Low Testosterone in Women – Signs, Symptoms + Treatment Guide

Weight gain, low sex drive, hair loss, decreased energy and depression.

What do these things all have in common?

They can all be caused by low Testosterone in women. 

If you were under the impression that Testosterone was a male hormone, think again:

Testosterone is a very important hormone for women as well as men. 

And unfortunately, it's one of those hormones that is often ignored by Doctors. 

Or worse, your symptoms may be misdiagnosed as depression or as a "normal" consequence of aging. 

And that's too bad...

Why?

Because you can replace testosterone safely and effectively with the right knowledge to help you get back to feeling "normal".

Let's dive in...

More...

Signs and Symptoms you have Low Testosterone

Are you in your 40's to 50's? 

Have you had menopause?

Have you noticed a change in your mood or just overall the way that you feel?

If you are like many women out there you might not be feeling like yourself, leading to look into hormone replacement. 

And because each hormone can cause different symptoms you are probably wondering WHICH hormone is causing your problem(s).

Well, let's figure it out.

Low testosterone in Women usually presents with one or more of the following: 

  • Decreased sex drive or decreased libido (including lack of interest in sex or difficulty in getting aroused)
  • Inability to build muscle mass, inability to maintain muscle mass or "sagging" especially in the upper arms
  • Depressed mood or increased irritability
  • Inability to lose weight or increased weight gain (especially without a change to your diet)
  • Decreased energy levels or fatigue
  • Hair loss or thinning of the hair

​Now what can be confusing is that some other hormone imbalances can cause similar issues, so it's worth taking a look at those as well...

Low testosterone should be differentiated from low thyroid (hypothyroidism) which presents with one or more of the following:

  • Fatigue and exhaustion especially after a good nights sleep
  • Increased hair loss
  • Changes in mood including depression or anxiety
  • Weight gain or weight loss resistance
  • Changes in skin, hair, and nails
  • Cold hands or feet and inability to tolerate cold temperatures
  • Difficulty with sleep including insomnia or REM sleep disorders

Low testosterone should also be differentiated from menopausal symptoms (low estrogen and low progesterone) which usually presents with one or more of the following:

  • Hot flashes or changes in body temperature throughout the day
  • Increased fluid retention or swelling
  • Changes in mood including depression, anxiety or irritability
  • Not feeling like "yourself"
  • Weight gain (usually 10-15 pounds)
  •  Insomnia or waking up feeling flushed or hot
  • Inability to tolerate hot temperatures
  • Changes in sex drive or libido or pain with intercourse

Hopefully, you can see the overlap in these symptoms which is why it is so critical to CHECK your labs and use them in conjunction with your symptoms to really determine what your issue is. 

Now in truth, you should realize that most women are going to be low in SEVERAL of these hormones which is why they will likely experience major overlap in their symptoms.

A good place to start is with the most worrisome of your symptoms and the most worrisome of your lab results.

This way you can systematically determine what the main issue is for you and treat that.

But what causes these low hormone levels in women anyway?

Are all women doomed to developing low testosterone? (The answer might surprise you)...​

What causes low Testosterone in Women? 

Let me get this out of the way early:

Yes, most women WILL experience a decline in their testosterone levels.

Just like men go through andropause, women go through menopause + an equivalent to andropause.

If you didn't already know:

Andropause = age-related decline in testosterone

age related decline of testosterone in women

Menopause = age-related decline in estrogen/progesterone

age related decline of estrogen and progesterone

Somatopause = age-related decline in growth hormone

age related decline of growth hormone in women

So, even if you lived a VERY healthy and relaxing life - your testosterone levels WILL eventually go down.

But there are other issues that can premature lowering of testosterone levels.

And these other issues help to explain why some women are experiencing lower than normal testosterone levels younger and younger.

What issues am I talking about?

Hormone imbalances.

Specifically insulin resistance.

You can see several studies showing that insulin resistance can cause BOTH elevated levels of testosterone (1) and decreased levels of testosterone (2).

I've found that women who tend to have INCREASED levels of testosterone due to insulin resistance often fall on the PCOS spectrum.

And women who tend to present with LOW levels of testosterone with insulin resistance tend to present with weight loss resistance, decreased libido and mood changes.

But just realize that insulin resistance can cause either LOW or HIGH levels of testosterone depending on your body.

This is also very important when you consider that about 50% of the population has insulin resistance to some degree (3). 

​That means that statistically speaking you have a 50% chance of having insulin resistance and having issues with your testosterone levels. 

If you don't have insulin resistance your testosterone will eventually decline with age (4). 

But don't let this freak you out.

Why?

