Does the word testosterone make you think about bulging muscles, mega competitiveness, and aggressiveness? If so, you're not alone. Testosterone is often considered a “male” hormone, but in fact, it is critical for women's health.
Testosterone is an androgen involved in sexual desire, arousal, bone density, immunity, and muscle mass. This hormone also affects mood, energy levels, and overall well-being.
Like any other hormone, balance with other sex hormones is critical to maintaining optimal health. Low testosterone levels can lead to a host of issues, including fatigue, low interest in sex, and more.
In this article, we'll discuss the causes and solutions for low testosterone in women, plus the symptoms to look out for.
What Are the Signs and Symptoms of Low Testosterone in Women?
You have androgen receptors in almost all tissues in the body, so testosterone can influence many different systems and functions. This can make it difficult to know if low testosterone is the root cause of specific symptoms.
That said, here are some common signs and symptoms associated with low testosterone:
- Low sexual desire and satisfaction
- Difficulty orgasming
- Anxiety or depression
- Physical fatigue
- Bone and muscle loss or weakness
- Joint pain
- Cognitive changes
- Insomnia
- Dry skin and thinning hair
- Weight gain
- Loss of muscle mass
- Feeling lack of motivation
- Crying easily
Since many of these can also be caused by other conditions, it's important to talk with your healthcare provider if you're experiencing any of these symptoms. They can help you determine if low testosterone is the root cause and develop a treatment plan.
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Causes of Low Testosterone in Women
There are several causes of low testosterone in women. The primary reason is that it naturally declines starting in the mid to late 30s and continues later in life.
Testosterone is made in the ovaries, adrenal glands, and fat cells. As we age, the ovaries produce less and less testosterone. But other things can lead to low testosterone levels, including:
- Impaired production of or reduced ability to convert testosterone precursors like dehydroepiandrosterone sulfate (DHEA-S) and dehydroepiandrosterone (DHEA).
Precursors (or prohormones) are hormones the body uses to make other hormones. DHEA is a common one, and it's used as a supplement to increase testosterone levels.
- Poor adrenal gland function. The adrenal glands produce DHEA, so if they're not functioning correctly, DHEA levels can be low. This can be due to HPA-axis dysregulation (aka adrenal fatigue) or adrenal insufficiency (more on this below).
- Surgery, specifically in which the ovaries have been removed. This is known as surgical induced menopause.
- Certain medications, especially related to taking the birth control pill.
How Are Testosterone Levels Tested?
If I suspect someone has low testosterone, the first step is to order a hormone panel. This will give us an idea of not just testosterone levels but also DHEA-S, estradiol, and other key hormones.
I also like to see free and total testosterone. This measures the “free” or bioavailable testosterone that the body can use right away, and the total amount of testosterone in the body. I also include Sex Hormone Binding Globulin (SHBG), a protein that binds to testosterone and makes it unavailable for use in the body. And, of course, DHEA-S to assess how well the body can produce testosterone.
What's the Connection Between Low Testosterone and Inflammation?
Drops in estrogen are linked to increased inflammation, which partially explains why women are more at risk for chronic diseases after menopause. But testosterone may also play a role in inflammation.
Although most studies are on men, it's helpful to look at what we know about testosterone and inflammation in men to understand the potential implications for women. Of course, studies in women would be ideal, but we have to work with the information we have.
One study found that low testosterone was associated with higher levels of markers of inflammation like tumor necrosis factor-alpha (TNF-alpha). TNF-alpha is involved in several inflammatory conditions like Crohn's disease, rheumatoid arthritis, and more. On the other hand, testosterone could also help reduce inflammation in the body because it inhibits the expression of inflammatory molecules.
Low testosterone levels are linked to metabolic syndrome (a group of conditions that increase the risk for heart disease, stroke, and diabetes), heart disease, and increased mortality. One reason for this may be inflammation.
It also helps regulate fat tissue and blood sugar metabolism, so these functions can go awry when levels are low. When patients are concerned about weight gain or inability to lose weight, testosterone is one hormone that I make a point to check.
Connection Between Testosterone Levels and Adrenal Gland Function
As I mentioned earlier, your adrenal glands are one of the major places where testosterone is produced. So, it's not surprising that there's a connection between adrenal gland function and testosterone levels.
Your adrenal glands are two small glands that sit on top of your kidneys. They produce several hormones, including DHEA, cortisol, epinephrine, and norepinephrine. These hormones are involved in stress response, energy production, regulating inflammation, anti-aging, blood sugar regulation, and more.
Around 25 percent of androgen production happens in the adrenal glands. Nearly all the DHEA-S in the body is made in the adrenal glands. DHEA and DHEA-S are converted into testosterone with the help of enzymes (and they can also be made into estrogen).
So adrenal gland function is super important for healthy testosterone levels. And once those ovaries call it quits with hormone production, you’ll be looking to your adrenal glands for estrogen and testosterone. That’s why now is the time to take care of those little glands.
