Low T in Women: All Your Questions Answered

This guide discusses low testosterone in women—a frequently overlooked or misdiagnosed condition—in detail.

The document can be read in full for a complete overview of female low testosterone, or this table of contents can be used to locate the answers to specific questions you may be asking.

1. Women Have Testosterone?
2. Symptoms of Female Low Testosterone (Hypogonadism)
   
   1. Fatigue and Exhaustion — What Do They Mean?
   2. Mood Swings, Depression, and Low Mood
   3. Anxiety
   4. Difficulty Concentrating and Short-Term Memory Loss
   5. Decreased Interest in Sex and Difficulty Climaxing During Intercourse
   6. Weight Gain or Difficulty Losing Weight
   7. Loss of Muscle Mass
   8. Changes in Bone Density
   9. Hair Loss or Thinning Hair
   10. Dry or Thinning Skin
   11. What if My Low T Symptoms Are Only Minor?
3. What Causes Low Testosterone in Women?
   
   1. The Causes of Female Low Testosterone Are Not Well Understood
4. High Testosterone or Low Testosterone? — A Frequent Misdiagnosis
   
   1. Being Diagnosed with PCOS Regardless of Symptoms
5. I Might Have Low T — What Do I Do Next?

Low testosterone in women is a real condition that can be just as physically debilitating as in men. While not often publicized, it is far more common than you probably expect.

Women’s bodies have 3 major sex hormones. The primary focus when dealing with women’s hormone health and hormone imbalance has always been on the 2 “female” hormones: Estrogen and progesterone.

Testosterone is often ignored or overlooked, and female low testosterone is often misdiagnosed.

1. Women Have Testosterone?

The short answer is yes.

Just like men, women have testosterone in their bodies at all ages (not just during childhood or puberty), but the levels are roughly 1/10 the level that is considered normal for men.

A woman’s body need testosterone to function properly, to regulate certain systems, and to remain healthy. That means when a woman’s body fails to produce a sufficient amount, she suffers from low testosterone.

Unpleasant symptoms result as these systems fail to function properly.

However, long-term health isn’t actually about testosterone by itself, or the levels of any single hormone—it’s about low levels of testosterone in proportion to your other hormones.

If any of these hormone levels get out of sync with the others, you’ll likely develop one or more of the common symptoms of hormone imbalance.

2. Symptoms of Female Low Testosterone (Hypogonadism)

The telltale symptoms of female low testosterone often indicate the need to consult with a medical professional who can check your hormone levels and help you determine the best course of action.

If you’re experiencing one or more of the following symptoms, you might be suffering from low testosterone:

1. Fatigue and exhaustion
2. Mood swings or low mood (mild depression)
3. Anxiety
4. Difficulty concentrating and short-term memory loss
5. Decreased interest in sex and difficulty climaxing during intercourse
6. Weight gain or difficulty losing weight
7. Loss of muscle mass
8. Changes in bone density
9. Hair loss or thinning hair
10. Dry or thinning skin

Let’s look at these symptoms in detail and discuss how they manifest.

2.a. Fatigue and Exhaustion — What Do They Mean?

While considered a male sex hormone, testosterone plays a big part in the energy levels of both men and women, meaning when your testosterone is low, you start to experience symptoms like fatigue — probably the main reason women come to us for a consult to check their hormone balance.

When we talk about the word “fatigue,” what we mean is a lack of energy — feeling tired, sleepy, exhausted, drained, or worn out, often with no explanation for your lack of energy,

You may often feel tired, even when you’re able to obtain a full night’s sleep, or you may find it difficult to sleep through the night. Disrupted sleep is another common symptom for women with low testosterone. A healthy hormonal balance is key to achieving consistent, restful sleep.

To clarify:

• It’s normal to feel fatigued when you’ve only had 3 hours of sleep or you’ve worked for 12 hours.
• It’s not normal to feel fatigued when you’ve had 8 hours of rest and a few days off.

We’re referring much more to the second variety, this abnormal, lingering exhaustion.

Unfortunately, not only is fatigue incredibly common, it also has a wide variety of possible causes, such as:

• Heart disease
• Thyroid problems
• Anemia
• Sleep apnea
• Vitamin deficiency

However, there’s one common cause of fatigue in women that’s often overlooked — low testosterone.