Because it's very possible to replace those low testosterone levels in a safe and effective way to help you start feeling better.

But first, what kind of benefits do you stand to gain?​

Benefits of Replacing Testosterone in Women

Each woman will have different benefits when replacing testosterone.

It really depends on the symptoms that they PRESENTED with.

So, for instance:

If low testosterone is causing issues with libido or weight gain, then replacing your levels may help with these 2 issues.

Make sense?

Below I've included a list of the changes that you might expect to see (based on my clinical experience in replacing testosterone in women). 

Benefits of replacing Testosterone in women: ​

#1. Improved Weight Loss

​Many of the studies that exist out there for testosterone replacement are primarily directed at men. 

There is a clear correlation between weight loss and testosterone replacement (5).

While there are fewer studies showing that testosterone therapy helps weight loss in women, there is a clear correlation that is seen clinically.

In my experience, women experience MANY of the same benefits that men do when replacing testosterone. 

While the weight loss when replacing testosterone is not as profound in men as it is in women, it can absolutely still help.

This is likely due to the fact that testosterone helps boost metabolism by helping women build muscle mass (6). 

The combination of increased energy and increased muscle mass is probably responsible for the extra weight loss that many women experience while taking testosterone. 

Realize that testosterone is certainly not a magical weight loss pill, however.

Increasing testosterone will likely result in modest weight loss (on the order of 5-15 pounds) unless it is used in conjunction with other hormone replacement, dietary changes, etc. 

#2. Improved Mood

The correlation between mood and testosterone is well established (7).

Low levels of testosterone are associated with higher rates of depression in women. 

The combination of menopause + low testosterone sets women up for depression.

If you see your PCP you will most likely be prescribed an anti-depressant when in reality the change in your mood is likely related to your hormones!

Don't fall for this trap.

​You remember the saying "Grumpy old men"?

They get grumpy because their testosterone levels fall, if you replace them they become much happier, more relaxed and less irritable.

low testosterone and mood

The same thing is true with women who supplement with testosterone.

Adding testosterone to your regimen (as a woman) can help boost mood (decrease depression-like symptoms), reduce irritability and improve quality of life. 

#3. More Muscle Mass (and therefore a better metabolism)

Do you feel like its difficult to gain or hold onto muscle mass despite exercising like crazy?

​Low testosterone may be playing a role. 

In fact, it just might be the combination of low progesterone + low testosterone leading to many of the issues that women face in regards to muscle mass.

​I'm sure you have seen the effects of decreased muscle mass in elderly women with flabby skin (especially in the arms) and thin extremities. 

Studies show that testosterone and progesterone (8) BOTH have an impact on muscle mass and muscle growth. 

We've already established that after menopause women have low levels of BOTH so many are set up for a double whammy.

The decrease in testosterone causes atrophy of the muscles in the body. 

Often, space, where the muscle should have been, is replaced with fatty tissue which causes the saggy of the skin and flabby skin that some women experience. 

Adding testosterone can help build muscle mass (which in turn boosts metabolism). 

#4. Higher Sex Drive and Libido

Even if you have no interest in improving your mood, losing extra weight or building muscle mass - maybe increased sex drive and libido will catch your eye?

Testosterone as a hormone is clearly associated with sex drive in women (of course it's not the only thing involved but it is very important). 

One very interesting fact about women is that (unlike men) their sexual lives tend to last as long as they have a willing partner (9). 

And since sexual activity is associated with numerous health benefits (10), this becomes very important!

​Testosterone can help libido and sex drive in a couple of different ways:

1) Increased desire to have sexual intercourse - If your desire is lower than normal, or you have noticed that it has decreased over the last several years then testosterone may be of benefit.

2) Improved sexual pleasure - The intensity and pleasure of intercourse are ALSO improved (in addition to increased desire) in some women who supplement with additional testosterone (11).

It will NOT help if you are having painful intercourse which can happen with menopause. ​

The decline in estrogen levels can cause changes in the vaginal wall which can lead to vaginal atrophy (12) and pain during intercourse.

Pain with intercourse can lead to a decreased desire for sex, but this should be differentiated from the scenarios above.

​To recap: 

Supplementing with testosterone can boost desire (AKA increased sex drive and libido) as well as pleasure and intensity during sex. ​

To get the most benefit and biggest "bang for your buck" applying the testosterone vaginally seems to boost these effects even further. 

In fact, many women who apply the testosterone transdermally (on their skin elsewhere) don't always get the added benefit of increased libido until they apply it vaginally. 

#5. More Energy

Many women do experience increased energy while supplementing with testosterone, but this is more of a subjective response to the treatment.

