The relationship between women and testosterone is poorly understood.
Testosterone is commonly blamed for libido problems… but that’s all anyone ever really talks about.
There is however a lot more to testosterone than meets the eye! Sufficient testosterone is important for mood, for energy, for cognitive function, and for overall health. Without testosterone, your energy and happiness can really suffer. How to know if you have low testosterone?
Most women are not in danger of insufficient testosterone levels. But you altogether might be, depending on your age and the type of health conditions and stressors you have endured over the years. This blog is a great starting place to learn about testosterone, and to help you identify if you suffer from low testosterone.
(And for even more on this topic, check out this book by Dr Sarah Gottfried, one of my favorites that addresses hormones and menopause.)
What testosterone does for YOU
Testosterone is important for your health because it plays a key role in reproductive function, in mood, and in physical fitness. Here are some of the things testosterone does, and why having low testosterone is a real problem. Testosterone:
-Enables female athletes to make greater increases in both lean mass and power. This study demonstrated gains in lean mass, chest-press power, and loaded sair-clibmer power in 71 women who had low testosterone due to menopause and/or hysterectomy.
-Increases sex drive, as shown by just about every study on menopausal sex drive. The measurements shown to improve are one measure of sexual fuction called the composite Brief Index of Sexual Functioning for Women, reported thoughts/desire, reported feelings of arousal, and frequency of sexual activity.
-Supports bone health. Even while estrogen is well known as the ‘bone mineral density’ hormone, studies like this one have shown that adding sufficient testosterone to the mix vastly increases success with bone strength, osteopenia and osteoporosis.
-Helps manage pain. At least we think. Rodent studies demonstrate that newborn female rats injected with testosterone experience better pain management than those that do not. But we are not quite sure if this effect extends to humans and how well.
-Manages mood and mental focus. Testosterone appears to help women feel motivated and upbeat. Depression, mood swings, and other unexplained emotional symptoms can be caused by decreased testosterone levels. Women with low testosterone also report failing to enjoy activities they once loved.
Testosterone production
So how does your body do these things? Where does testosterone come from?
Testosterone is produced in part by the ovaries, and in part by the adrenal (stress) glands.
Both of these organs take their cue from the pituitary gland, so any sort of pituitary malfunction – whether due to a common problem like stress, or to something less common like a tumor – will hinder testosterone production.
The pituitary gland usually functions healthfully in adolescents and women of reproductive age. Once a woman enters menopause, however, it stops sending signals to the ovaries. (This is natural, it’s supposed to happen!)
Nevertheless, menopause can cause some problems and symptoms. In menopause, because hormones are no longer being produced by the ovaries, the bulk of hormone production is left up to other glands, like the adrenals. Sometimes this isn’t sufficient, and testosterone (and estrogen and progesterone) levels suffer.
Average testosterone levels
The standard healthy range for testosterone levels for adult women is 15-70 ng/dl.
Unfortunately this is a fairly large range. This means that you may experience some level of dysfunction – whether your levels are too high or too low – without actually falling outside of the normal ranges.
Testosterone levels rise throughout puberty (along with the rest of the sex hormones), and they stay relatively stable throughout young adulthood and middle age. During menopause testosterone levels drop significantly, as I just mentioned, due to the Retirement of the ovaries.
(Personally my ovaries will be retiring to Key West.)
Signs your testosterone levels may be low
There are many signs that you may wish to investigate your testosterone levels. They are:
-Osteoporosis, osteopenia or low bone mineral density (most likely coupled with low estrogen)
-Poor memory and brain fog
-Low mood, lack of motivation, no goals, and no competitive spirit
-Low libido
-Poor pain tolerance
-No evidence of ovulation (which would include spiked libido, increase in vaginal discharge, spike in body temperature)
Causes of low testosterone
Many things may contribute to low testosterone levels. Far and away, the most common cause of low testosterone in women is menopause. Second to that is an ovariectomy. In addiction to these two landmark cases, there are also:
-Stress, since stress can decrease reproductive function and divert your body’s resources away from sex hormone production and toward stress hormone production
-Sedentary lifestyle, since testosterone production is supported by exercise
-A very low fat diet (less than 30 grams of fat/day), since fat is necessary for producing hormones
–Estrogen dominance – you may experience symptoms of testosterone insufficiency if your estrogen levels are too high, since estrogen causes testosterone to become bound and inactive in the bloodstream (thus why they must always be in proper balance)
-A pituitary tumor. This is rare but not impossible! Doctor’s can screen for it with an MRI.
What to do about it
1) Overcome estrogen dominance.
Sometimes you just need testosterone alone. This would be the case if you are estrogen or progseterone dominant, regardless of your age. In that case you may wish to take a very small dose of a bioidentical testosterone hormone. My preferred method however would be to overcome the estrogen dominance via the methods I describe here.
