Changes around perimenopause or after menopause, when ovarian hormone production naturally declines

Because so many of these issues have multiple possible causes, self-diagnosing low testosterone based on symptoms alone is unreliable.
That’s where a thorough evaluation comes in.

What Causes Low Testosterone in Women?

Women’s hormone systems are complex, and testosterone is just one hormone in a very crowded hormonal group chat.
Several factors can contribute to low levels.

1. Natural aging and menopause

Testosterone levels in women tend to peak in early adulthood and gradually decline with age.
By the time you reach menopause, levels may be roughly half of what they were in your 20s.
This decline can contribute to changes in libido, energy, and body composition, especially when combined with dropping estrogen.

2. Ovarian causes

• Surgical removal of the ovaries (oophorectomy): Sudden loss of ovarian hormones, including testosterone, often leads to abrupt symptoms.
• Ovarian failure or damage: Conditions that impair ovarian function, such as certain autoimmune diseases or chemotherapy, can reduce testosterone production.

3. Pituitary or hypothalamic disorders

The pituitary and hypothalamus act like your hormonal command center. Tumors, radiation, genetic conditions, or severe systemic illness can interfere with the hormones that tell the ovaries and adrenal glands to make testosterone.
This is sometimes called secondary androgen deficiency.

4. Adrenal gland problems

The adrenal glands also produce androgens. Adrenal insufficiency, certain medications, or long-term steroid use can lower adrenal androgen output, contributing to low testosterone levels.

5. Medications and medical treatments

Some medications can lower testosterone or blunt its effects, such as:

• Long-term systemic corticosteroids
• Some hormonal contraceptives or hormone therapies
• Certain psychiatric medications
• Treatments for cancer, including chemotherapy or radiation affecting the ovaries

6. Chronic illness and lifestyle factors

Overall health strongly influences hormones. Potential contributors include:

• Uncontrolled chronic illnesses (e.g., poorly managed diabetes, severe inflammatory conditions)
• Significant or rapid weight changes
• Chronic stress and high cortisol levels
• Overtraining and under-fueling (think intense exercise with insufficient calories)
• Sleep disorders, such as untreated sleep apnea or chronic insomnia

Often there isn’t just one cause. Aging, stress, poor sleep, and medication use can stack together, quietly pushing testosterone levelsand your quality of lifedownward.

How Is Low Testosterone Diagnosed in Women?

If you suspect low testosterone, resist the urge to order a random online lab test and self-treat.
Proper evaluation matters, because hormone patterns can be subtle and complex.

Step 1: Detailed history and symptom review

Your healthcare provider will usually ask about:

• Sexual desire and satisfaction
• Energy levels, mood, and sleep
• Exercise, diet, and recent weight changes
• Menstrual patterns and menopause status
• Medications, supplements, and medical conditions
• Stress levels and relationship factors

Step 2: Physical exam

A physical exam may look for signs of hormone imbalancesuch as changes in hair growth, skin, weight, or muscle mass.
If sexual symptoms are prominent, a pelvic exam may help identify other causes like vaginal dryness, pain, infections, or dermatologic conditions.

Step 3: Blood tests

Blood tests can measure:

• Total testosterone (and in some cases free testosterone)
• Other sex hormones, such as estrogen, progesterone, LH, FSH, and prolactin
• Thyroid function
• Metabolic markers (like glucose and cholesterol)
• Sometimes DHEA-S and other adrenal androgens

Because women’s testosterone levels are naturally low, they can be hard to measure accurately.
High-quality assays and appropriate reference ranges are important.
Your provider will interpret results in the context of your symptoms, not just a lab printout.

Treatment Options for Low Testosterone in Women

There is no one-size-fits-all “testosterone fix” for women, and it’s important to know that in the United States,
testosterone is not FDA-approved for treating female sexual dysfunction at this time.
That said, some evidence supports carefully supervised use in very specific situations, and there are many non-testosterone strategies that can help.

1. Address underlying causes first

If low testosterone is secondary to another condition, treating that problem can improve hormone balance. Examples include:

• Optimizing thyroid disease management
• Adjusting medications that may affect libido or hormones
• Treating adrenal insufficiency or pituitary disorders when present
• Improving sleep, nutrition, and stress management

2. Lifestyle and supportive changes

While lifestyle alone may not “cure” low testosterone, it can significantly improve symptoms:

• Strength training: Helps support muscle mass, strength, and metabolism.
• Balanced nutrition: Adequate protein, healthy fats, and overall calories support hormone production.
• Sleep hygiene: Consistent, high-quality sleep is key for hormonal regulation.
• Stress reduction: Mind-body practices, therapy, or boundaries at work/home can calm chronically high stress.
• Relationship and sexual communication: Open conversations with your partner may relieve pressure and improve intimacy.

3. Hormone therapy (including off-label testosterone)

In certain postmenopausal women with clearly documented low sexual desire that is distressing (often called hypoactive sexual desire disorder, or HSDD),
some specialty guidelines support a short-term trial of low-dose transdermal testosterone under expert supervision.
This is typically reserved for women who have:

• Persistent, bothersome low libido not explained by other factors alone
• Documented low androgen levels
• No contraindications, such as pregnancy, androgen-sensitive cancers, or uncontrolled medical conditions

Even in these cases, treatment is usually:

• Short-term (often 3–6 months to gauge benefit)
• Given in low, physiologic doses (not “bodybuilding” levels)
• Monitored closely for side effects: acne, hair growth, voice changes, or lipid changes

Because testosterone therapy for women is off-label and somewhat controversial, it should be managed by a clinician experienced in female sexual health and hormone therapy.
Over-the-counter “testosterone booster” supplements and unsupervised compounded hormone creams may be risky and unpredictable.