I suspect that increased energy likely comes from improved muscle mass, increased metabolism and changes in mood.

But no matter the reason, it's still true that testosterone can BOOST energy levels in many women. ​

​If you are experiencing decreased energy levels make sure you ALSO check your other sex hormones (estrogen and progesterone) in addition to thyroid hormone

Usually, low energy levels are associated with one or more hormone imbalances. 

Treatment for Low Testosterone in Women

​If you've been reading this post so far and you're interested in learning more about supplementing with testosterone then read on...

I don't recommend that women just take extra testosterone for the sake of it. 

Instead, they should be evaluated based on their symptoms and on lab results.

So it becomes really important to understand what "normal" testosterone levels are because most Doctors aren't familiar with ordering and managing hormone levels. 

It's also important to realize that when supplementing with Testo​sterone as a woman we are talking about doses MUCH smaller than what a male would get. 

​How to check your Testosterone Levels

Like thyroid function, there is a difference between "normal" and "optimal" levels of testosterone. 

First off:

To accurately test testosterone levels you need to check for BOTH Total and Free testosterone levels in the serum. 

Below I've included some tests results from a patient of mine with sub-optimal testosterone levels:

Low normal testosterone levels

You can see from this example her personal total testosterone was 23 with a reference range that spans 14 to 76. 

Her value of 23 technically put her in the "normal" range but certainly not the optimal range. 

Likewise, you can see her free testosterone at 0.27 with a reference range of 0.10 to 0.85 - again putting her in the low range of normal. 

This is a perfect example of a patient who might benefit dramatically from Testosterone replacement and supplementation. 

Generally, I like to see testosterone levels in the upper 50% of the reference range. 

Treating testosterone is completely different, but if you are NOT taking testosterone then an "optimal range" to shoot for would be that upper 50%. 

I've also included an example of insulin levels and blood sugar that commonly accompany low testosterone levels:

Insulin resistance with low testosterone

​Because of the associated with insulin resistance and low testosterone I always recommend that each patient gets ALL of their hormones checked at the same time. 

This helps to create a "story" of what is happening in the body. ​

​Testosterone and Autoimmune disease

​I also want to take a second and mention the link between low testosterone levels and autoimmune disease - which can be another huge reason to consider adding testosterone to your regimen. 

There is a reason that most autoimmune diseases ​are found in women and one of those reasons is felt to be testosterone levels. 

Testosterone has an impact on the immune system (13), specifically that it can help balance the system that helps your immune system differentiate between self and foreign. 

It does this by altering T cell immunity and helping to boost the TH1 response (14).

In my practice, I've found a strong correlation between low normal testosterone levels (or even non-existent testosterone levels) and autoimmune disease, especially in women. 

Boosting testosterone levels can help boost your immune response and with other changes to lifestyle and diet I've seen it also help reduce antibody levels in some cases. ​

This would be yet another reason to consider adding testosterone therapy to your regimen if you are a woman. ​

​How to take Testosterone

There are many ways to actually take Testosterone, but the most important part is this:

The testosterone should be given either by intramuscular/subcutaneous injection or via transdermal application.

Basically, you should NOT be taking testosterone as an oral supplement.

Because of this testosterone comes in many preparations:

  • Hormone Pellet - This is a device filled with a pre-set amount of hormones that can be surgically inserted into the body to allow a release of hormones over a period of time. 
  • Testosterone creams/gels/liquids/patches - In these preparations testosterone is bound to a carrier that diffuses through the skin for absorption. Gels are generally used for men while creams are generally used for females. Some formulations don't allow for vaginal application, which can be a downside. 
  • Testosterone injections (Subcutaneous or intramuscular) - Injections can be as frequently as every week and usually contain a large boost of testosterone that slowly fades over time (usually days). This application doesn't allow for vaginal placement. 
  • Testosterone liquid in an organic base - This is my preferred route which I will discuss below. 

​When supplementing with any hormone I find that it's always best to try and mimic or emulate what a woman's body would have done normally when she was younger. 

That means mimicking the release of testosterone during a woman's cycle:

testosterone levels throughout menstrual cycle

​You can see the testosterone levels are relatively stable with a boost around ovulation (which helps explain the increased sex drive around that time of the month for many women). 

My preferred route is through topical/transdermal applications that allow for vaginal placement to get that extra boost of libido.

I also will switch to smaller doses of subcutaneous or transdermal testosterone shots in some women with autoimmune disease to get a "boost" that slowly declines over the next several days.