2.b. Mood Swings, Depression, and Low Mood

In addition to controlling energy levels, testosterone and other hormones play important roles in mood regulation, and imbalances can leave a woman feeling out of sorts on any given day, as this study demonstrates.

Do you identify with any of these key signs of low testosterone in women?

• Unexplained low moods
• Bouts with the blues
• Mild to moderate depressive periods

Even if you are not experiencing severe depression, you may still be having unpredictable mood swings, or even just a general “low” feeling that we often refer to as low mood as a result of low testosterone.

There’s good news, too. One study found women suffering from depression had a marked increase in mood after being put on testosterone replacement therapy and that women who took testosterone had higher levels of overall well being.

Women often consider taking prescription medication to combat these very difficult times of low mood, believing there are no other options available.

Talk to your doctor about the possibility of low testosterone. It might be possible to treat the source of the overall problem (hormone levels), rather than simply improving a single symptom through medication (with associated negative side effects).

2.c. Anxiety

Low-level anxiety with no known cause, particularly without having experienced difficulties in the past, may indicate a hormone issue like low testosterone.

Anxiety connected to low testosterone is usually more of a mild irritation, but it could be strong enough to cause panic attacks in some cases.

Mood-related symptoms, like anxiety and depression (discussed in the section above), occur because hormonal fluctuations often cause changes in brain chemistry that affect mood and neuropsychiatric regulation.

If you suddenly experience bouts of anxiety, especially if you have never had anxiety issues in the past, you may want to consider being tested for low testosterone.

2.d. Difficulty Concentrating and Short-Term Memory Loss

One of the difficulties in detecting low testosterone in women is that the symptoms often mimic the classic signs of aging.

Having uncharacteristic difficulty concentrating on tasks that used to be easy for you is often blamed on getting older, often occurring along with mild confusion or difficulty with short-term memory.

The severity of memory difficulties can vary widely. In minor cases, women may feel more overloaded and have more difficulty managing a busy schedule that they used to handle with ease.

Some people suffer to a point that they start worrying about Alzheimer’s or dementia.

If you are concerned about serious memory deficits, consider that Alzheimer’s patients typically suffer from some or all of the following:

• Difficulty communicating or finding words
• Inability to plan ahead
• Frustration when organizing daily tasks or events
• Loss of some motor function and coordination (such as walking or reaching for items)
• Agitation
• Paranoia
• Hallucinations
• Socially inappropriate behavior

If you’re experiencing symptoms of mild to moderate memory loss or difficulty concentrating without the more serious signs of Alzheimer’s, consider the possibility of low testosterone or other hormone imbalance and check with your medical provider.

2.e. Decreased Interest in Sex and Difficulty Climaxing During Intercourse

Just like in men, testosterone affects sexual arousal in women. The effects of low testosterone can affect women’s sex lives in a few different ways:

• Decreased libido
• Less frequent sexual activity
• Fatigue
• Fewer sexual fantasies
• Decreased pleasure from orgasm
• Less satisfaction from sex
• Less desire for or interest in sex
• Vaginal dryness
• Depression

Because all of these symptoms are often associated with low testosterone, low estrogen, or other hormone imbalances, as well as many other types of illnesses, diagnosis without a medical consult and blood testing is almost impossible.

This Psychology Today article advised healthcare professionals to look carefully for low testosterone disguising itself as low mood or loss of interest in sex

Many studies support this idea—this study found that women with higher levels of testosterone found masculine features more attractive.

Another study found that women who underwent testosterone replacement therapy found improvements in almost every aspect of their sex lives, from frequency of sexual intercourse and pleasure of orgasm to increased masturbation and sexual fantasies.

Another study found that women with lower levels of testosterone generally had lower libidos than their counterparts with normal levels of testosterone.

Using the Female Sexual Function Index (FSFI), researchers found that desire, arousal, lubrication, and orgasm were statistically significantly higher in women with higher levels of endogenous (natural) testosterone.

Yet another study found that supplementing women with hypoactive sexual desire disorder with testosterone improved both their distress with having little sexual desire and their sexual desire itself.

In short, your sex life is powerfully influenced by your testosterone levels, not just your estrogen levels.

2.f. Weight Gain or Difficulty Losing Weight

Many women experience a vicious cycle of progressive weight gain (possibly leading to obesity) as a symptom of low testosterone.

