Testosterone in Women

When talking about testosterone, we know that the most common thing to think about is men, as testosterone is classically known as the primary male sex hormone. However, women also produce testosterone; like men, they need it for proper body function. So it doesn’t make much difference in that sense, although they differ in many other ways. Let’s find out below.

What is testosterone?

Testosterone is a steroid sex hormone that belongs to the group of androgens. It is found in low concentrations in women, unlike men (10 times more than women), but those low concentrations are essential to support hormonal balance and overall feminine health.

Where is it produced?

In adult women, this hormone is produced in different places and in different ways.

The ovaries produce twenty-five percent of it, the other 25% by the adrenal glands, and the remaining 50% by converting androstenedione and dehydroepiandrosterone (androgenic hormones) in testosterone, with its highest production in the 20s and 30s.

As a woman gets older, testosterone levels decrease. At age 40, it is reduced by approximately 50%; in the 50s, it reduces by 25% more.

What are its functions?

In women, testosterone participates in several processes and fulfills various functions:

One of the most noteworthy is that this hormone interferes with the production of estradiol, a female estrogenic hormone. Testosterone is also involved in proper ovarian function and follicular development, making it a critical part of female ovulation.

Testosterone also participates in:

  • Sexual function, libido, or sexual desire
  • The appearance of body hair
  • Musculoskeletal. It participates in the development of the musculature and contributes to the excellent condition of the bones.
  • Cognitive function (faculty of learning, remembering, planning, etc.)
  • Mood

Testosterone also plays a vital role in cardiovascular health. Several studies have defined its vasodilator effect since it enhances the nitric oxide pathway and its action on the endothelium of blood vessels. Nitric oxide is a substance that enlarges blood vessels to promote blood flow. This action ultimately decreases blood pressure, which, in the long run, benefits the feminine body and heart health.

What are normal testosterone levels in women?

To answer this question, it is necessary to know that testosterone is found in two ways in the body. Total testosterone is the total hormone produced and which is bound to proteins, while free testosterone equals between 1 to 3% of the total and is the one that produces the real body effects.

In this sense, total testosterone concentration over their 20s is approximately 12 to 60 ng/ dL, and in menopause, up to 50 ng / dL. Unlike total testosterone, the normal concentration of free testosterone depends on the phase of the menstrual cyclehaving to:

  • Follicular phase: 0.2 – 1.7 ng/dL. 
  • Mid-cycle: 0.3 – 2.3 ng/dL. 
  • Luteal phase: 0.17 – 1.9 ng/dL. 
  • Postmenopause: 0.2 – 2.06 ng/dL.

When these values are altered, either because they decrease or increase, women can show alterations in their organisms that require professional attention.

Low testosterone levels

Signs and symptoms

Among the signs and symptoms of low testosterone levels in women are:

  • Decreased sexual desire or libido – This is one of the main symptoms that women experience. They lose interest in sex and also have a constant sense of frustration, sadness, anguish, and decreased self-confidence.
  • Decreased ability to reach orgasm
  • Vaginal dryness
  • Sleep disorders
  • Loss of bone density
  • Loss of the feeling of well-being
  • Chronic stress and depression
  • Loss of muscle mass, accumulation of body fat, and weight gain
  • Tiredness and fatigue, slowness and lethargy
  • Thinning hair and dry skin
  • Fertility problems and alterations in the menstrual cycle
  • Fatigue and low energy.


As the years go by and menopause arrives, testosterone and other hormone levels decrease in women. However, other circumstances can also decrease them, for example:

  • Endocrine disease – In the case of adrenal insufficiency (when the adrenal glands do not function properly), hypopituitarism (is a disorder in which the pituitary gland does not produce the average amounts of one or more of its hormones).
  • Addison’s disease
  • Bilateral oophorectomy (surgical removal of the ovaries)
  • Surgical removal of the adrenal glands
  • Drugs – The use of medications such as oral contraceptives, antidepressants, antihypertensives, and opiates has an antiandrogen effect that decreases hormones, including testosterone.
  • Early ovarian insufficiency (IOP)
  • Early menopause
  • HIV infection
  • Anorexia nervosa
  • Unhealthy habits include very restrictive diets, lack of rest and sleep, and prolonged stress.
  • Chemotherapy and radiotherapy


Replacement therapies can effectively treat low testosterone levels. In this case, the external testosterone administration can provide hormones at proper levels for each woman’s needs and improve the irritating signs and symptoms.

These therapies are indicated by the attending physician when blood studies have confirmed that the levels are indeed low, coupled with typical body manifestations. You should note that some drugs used to replace estrogen already contain testosterone, so you may not need supplementation.