Generally, I don't recommend pellets for the following reasons:

  • The dose is hard to adjust and each person needs a unique dose - That means if you overestimate or underestimate the dose you have to wait several months for the pellet to "expire"
  • No vaginal placement
  • Surgical incisions needlessly increase the risk for complications like infection or postoperative bleeding
  • Hormone levels with pellets generally provide a MASSIVE boost to hormone levels that then tapers off over time to "baseline" which does not mimic the testosterone levels of a healthy young woman

For these reasons, I tend to stay away from pellets as a way to replace hormone levels. 

​Negative Side Effects of Testosterone?

Maybe you are thinking right now:

What's the catch?

And I wouldn't blame you, but I'm here to tell you that generally testosterone is tolerated VERY well in most women.

Why?

Because when I (and other hormone doctors) replace hormone levels our goal is to only replace what your body NEEDS.

So, as long as you just provide what the body needs and not more than what it is used to there shouldn't be any negative side effects.

This isn't always true, because some people are very sensitive to hormones/fillers/binders/etc. but it is true for the majority of patients.

When testosterone isn't well tolerated the side effects tend to be mild:

  • Irritability or change in mood (especially anger)
  • Acne or increased propensity to develop pimples
  • Oily skin or changes in complexion
  • Mild fluid retention or swelling

​These side effects are quite rare but they do occur on occasion. 

In my experience, only 1 out of 20 women will experience one of the side effects above in the doses that I recommend. 

Wrapping it up

To recap:

Testosterone is a very important hormone in women and low levels can lead to serious symptoms that can be mistakenly diagnosed by providers who aren't knowledgable about hormone replacement. 

Supplementing with testosterone (in healthy amounts) can lead to increased weight loss, improved mood, increased libido/sex drive, increased energy and increased muscle mass. 

When supplementing with Testosterone I recommend using transdermal application and if libido is an issue then vaginal application seems to work the best for most women. 

When possible I recommend avoiding pellet forms of hormones due to risks from the surgical application of the pellet and the inability to really titrate hormone dosing. 

If you follow these guidelines replacing testosterone can be very helpful and rewarding. 

Now it's your turn:

Are you currently using testosterone? 

Has it helped you with any of your symptoms? Why or why not?

Leave your question below and I will personally respond. 

References (Click to Expand)

This post was most recently updated on February 8th, 2019

Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders.He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances.You can read more about his own personal journey here.

142 thoughts on “Low Testosterone in Women – Signs, Symptoms + Treatment Guide”

  1. Hello,

    I’m a 37 year old male. Recently got my thyroid in balance in WP Thyroid, with Low Dose Naltrexone to help lower TPO antibodies (at 250 now)..
    Recently we check and my testosterone is around 300. I just started compounded cream.

    I’m just wondering why men weren’t mentioned in your article? Can I expect to have similar results with the testosterone replacement?

    • Hey Thomas,

      I will come out with an article targeted specifically for men, testosterone replacement therapy in men is much different so it really deserves its own article.

      Treating men with testosterone is awesome because their results are even more impressive than women, provided you do it correctly. So, yes, you should experience much of the same symptoms if your TRT is adequate (but realize it’s different than what is outlined in this article).

  2. Dr. Childs,

    A little more than a month ago I started Testosterone. My doc has me on 2mg (1mg AM & 1mg PM) 2% I believe. By the end of my first month I felt like my Testosterone may have been converting to Estrogen. I experienced sore breasts and bloating and some anxiety. The only positives were some improvement in my skin texture, a bit more energy and clearer thinking early on. I was applying vaginally. My T was compounded in a versabase cream. Refill was in a versabase gel. Absolutely no improvement in libido nor weight loss or muscle strength despite exercising 3-4x per week doing weight lifting and HIIT on treadmill.

    I did cut back to one a day and still felt it was converting to Estrogen. Now I am doing it once a day every other day. Still getting some breast soreness.

    Do my symptoms of breast soreness, bloating/fluid retention, anxiety lead you to believe it is converting to Estrogen and if so, what are natural supplements that could be used to stop the aromatasing? I assume that’s what’s happening. My SHBG is high due to higher T3 levels as well. I am not terribly overweight, but maybe 20 lbs. or so. My A1C is 5.6, insulin 4.8 and estimated avg. glucose 114.

    Any ideas? My conventional doc will not run more labs until November… Was it wise to back off the dosing or was there an adjustment period where my symptoms should’ve been expected and I jumped the gun cutting back?

    Any advice is greatly appreciated. There really seems to be an art to this…

    Thanks,
    Laura 🙂

    • Hey Laura,

      Some doctors tend to overdose women on Testosterone to try and get some weight loss benefit. I can speak to your specific situation but I can tell you that you aren’t likely to lose any weight until you treat your insulin resistance.