Extra body fat can produce excess estrogen, which, in turn, drives relative testosterone levels even lower.

Once this cycle has started, it can be very hard to break.

Like many of the other symptoms of low testosterone, many women will mistakenly chalk up this weight gain to getting older.

However, if the root cause is low testosterone or hormone imbalance, treating that root cause (by restoring hormonal balance through Testosterone Replacement Therapy or other hormone replacement) could get your body functioning properly again—slowing, stopping, or even reversing the cycle of weight gain.

2.g. Loss of Muscle Mass

Much as it does in men, testosterone affects muscle mass production in women.

Women with low testosterone often experience a loss of muscle mass and muscle tone, no longer seeing the results they expect when they lift weights.

Data collected by the North American Menopause Society in a study on 71 postmenopausal women who had undergone a hysterectomy supports this conclusion.

The women received supplementary testosterone over a 12-week period, and gains in lean mass, chest-press power, and loaded stair-climber power were observed.

If you’re seeing a physical decline and loss of muscle mass, talk with your doctor and have your testosterone levels checked. Like weight gain, loss of muscle mass may be reversible, too.

2.h. Changes in Bone Density

Testosterone works together with a form of estrogen known as estradiol to promote healthy bone growth and bone healing.

As women go about their daily activities, bone is worn away. New bone tissue is generated to repair the damage and keep the skeletal structure strong and healthy.

When these key hormones become unbalanced, this regrowth process short circuits or becomes inefficient, and the result over time is a loss of bone density.

In one study, conducted over a 2-to-8 year period, researchers found that low testosterone levels were closely associated with loss of bone mass in both premenopausal and postmenopausal women.

In severe cases, this is known as osteoporosis, a condition where bones become brittle and easily damaged.

Staying active and adjusting your diet are crucial to maintaining a healthy hormonal balance and fighting a loss of bone density in general.

2.i. Hair Loss or Thinning Hair

Hair loss is one of the more visual symptoms of low testosterone, and it can drastically affect women’s self-esteem and sense of well-being.

Testosterone supports healthy hair production and maintenance, and an imbalance can result in patchy hair on the head, or even baldness in women.

Although hair loss from low testosterone will be most obvious on the head, hair loss on other areas of the body may also occur, though it’s typically less noticeable, particularly in women who regularly shave their legs and armpits.

If you notice that you’re not having to shave your legs or armpits as often as you normally would, or if you notice that your hair is getting patchy, that may be a sign of low testosterone.

2.j. Dry or Thinning Skin

The balance between testosterone and estrogen in both men and women helps determine their skins’ thickness and texture.

Women’s skin is 20% thinner on average than men’s. It holds less moisture and less collagen, making it significantly more fragile and more susceptible to thinning or losing its youthful quality as a result of low testosterone levels.

Premature aging due to changes in the skin’s quality can negatively affect women’s self-image and appearance, but it’s a symptom that could see significant improvement through treatment.

2.k. What If My Low T Symptoms Are Only Minor?

Many women will experience only mild or occasional symptoms of low testosterone.

In some cases, women’s hormones naturally hover very near the bottom of the “normal” range, and levels can dip into the “low” range due to any number of health factors.

If you’re one of those women, you may experience one or more of these symptoms when levels dip, and yet feel mostly fine at others.

It can be confusing to feel normal and then find yourself suffering.

In these cases, it’s a good idea to keep an eye on your diet and exercise. Without proper nutrition and maintenance, your body will not operate properly, and hormone production can easily be disrupted, sometimes resulting in symptoms.

These systems can malfunction for many different reasons, but an imbalance like low testosterone can lead to serious symptoms that affect how you feel, how you look, and your overall sense of wellbeing.

3. What Causes Low Testosterone in Women?

The short answer is that there are many possible causes.

The causes of low testosterone in women haven’t been studied nearly as much as in men, but researchers have found a number of causes in women, including:

• Getting older: Most women’s testosterone levels decrease naturally from an early age
• Oophorectomy: Ovary removal can reduce testosterone levels in women
• Ovarian failure due to chemotherapy drugs or other drugs: Also known as chemical oophorectomy, any substance that affects your ovaries can decrease testosterone levels
• Estrogen therapy: Estrogen suppresses production of the hormone responsible for stimulating testosterone production — this includes birth control
• Hypothalamic amenorrhoea: Cessation of menstrual periods in a woman before menopause; possible causes could include stress, extreme weight loss, or extreme exercise
• Early menopause (before the age of 40): Also known as premature ovarian failure
• Adrenal gland issues: Also known as adrenal insufficiency
• Pituitary gland issues: Hypopituitarism or hyperprolactinemia

Some research suggests a genetic abnormality that complicates the natural production of DHEA and DHEA-S, which are used to form testosterone in women’s bodies, as a possible cause.