Some of the testosterone replacement therapy options are:

  • Transdermal gel
  • Injectable testosterone (intramuscular or subcutaneous)
  • Oral tablets
  • Testosterone patches (can be applied to the oral cavity or skin)
  • Nasal testosterone.
  • Subdermal implant.

If needed, you must take the treatment under strict medical supervision, so physicians can verify that the therapy is effective and possible side effects are monitored and controlled.

On the other hand, lifestyle changes can increase testosterone. Some include improving sleep quality, controlling stress levels, staying active by doing physical activities and exercises that improve endurance and strength, and eating healthy, including vitamins such as A, D, and E, and zinc and magnesium.

High testosterone levels

Signs and symptoms

  • Hirsutism – Increased body hair growth, especially pubic, facial, and midline hair.
  • Deepening of the voice
  • Alopecia – Scalp hair loss is another clinical manifestation of high testosterone levels. When it is marked, it is evident that baldness tends to follow a male pattern.
  • Acne – The sebum stimulation supported by testosterone produces oily skin and the consequent appearance of acne.
  • Oily hair
  • Menstrual cycle irregularities – By the involvement of ovulation. There may be no bleeding and bleeding between menstrual cycles, in addition to the greater chance of infertility.
  • Increase in the size of the clitoris and its sensitivity
  • Increased sexual desire
  • Changes in behavior and aggressiveness
  • Decreased breast or breast size
  • Miscarriages
  • High blood pressure and high cholesterol
  • Fretfulness
  • Snoring
  • Hepatitis


One of the leading causes of high testosterone in women is polycystic ovary syndrome (PCOS). This endocrine problem is widespread today, especially in childbearing age.

Other causes of high testosterone

  • Ovarian cancer
  • Tumors in the adrenal glands
  • Adrenal hyperplasia
  • Dysfunction of the adrenal gland
  • Pregnancy
  • Trophoblastic disease during pregnancy
  • Early puberty
  • Hyperthyroidism or hypothyroidism
  • Hyperglycemia or elevated blood sugar levels
  • Insulin resistance
  • Diabetes
  • Drugs – By the use of anticonvulsant drugs, barbiturates, estrogens
  • Poorly controlled testosterone replacement therapies
  • Lack of exercise and sedentary life
  • Obesity


When it comes to elevated testosterone levels, the treatment will depend on the cause. However, commonly used medications include: 

  • Oral contraceptives (OCDs). This treatment option has been very effective in women with elevated testosterone levels. They block total and free testosterone and decrease their values in the blood.
  • Metformin. This drug, used to treat diabetes and insulin resistance, also inhibits testosterone. This may be because it inhibits cytochrome P450-C17a, a key enzyme in synthesizing steroid hormones.
  • Spironolactone. This drug is one of the most widely used antiandrogens in the United States, but it is also a diuretic, so it is used as a treatment for heart failure and high blood pressure.
  • Glucocorticoids. According to several studies, glucocorticoid therapy reduced testosterone in women with chronic hirsutism.

If needed, a health professional must indicate all of these medications (or just some of them) under rigorous monitoring. Remember that doses depend on each patient’s needs and the treatment response.

Last but not least, you can reduce testosterone levels with certain natural practices and recommendations, such as:

  • Eat a low-fat diet – Testosterone needs the production of cholesterol to develop in the body.
  • Reduce sugars, mainly processed sugars.
  • Include the green té in the daily diet.
  • Decrease the ingestion of carbohydrates such as rice, pasta, potato, and white bread.
  • Include food that is high in omega 3 (almonds, walnuts, flax seeds, natural licorice, peppermint, mint, and fish – salmon, tuna, sardine, mackerel) since it lowers testosterone levels
  • Exercise regularly
  • Reduce daily stress levels through relaxation techniques such as yoga and meditation

HRT Doctors Group offers a number of female protocols that may include testosterone. Our experienced medical professionals can provide you with personalized care and advice to help you achieve your health goals. Don’t wait – make an appointment with us today and take the first step towards better health and wellbeing!

Dr. Melissa VanSickle

Dr. Melissa VanSickle

Dr. Melissa Vansickle, MD is a family medicine specialist in Onsted, MI and has over 24 years of experience in the medical field. She graduated from University of Michigan Medical School in 1998. She is affiliated with medical facilities Henry Ford Allegiance Health and Promedica Charles And Virginia Hickman Hospital. Her subspecialties include General Family Medicine, Urgent Care, Complementary and Integrative Medicine in Rural Health.


  • University Of Michigan Medical School