  3. Hi Dr Childs, My Dr is working on my thyroid because it was above the normal range. We have managed to bring it down considerably. I still struggle with my weight. Should I have her add testosterone tests to be sure that they are not out of whack also. Thank you for reading this. God bless

    • Hey Lisa,

      I think that checking your testosterone is reasonable, but the majority of weight loss resistance does not come from thyroid or testosterone – usually leptin and insulin.

  4. I am 48 with estrogen dominance, I am using 800 mg of natural progesterone to try and overcome this. I was using testosterone, but I noticed they had added two esteogens to it, and I do not need more of that. So I stopped.

    I just had blood work done, trying to figure this all out as my GP doctor is clueless.

    TOTAL Testosterone 30 ref. Range of 2-45
    Testosterone free 2.0 ( 0.1-6.4)
    DHEA S 50.7

    I also have thyroid issues, on two grains of nature throid but my free t4 is still low, while my TSH is 0.46.

    Not sure what all this means?

    Thank you!!

    Anne

  5. Problem is how much do these tests cost and the testosterone too? Even though I do have health insurance all these tests start to add up and sometimes insurance doesn’t cover much.

    • Hey Marie,

      I think a bigger problem would be to go without treatment! Also, I order all of these tests that I discuss on my blog and insurance always covers them.

      • I thought I read you don’t take insurance? but stated your tests are usually covered by insurance? I too am having thyroid issues- and found you while googling thyroid issues! 🙂 Your info really interests me and just started reading your stuff!

        • I don’t take insurance in the office but insurance will cover medications and labs if you have it. I hope you find the info helpful!

  6. It’s been 5 miserable years that I’ve experienced pains that it’s gotten worse and it’s a struggle for me. Blood levels come out in the normal range it took 3 years or so that finally I’ve got levothyroxine it’s started with 25cmg then 50 now at 75 but lots of chronic pains hard to get up from sitting it’s has brought me down with sadness depressed fatigue started me with other meds but haven’t seen improvement I’ve been to chiropractor rhythmatogist now to pain management finally its fibromyalgia it’s so painful taking lots of meds and no relief stomach upsets always from meds and menopause just horrible would like to see if you can suggest if anything else can help me my meds are meloxican,sulfassalazine,gabapentin,naproxen,simvastatin, and then just took a vitamin D 1.25mg ergocal. Low vitamin D please anything that I can feel better age 51 and tired of living in pain:,(

  7. What do you think about taking bioidentical testosterone/progesterone in the form of a trouche made in a compound pharmacy? Or is the cream far superior?

    • Hey Shauna,

      I pretty much always prefer the transdermal route whenever possible and as long as absorption isn’t an issue.

        • Hi Brenda,

          You’ll probably have better luck with the transdermal route or via injections. Even if one formulation wasn’t absorbed well you can try it in different places on the body and with different storage vehicles.

  8. How can I get testosterone cream? My doc tested me for thyroid, adrenal and testosterone. She put me on 1 grain nature throid , adrenal supplements, iodine supplements and recommended the testosterone pellet. My T was 24. She said not optimal. She only does pellets and I’m hesitant. Any recommendations? I’m frustrated because even with all started on, I’m still gaining weight. (Tried hcg and lost 9 lbs 1st week but gained back during menstruation in 2nd week ). I just want to feel normal again. No more aches, pains, no energy and weight gain). Heck I even gained weight with the Lap Band. Help!!!!

  9. Hello,
    I had lab work donelast week, and my testosterone level was low 5ng. preferred range 8-48. My T3 uptake was low as well, 23. Preferred range 24-39.

    I have thinning hair around my temples, weight gain in stomach and arms. Low energy, depression, sleep issues,and lack of motivation. I prefer natural ways to treat issues, do I need to take testosterone? How can I treat these low levels. Is there a dr you can recommend in the Dallas, Texas area.

    Thanks

    • Hey Tamar,

      Labs are really only a small part of the overall picture so you need to look at symptoms and other hormones as well. Unfortunately I don’t know anyone in that area.

  10. Started testosterone cream 1 month ago at 20 mg once daily. Labs were 5 (range 8-48). Energy level up a bit, no change in sex drive, face breaking out a little. Zero weight loss–eat Paleo and exercise 4 times/week. How long does it take for a difference with weight to occur?