Adrenal Fatigue and Low Testosterone
There are two ways that adrenal gland function can impact testosterone levels:
First primary adrenal insufficiency (or Addison's disease) is a life-threatening condition where the body can't produce enough adrenal hormones. This can lead to low DHEA levels, which can lead to low testosterone levels.
But more commonly, I see what's known as “adrenal fatigue,” actually called HPA-axis dysregulation. This is a condition where the adrenal glands and the brain aren’t in sync as they should be, leading to issues in hormone production and utilization. It doesn't mean your adrenals are exhausted. It just means they're not functioning optimally.
Chronic, unrelenting stress doesn't give the adrenals a break. Your body keeps pumping out cortisol, plus other hormones to try and make even more cortisol. Eventually, the production of all hormones drops, including DHEA, impacting testosterone production. While this may feel like a betrayal by your body, it is actually how your body keeps you from overproducing the pro-aging hormone—cortisol.
Adrenal Fatigue Symptoms
HPA-axis dysregulation can look like other conditions, which is why it's often misdiagnosed. But there are some common symptoms including:
- Fatigue
- Brain fog
- Insomnia
- Anxiety
- Depression
- Blood sugar imbalances
- Low blood pressure or lightheadedness when standing up too quickly (orthostatic hypotension)
- Cravings for salty or high-fat foods
- Low libido
Many of these symptoms are also common in low testosterone, so working with a practitioner who understands HPA-axis dysregulation is essential if you're experiencing any of them.
Adrenal Gland Support: DHEA
If your DHEA and testosterone levels have plummeted, supplementing with DHEA could help.
Genetic abnormalities could also impact how much DHEA or DHEA-S someone makes or the enzymes that transform them into testosterone. This would be another time where hormone replacement therapy could be beneficial.
DHEA hormone replacement therapy isn’t a root cause solution to HPA dysregulation (aka adrenal fatigue). In my naturopathic endocrinology practice I use DHEA hormone replacement therapy in cases of low testosterone levels and vaginal dryness when all other symptom root causes have been addressed.
While DHEA is over-the-counter, I do not recommend taking oral DHEA supplements without oversight from a medical provider. While it may seem harmless, DHEA can be converted into estrogen or testosterone, which may create an imbalance in either. The result may be symptoms like heavy periods, breast tenderness, acne, and irreversible hair loss.
DHEA Dosage for Improved Testosterone Levels
Working with a practitioner who understands how to support adrenals and hormone health is important. Depending on symptoms and other factors, dosing with DHEA will be different for everyone.
DHEA dosage ranges based on their intended use, the individual’s health conditon, and how the person responds to therapy. For vaginal dryness and sexual desire, the dose may be 20 mg applied to the vulva. But for someone looking to improve their fertility or IVF outcomes, a dose of 25 mg three times a daily orally may be used. How to know what’s best for you? Talk with a provider about your health history and goals.
Few side effects are noted with DHEA supplements, aside from some related to higher testosterone (acne or unwanted hair growth, for example), which may be a problem if you’re prone to convert testosterone into DHT. It can interfere with certain medications, and there are health conditions where DHEA supplementation is not recommended, so make sure to talk to your practitioner first.
Natural Treatments for Low Testosterone
- Give your adrenals some love. Start by getting enough sleep every single night. Consider adrenal-supportive herbs like ashwagandha or licorice root, which help the body deal with stress.
I've created an Optimal Adrenal Kit that includes these adrenal supportive herbs and more to help support optimal adrenal and hormone health.
- Get moving. Exercise can help regulate hormones and is excellent for overall health. Studies show regular exercise, especially strength training, can increase testosterone.
If you're already dealing with adrenal fatigue, too much exercise can actually make things worse. So start slow and build up from there.
- Get enough zinc. This mineral is essential for testosterone production. You can find it in pumpkin seeds, oysters, beef, chicken, and beans. If you don't eat meat or seafood, consider supplementing with zinc (just balance with copper).
- Optimize your diet. A nutrient-dense diet is key for adrenal and hormone health. Make sure to include plenty of healthy fats, like avocados, olive oil, coconut oil, and nuts and seeds. Eat plenty of vegetables (aim for at least half your plate at each meal), some fruit, and quality protein sources.
Final Thoughts on Low Testosterone in Women
Low testosterone is a common problem in women, but it's often overlooked. If you're experiencing any of the symptoms I've mentioned, make sure to get tested. DHEA supplementation could help, but working with a practitioner is essential to ensure you're dosing correctly.
There are also many natural ways to support optimal hormone health. Getting enough sleep, exercising, and eating a nutrient-dense diet are all pieces of the puzzle.
If you aren't sure where to start with a hormone-balancing diet, check out my Hormone Starter Kit, which includes a 7-Day Meal Plan and Hormone Recipe Guide.
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