Doing weight lifting exercises like these and some HIIT exercising can also be an extraordinary help.
2) Boost hormone production generally
Other times what women need is to increase all of their sex hormone levels. This often happens with hypothalamic amenorrhea, stress-based health problems, ovariectomies, and menopause. You can do this by:
-Increasing the fat content of your diet to at least 45 grams a day (or 25% of calories)
-Being sure to eat at least 75 grams of protein every day
-Eat carbohydrate with at least two meals a day
-Boost thyroid hormone health via the many complex ways that can be done, such as described here in my favorite thyroid resources (here for Hashimoto’s, here for general hypothyroid)
So in summary…
Most women of reproductive age are not at risk of low testosterone. But you may be if you’ve suffered from hypothalamic amneorrhea, any sort of HPA axis disruption, or the detrimental effects of a very low, vegetarian style, restrictive diet. You could also experience symptoms of low testosterone if your estrogen levels are too high.
The best thing you can do for this is to overcome estrogen dominance, as well as to boost hormone production. If in menopause, you may wish to consider bioidentical hormone therapy, but a more natural route would be to balance your hormones with diet and exercise.
Your libido, your lovers, your brain clarity, and your goal-driven, competitive edge may thank you. 🙂
For some further reading –
I really like what Sarah Gottfried has to say about menopause and hormone balance in her best-seller here.
And here’s a great tongue-in-cheek and insightful look at testosterone and human societies: The Trouble with Testosterone, which I love so much. Plus it’s SO PALEO!
What do you think? Do you have LOW T? What have you done about it?
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Great article as usual, Stefani! I am 43 and have Hashimoto’s. I changed to a paleo diet two years ago and noticed many improvements in my health. I still struggle with some symptoms that I think are primarily due to the Hashimoto’s (iron-deficient anemia, for instance). But one very clear difference is much higher libido – based on the information above I would attribute this to the higher fat, higher protein diet I now eat. Yea for paleo! I’m really interested to see if my eating habits will make the transition into menopause easier as well.
Hi Stefani,
Had my estrogen, progesterone, and testosterone levels tested recently. Endochronologist reported…Was low in progesterone and testosterone.
estrogen was fine
progesterone was on very low end…was suggested use of over the counter cream…which I do..
testosterone was very low…doctor told me she would not treat
Have symptoms as noted in article that are not being addressed by doctor.
Not sure where to go for help.
I have been eating paleo without much change…have gained weight and symptoms are not better…so am doing something wrong
I love following your posts…reading articles…
Youtube.com search Dr John Bergman. excellent videos on women and hormones and how to naturally balance
Thanks for another great article. You are my go to for everything hormones! Have you seen this before – low est, low prog, low test, high SHBG, severe acne & scant but regular periods ? This is me and I am really at a loss…. Any advice would be helpful.
yeah. it sounds very HA-like to me, like pituitary shut down. I do find it puzzling that you have regular periods still, unless you are on the pill or something similar?
I am not on the pill but I finished fertility hormone treatments in March of 2014 where they had me on and off the pill (in between injections for IUI). My periods finally resumed 11/2014. I’m wondering if the fertility hormones what he’d me out and my body is trying to detox from them? Even a year + later?
*whacked me out*
Can being on the pill also give you symptoms of low testosterone by raising estrogen and progesterone levels?
Very smart, Emily! It’s a definite possibility!!
Great post Stefani!
I just got my labs back and for testosterone (immulite) the report says <20. I'm not sure what that means, but it doesn't look good when the reference values are 17.5 – 43.51 ng/dL. (30.5 +/- 13.0). I can't talk to my doctor until later this month, but its likely that I have a combination of PCOS and HA, based on ultrasounds and the other lab work that my LH levels are higher than FSH. Also, I am currently on day 88 of this cycle! I so badly want to fix this, but I get conflicting information, especially on what to eat or how much to exercise. How do I know what's best for me?
It means that HA is DEFINITELY more of a concern for you than testosterone. I’d call that ‘type 2’ pcos. I would do the HA type things for recovery to see if that helps. Don’t sweat the 88 days… I went something like 1600 🙂
My free testosterone is so low that the lab couldn’t even measure it… they just left a note on my results! If you have any tips for how to raise it naturally that would be great? My estrogen is high and my SHBG is off the charts and I have no idea how to fix it. I’ve gone from being really strong and lean to extremely overweight in 12 months which is very depressing 🙁
your testosterone will improve if you can bring your restrogen down as high estrogen lowers testosterone levels!