  11. Hi Dr. Childs,
    Thank you for your wonderful article. I’m a 43 year old woman and still getting my periods. I have been having symptoms of low testosterone, no sex drive at all, loss of muscle mass and that sagging arm skin as well as muscle loss in my legs, this was never ever a problem before, a lot of fatigue I’ve suffered with a bit of depression and anxiety but it has increased, I talked with my psychiatrist and we didn’t want to make any changes until I just saw my gynecologist and have my hormones checked, my thyroid and glucose testing have already been done several times and are fine, however I just got my results from the gynecologist and my testosterone was low at .4 with a range of normal being 1.1 – 5.8, I was thinking wonderful we will be able to supplement and when I got a call back I was told the doctor didn’t want to add testosterone , my heart dropped, I have been searching for answers as its affecting my life, I had read some doctors don’t like to treat women with low t, any advice for when I hear back, I had said to the nurse I’ve been having these problems, we did all these blood tests got an answer and we aren’t going to do anything? I’m confused. Sincerely, Megan

    • Hey Megan,

      It’s important to find doctors and physicians who are knowledgeable about treating hormone imbalances otherwise you will end up frustrated and wasting your time in the long run.

    • For what it’s worth, I am almost 43… I was suffering sever exhaustion, depression, brain fog, anxiety/panic attacks, low sex drive, etc… I had every symptom but the weight gain. I reached a point where my concerned for my well-being became a chronic thought. I knew SOMETHING was wrong but I couldn’t figure out what. My blood work all came back great. Anti depressants didn’t help. Nothing helped… All of this gradually came on over the course of 7 years. I never in a million years thought testosterone was the problem. Why on earth would I think that?! It took a friends observation and advice to try test and I can’t begin to tell you how quickly everything turned around! Night and day! Injectable Tri-Test CEP 100-75-25 has changed my life… Go find another doctor ASAP!

  12. Hi Again Dr. Childs,

    I had another questions, I have heard taking DHEA at 25mgs and working up to 100 mgs and then down to a maintenance dose of 25mgs evens out low t levels, any truth to this, I had just left a previous comment of my gynocologist revealing low testosterone of a result of .4 with a normal reference range of 1.1-5.8, also I was wondering with your knowledge are you able to treat me? I feel I finally have an answer after feeling terrible for so long.
    Sincerely,
    Megan

    • Hey Megan,

      I’m not accepting new patients currently and in regards to your query about DHEA it can be hit or miss. DHEA is a precursor hormone that can be converted into either estrogen metabolites or androgen metabolites and you don’t really have control over that conversion process.

  13. You mentioned in the article that you prefer “Testosterone liquid in an organic base” . Can you tell me more? I use a combo Progesterone & Testosterone cream but don’t apply to vaginal tissue. Even though my free Testosterone levels have come up nicely, I’m not really enjoying the increased libido I thought I would have. Thanks for any additional info, I’m loving all the info you put ourselves!!

    • Hey KW,

      I generally recommend against the use of compounded multiple hormone creams due to potential absorption issues.

  14. I have been getting hormone pellets for several years. When i began my testosterone level was 10 and I was 42 years old. I have had spikes up to 220 and I was very sexually aggressive. I asked my doc to lower my dose and I’ve been doing ok for several years but I do notice that for severl weeks after I have them inserted I am very irritable. I would like more information on your liquid method and creams.

    Thank you,
    Elizabeth

  15. I recently did some hormone testing and was told that my testosterone levels are very low. In the past 4 years I have gained a lot of weight, and it has been hard to try to lose it. I’m also very moody, anxious, and always tired even when I sleep seven or eight hours. How long would I need to use this type of cream, and what would be the percentage of cream that is appropriate to use for a woman?

  16. I had my hormones checked, and all but mine were normal except testosterone. It was very low. Dr suggested cream to rub on but I told him I needed to do research first. I guess I was concerned about side effects, but I think the symptoms I’ve been experiencing lately have to do with this. It’s been very hard to just lose 20 pounds, low sex drive, brain fog, fatigue, feeling blue often for no reason, no get up & go. So I guess it wouldn’t hurt to try?

    • Hey Kc,

      Many women do quite well on testosterone (but not all), prior to using it make sure you get your other hormones evaluated as well.

  17. What are your thoughts on low progesterone? Mine basically went to zero – well all my female hormones and testosterone went to zero last year, I then gained 15 lbs without changing diet, exercise etc. I have started on T cream, but have been also taking Progesterone the past 8 months or so. I am not seeing any weight loss despite removing gluten, processed carbs, etc. My diet is very clean. I am taking Naturthyroid ( wondering if i should try WP instead) and really am at a loss as to why I can’t seem to lose even 1 LB!!!! I do have a good dr that is willing to work with me – considering asking for LDN as my inflammation markers are high, as well – not sure if due to hashimotos or other issues. As you can see I am a mess!