Another possibility is that catalytic enzymes needed to convert these precursors (DHEA and DHEA-S) into usable testosterone may be insufficient.

3.a. The Causes of Female Low Testosterone Are Not Well Understood

The source of low testosterone in women is not well understood because there are so many possible causes, and its symptoms look so much like the symptoms of other hormone imbalances, including low estrogen.

It’s logical to blame other hormones initially, like estrogen or progesterone, because the symptoms that come with being deficient in any of these hormones look quite similar.

In fact, it’s not often the case that just one hormone has become unbalanced, but that several of them exist in an overall state of imbalance.

Symptoms indicating hormone fluctuation at the onset of the menopausal cycle also appear similar. In particular, low libido or low sex drive has traditionally been attributed to low estrogen caused by the beginnings of menopause.

As we’ve mentioned earlier, low testosterone in women is often simply written off as the less attractive aspects of growing old — weight gain, difficulty losing weight, and hair loss are more frequent with age.

Hormone production changes as we age, resulting in some physical changes, but imbalance is not something that simply has to be accepted.

Most of these underlying causes are related to ovarian function, and medical providers sometimes misdiagnose women as having high testosterone, when, in fact, it is low. It will likely require blood testing to identify the source of the problem and determine the proper corrective treatment.

4. High Testosterone or Low Testosterone? — A Frequent Misdiagnosis

This is a significant problem, so we’re going to discuss the high testosterone misdiagnosis in some detail.

Your medical care provider misses the mark with hormone testing and reaches the wrong conclusion:

Your testosterone is too high.

This can happen for a variety of reasons.

Maybe they only looked at your total testosterone (and didn’t consider your free testosterone).

Maybe they did look at your free testosterone, but they ordered the wrong study.

Maybe they just made a mistake.

If you’ve gotten your tests back and they show your testosterone is too high, you might want to get a second opinion. If your testosterone is already below normal, pushing it even lower can be nothing but detrimental (and exacerbate the symptoms you’re already having).

The failure to look at a calculated free testosterone test (not an analog or “direct” free T test) often results in misdiagnosis because the only portion of your total serum testosterone that is active is your free testosterone.

Almost all of your total testosterone is soaked up by albumin and a blood globulin called SHBG (sex hormone binding globulin), rendering it effectively useless as it just floats through the bloodstream (instead of doing its job in the tissue).

These levels, or sizes, of these “sponges” can vary. Namely, your SHBG may be far too high, often the case if you have naturally high estrogen levels or if you are being treated with estrogens. Keep in mind that almost every birth control preparation contains estrogen.

The remaining unbound and active testosterone could be too little, even if your total is deemed “too high” by a lab test, and it may be your prescribed medications influencing the issue — where the misdiagnosis is likely to occur.

Unfortunately, a lot of women with hormone imbalances, including low testosterone, get lumped into a single category — PCOS.

4.a. Being Diagnosed with PCOS Regardless of Symptoms

Some providers see that your hormones are out of balance and immediately determine that you have PCOS without any further investigation.

While PCOS is one possible cause of hormone imbalance, it’s certainly not the only cause. There are many different potential causes of low testosterone in women that should be investigated before settling on PCOS as the culprit.

If you’re diagnosed with PCOS or high testosterone without proper testing of your free testosterone levels, we highly recommend you get a second opinion.

5. I Might Have Low T — What Do I Do Next?

If you think there’s a possibility that you have low testosterone, you need to see a medical professional to be sure.

A simple blood test can determine where exactly your levels lie, which is the first step in determining whether you need Testosterone Replacement Therapy (TRT).

Recovering from female low testosterone means becoming the woman you’re supposed to be right now—before illness, stress, injuries, surgeries, medications, and behaviors that damage testosterone production crept in and altered your hormone balance.

Click to schedule your free initial consultation today.