4. Other treatments for sexual symptoms

Depending on your situation, your provider might also discuss:

• Vaginal estrogen or other therapies for dryness or pain with sex
• Nonhormonal medications approved for certain types of low sexual desire in women
• Sex therapy or counseling for relationship issues, past trauma, or performance anxiety

Most women benefit from a combined approach: addressing medical factors, emotional well-being, relationship dynamics, and physical comfort during sex.

When Should You See a Healthcare Professional?

Schedule a visit with your healthcare provider if:

• Your sex drive has dropped significantly and it bothers you.
• You’re dealing with unexplained fatigue, mood changes, or brain fog that just won’t quit.
• You’ve noticed unusual muscle loss or recurrent fractures.
• You’ve had your ovaries removed, early menopause, cancer treatment, or a pituitary/adrenal condition and you feel “off.”
• You’re considering hormone therapy and want a safe, evidence-based plan.

Bring a symptom diary or notes to your appointment. Clear exampleslike “no sexual interest for 8 months,”
“can’t finish a workout I used to breeze through,” or “waking up exhausted despite 8 hours of sleep”help your clinician see patterns and choose the right tests.

Living Well with Low Testosterone

Low testosterone in women doesn’t mean you’re broken, less feminine, or destined to feel lousy forever.
It means your body is sending signals that something needs attentionsometimes hormones, sometimes lifestyle, sometimes both.

The most important steps are:

• Listen to your body and take your symptoms seriously.
• Avoid self-diagnosing or starting hormones without medical guidance.
• Work with a trusted clinician, ideally someone knowledgeable about women’s sexual and hormonal health.
• Focus on whole-person care: physical, emotional, relational, and sexual well-being.

With the right information and support, you can move from “I feel off and I don’t know why” to “I understand what’s happening and I have a plan.”
And that sense of control is powerful all on its own.

Real-Life Experiences & Lessons from Low Testosterone in Women

While every woman’s story is unique, many experiences around low testosterone follow familiar themes.
The details may differ, but the feelingsfrustration, confusion, and sometimes relief when they finally get answerstend to overlap.

“I thought I was just getting lazy.”

Imagine a woman in her early 40s who has always been active. She juggles a full-time job, kids, and a busy social life.
Over the last year, she notices she’s struggling to finish workouts, needs a nap by mid-afternoon, and feels strangely indifferent about intimacy.
Her first thought? “I must be slacking.” She tries more coffee, stricter diets, and longer to-do listsnone of which work.

When she finally sees her clinician, they discover a combination of early perimenopause, high stress, and slightly low testosterone for her age.
The plan focuses on improving sleep, adjusting her exercise routine, managing stress, and addressing perimenopausal symptoms.
She doesn’t magically turn into her 25-year-old self again, but with targeted changes, her energy and libido gradually return to a level that feels normal for her life now.

“My libido disappeared, and I thought it was my relationship.”

Another common experience: a woman in midlife finds her sexual desire slowly fading. She loves her partner,
but sex feels like a chore she’d rather avoid. She starts worrying that something is wrong with the relationship or with her emotionally.

After a thorough evaluation, she learns that several factors are teaming up against her libido: vaginal dryness causing discomfort, chronic stress, poor sleep, and lower testosterone levels.
Her treatment plan includes a mix of vaginal therapy for comfort, stress reduction strategies, better sleep habits, and careful discussion of whether hormone therapy is appropriate.
She and her partner also talk more openly about intimacy, taking the pressure off “performing” and focusing more on connection and pleasure.

“I tried to hack my hormones on my ownand regretted it.”

In the age of wellness influencers and online hormone test kits, it’s easy to be tempted by DIY hormone “optimization.”
Some women try unregulated supplements, compounded creams, or high-dose testosterone products marketed online with big promises and tiny disclaimers.

These do-it-yourself experiments can backfire, leading to side effects like acne, oily skin, unwanted hair growth, mood swings, or voice changes.
In some cases, lab tests later show testosterone levels that are actually higher than the typical male rangenot what most women are aiming for.

The takeaway from stories like this: feeling heard and guided by a knowledgeable clinician is far safer and more effective than hormone roulette with products that aren’t well-regulated.
Evidence-based care may not be as flashy as miracle cures, but it’s much more likely to help you in the long run.

What these experiences have in common

• Symptoms are often dismissed at first: by the woman herself, by others, or both.
• There’s rarely one single cause: age, stress, sleep, other hormones, medications, and life changes all interact.
• Relief comes from a plan, not a quick fix: combining lifestyle changes, emotional support, and medical care.
• Self-advocacy matters: asking questions, seeking second opinions, and looking for clinicians who take sexual and hormonal health seriously.

If you recognize yourself in any of these stories, you’re not aloneand you’re not “imagining it.”
Low testosterone in women is just one piece of a larger hormonal and life context, but understanding it can be a powerful step toward feeling more like yourself again.