  18. Hello, I do get testosterone injections about once every 2 months. I was getting them every month but my hair on my head was falling out like crazy, my voice changed so much I could hardly talk especially in the mornings, and i had lots of facial hair coming in. I feel like a slug when I don’t get the injection but I do not want to be a bald bearded woman with a deep voice. I don’t know what I should do. I know I need them but it seems the side effects are just to much. I’m wondering if maybe I need a much smaller dose once a month. Also I am taking progesterone pills on day 14 of my cycle for premenopausal symptoms. I am wondering if the timing of the shot is causing so many side effects. Thanks for your help.

    • I was really hoping for an answer to this one. I’m 30 amd taking 0.25 every week. Im getting facial hair and my voice cuts out. Not sire if that means the testosteroneis too high or if it is not being utilized by my body properly

  19. I have just read your article on low testerone in women. I have been struggling with no energy,no sex drive, weight gain,night sweats and was diagnosed with perimenapause. However, my estrogen level and my progesterone levels are normal, my testosterone level was <3. My doctors did not want me on hormones because I have heart stents. I am 46 yrs old and have been miserable. My gyn placed me on celexa and I was even more depressed so I stopped it. I am insulin resistant and on metformin and trulicity and my AIC is 6.5 now. So I spoke to my physcian today and I am going to start a low dose testerone gel. I am very hopeful. Thank you so much for your article. I also have had no concentration depression.

  20. Wow! You’re a popular guy! Your article is awesome. One question: Can low testosterone levels mimic or contribute to fibromyalgia? If so, then I not have fibromyalgia, but instead just need to get my hormone level where they should be. Any ideas on this would be awesome.

    Thank you for sharing this wonderful information!

  21. I used transdermal testosterone cream for a year and upon checking my levels found that they had actually decreased from super low to “undetectable.” I’ve tried pellets and shots with bad results as you describe in this article. My doc doesn’t seem to be familiar with the kind of testosterone you suggest using vaginally. I guess it’s my last hope since nothing else is working. Where can I get more information specifically on that?

    • Hi Melissa,

      I don’t have any information on the blog about specific dosages, etc. but I’m sure pretty much any hormone doctor or anti-aging specialist should be able to help you further.

      Over time I will put dosages and applications of testosterone for women in my weight loss guide, but I don’t have that information available at this time.

  22. Hi. I’m a 54 year old post menopausal woman.
    I say post cos that’s what I’ve been told.
    Up until October I still felt terrible after 12 years of suffering menopause symptoms.
    I finally got referred to a gyno specialist by my doctor.
    She prescribed me tesogel.
    Omg I wish I could have had this years ago. All my symptoms that I’ve suffered for years have gone. My libido has returned with a venganve.
    I don’t understsnd why this is prescribed for most woman except keep insisting they try hrt after another. I tried10 in all un till this.
    I’d just like to thank Mrs Singh for giving me this opportunity.

  23. I am a 45 yr old female. I have no clue about my labs, only that I was told by my Dr that I was on 0 T when I began treatment. I have not been regular with my treatment and I go thru swings.
    The things that I have noticed… when I am completely empty, menstration stops completely., my mood turns fowl.. I find fault with everything. I need naps. It affects me negatively at work as well. Weight gain. My spouse can spot it and tell when I am off the treatment.
    After treatment, periods resume 4-5 days later. Mood and energy levels increase significantly. I haven’t been regular with treatment enough to realize weight loss.
    I recently bottomed out, and had a emotional blowout at work and quit a job I loved.. Thankfully it was my job and not my spouse.
    Ladies.. think about what you are risking by putting treatment off for another day week or month.

  24. I had a radical hysterectomy 10 years ago at the age of 32. I was only using an estradiol patch until last fall, when my new PCP prescribed me EEMT. (Over the past couple years I’ve have severe hot flashes, no sex drive, depression, anxiety, weight gain of 30 lbs, loss of muscle tone, etc.). The EEMT wasn’t a miracle drug, but I have had marked improvement with my symptoms. Now my PCP has left the practice and I am having an awful time trying to find a physician who will even think about prescribing testosterone to me.

    Any advice? I’m going to try to get in touch with my old PCP to see if she can refer me to someone in our area. I feel SO much better with the EEMT. My blood pressure is close to normal numbers now (it’s been hard to control in the past) and I’m taking 1/3 of the dose of the antidepressant I took before.

    • Hi Kristi,

      I generally recommend against oral preparations of estrogen/testosterone because other routes of administration offer superior results without negative side effects.