I have low-T and Low progesterone, estrogen levels are excellent. I am hypothyroid and have issues converting to T3. My doctor could not figure out what was wrong with me. Thyroid labs running on the hyper side, yet I had NO energy and was in a severe depression. We have been TTC for 5 years and I am currently trying to get all of the hormones to “cooperate”. I seem to fix one and the others get out of whack. I have an issue with cysts most months. My cycles are like clock-work for the most part, occasionally if I have a large cyst they are extended by a few days.
I’m 24 and have a testosterone level of 6. It says normal is9-55. I’m tired all the time and have a huge belly fat problem. I CANNOT lose weight no matter how hard I try. Paleo diet included. I also struggle with depression. I hope finding this problem will help me. What do you think? What should I expect my doctor to say? And why is there not more about low testosterone levels in young women out there? It’s freaking me out!
Don’t be freaked out! There is a chance the two things are related, yes. Talking with your doc about the connection and possible causes in your life is definitely a smart next step 🙂
I just found out that my free testosterone is low. My doctor wants to put me on an adaptogenic birth control pill to help balance. Thoughts? I’m not on anything right now, I stopped the pill about 2 years ago, and have been dealing with many of the above symptoms since before quitting the pill. I’m 36, hypothyroid (diagnosed 1 year ago), and on thyroid replacement, which has resolved some of the symptoms, but not all.
Well. If you have symptoms that you think some better hormone balance could alleviate, getting on the pill may help. But I am skeptical of its interaction with women’s health in the long run. It wouldn’t actually “fix” anything – simply cover it up. Also, I am skeptical of using birth control to balance low testosterone. Birth control pills have progesterone and estrogen in them. If you take progesterone and estrogen, wouldn’t that simply create a greater imbalance with testosterone? Now, there are some kinds of progesterone that ACT like male sex hormones (to a degree) in the body, which could be what your doc intends. Yet I remain skeptical since it is still progesterone, and estrogen is still included. Your doc may also be intended to reduce estrogen or progesterone activity in your body with pill supplementation, but I am not sure low testosterone is a good enough reason to cut the legs out from under other hormones which seem to be doing quite well.
All in all, if it feels good then I think it’s fine, but I wouldn’t personally put stock in its ability to cause any kind of healing. Of cousre, I speak for myself and know nothing about your situation, so I cannot say one way or another. <3
Thanks for sharing Stef, I am suspecting that I have low testosterone but I didn’t seek for professional help yet.I don’t want to take any pills. Do you have any idea if there’s any other way to get my testosterone back to normal level?
Can low Testosterone cause recurrent miscarriages? And if so, how? I have no problem falling pregnant, but had 4 losses.
Hey love, I’m really sorry that I can’t answer your question, but I don’t want to step into the really deep waters of miscarriages without the proper training. I typically hear more that low progesterone is to blame – does this feel like a problem for you, the progesterone? Testosterone may play a role, though it also may just point to a larger problem such as a deficiency in hormone production altogether <3
I just found all all of my hormones are low. My doctor was most concerned with my testosterone being at 4. My estradiol was 11.4, FSH at 3.1, and my progesterone was 0.1. I’m on birth control currently so it is weird that my estrogen and progesterone are still low. I have at least two periods each month with usually other spotting and bleeding in between. I have a lot of symptoms of low T, but I am not sure what would be causing low hormones considering I am 29 and should not be nearing menopause. She wants me to supplement progesterone and testosterone. I just would like to know potential underlying reasons since it isn’t due to an estrogen dominance. She said typically if you have a lower estradiol your FSH is high or vice versa, but both of mine were low.
Are you undereating? underweight? Exercising a lot? Stressed? These could all cause all of your hormone levels to fall precipitously. It is also possible that an underlying autoimmune (such as hashimoto’s thyroiditis) or other condition is a problem – or perhaps a pituitary disorder. That would depend on if you suffer other symptoms in your life (such as GI) and if you have access to more tests?
I just learned my testosterone levels are non-existent and have low progesterone. I have persistent infections that I can’t get rid of and have Osteopenia. Learned this the hard way after breaking my nose 3 times in 2 years. I can hardly stay awake during the day without stimulants let alone get anything done around the house. The depression and anxiety is completely debilitating. By the way, I’m only 26. I have an insane amount of stress. I’m at a complete loss. What on earth does this sounds like?
undereating? low vitamin D? hypothyroidism? Stress? Stress is at least one factor, no matter what the underlying problem may be <3
I’m so confused, I have low estrogen, progesterone and testosterone. I have regular periods, but I suffer from debilitating panic attacks, anxiety and paranoia. I’m only 33. I’m suppose to get progesterone cream next week but will this help all of my levels?
It could. It sounds like you may suffer from stress that dampens your hormone production (though of course there are many other possibilities). If you use a progesterone cream it could help boost production in other areas certainly, but that is not necessarily guaranteed <3