  25. Hi Doctor,
    I have Hashimoto thyroiditis since the age of 30. Now I am 57 and can’t lose weight (5’3″ and weight is 178 and going up every month.)I am taking 2 pills of 65mg each of Nature-thyroid for the thyroid. I am taking testosterone bio identical cream low doses and I apply it on my leg. I will ask my doctor to use the vaginal testosterone since my libido is non existent. Like you I don’t like the idea of the pellet since you can’t regulate the doses. I also have painful intercourse for which I will probably need more estradiol. My doctor did not check for leptin or insulin resistance but I notice that on one test the glucose serum is high 120 and fructosamine is 244 (max 285) could that be an indication that I have insulin resistance? What is the name of the testosterone cream you recommend? Thanks, Louisa

  26. I’ve found some new and fantastic information on your web site. Thank you.

    I’m 41 years old and I noticed in my late twenties that my libido changed. I became more “numb” in my vigina. My sex drive was still high but I couldn’t feel as much as before. Since then the numbness has increased. A year ago I started having numbness in my genitals as well. And I have no sex drive left.

    At the same time I was diagnosed with hashimotos. A hormon panel was taken and my free testosterone was very low, 0,09 nmol/L. My progesterone was also a bit low. My SHGB sky high. I was given testosterone gel in hope of getting my libido back. It didn’t, BUT my stuttering since childhood almost disappeared!

    My questions are.
    Can that connected to my autoimmun disease?
    Can I try to apply the gel on my genitals for increasing my libido? Other parts of the body did not work.
    Can I use progesterone cream at the same time?

    Thanks a lot!

  27. Hi ,
    I am 54 years old , female . I have been experiencing several fairly acute symptoms that when visiting a GP who specialises in bio identical hormone therapy felt I needed to start transdermal treatment immediately …25 days on , 5 off but without doing any tests whatsoever . I agree that I am very obviously in need of HRT but without a baseline? The cream has given me is made up of 1scoop daily 2mg estriol, 0.5mg estradiol, 30mg progesterone,2.5mg testosterone. Two days in I feel my legs are holding water , am having hot flushes , mild feelings of panic …imagined ? Possible? I have an extremely sensitive system and am terrified that I am being fed hormones I might not need despite that symptomatically I concur that I am indeed needing but in what doses? My GP says that the dose is too low to have a negative impact and can only benefit me …your thoughts?? Would so appreciate some input 🙂

    • Hi Kay,

      Assuming you are menopausal you can make the assumption that your estrogen and progesterone are both low (this is afterall what defines menopause). Having said that, each person is slightly different and you really shouldn’t treat using this logic without assessing serum levels of hormones.

      Some sensitive people can most definitely react to even very tiny doses of hormones.

  28. Hi,
    Great article. I was wondering if there was a certain brand name or mixture of testosterone that you suggested or used the most for frmales. I know you said you like creams. Is there one that is more natural and free of a lot of unnecessary addititives. I also have low progesterone. Any suggestions for that. I live in a small town and am unsure that my doctor is very well educated in this topic so wanted to suggest this article and any other information I could provide him with.

  29. What then should am ideal level be for women like me who is using testerone cream now ..my last check it was kinda high I thought like.over 100. You said best to be in upper 50% range of normal right? So if I decrease my dose now that should help that correct? What’s the best normal range or avg you see is best for women ? Thanks

    • Hi Mary,

      Every woman is different so I can’t speak to your individual levels, some women do better on higher doses and some do much better on lower doses. It’s about finding what works for your body by assessing both your symptoms and your blood tests.

  30. I was diagnosed with Hashimoto’s earlier this year, my doctor thinks I’ve gone undiagnosed for over 10 years. I’m currently on 240mg of armour & just started T therapy 2 months ago because my body is quickly approaching 0 (my last lab was .7, down .3 from the previous). I’m only 28 years old and a fitness competitor (Competely natural, NO performance enhancing anything). I’m beginning to wonder if I should ask to change my meds, based on research I have found, I’m taking quite a high dose with my thyroid still not responding. My body is incredibly responsive to foods outside of hashimoto protocol too. I can’t swallow if I eat something you should stay away from. I fall asleep still without knowing and can’t focus for anything. I would forget where I was going or what I was doing regularly throughout the day. I’m also in an MBA program so I’ve been put on adderall in order to curb the fog a bit. I don’t know anyone with Hashimotos, so any help is greatly appreciated!

  31. Hi.. I was taking 1mg lozenger of bio identical derived from plants testosterone. I am 46 and a personal trainer. Body fat is around 15-16% and I am around 138 lbs. My blood work fasted is the following:
    Insulin 2.6 Lo
    Glucose 100
    Test 19.4
    Free Test 2.18
    progesterone .26
    estradiol 205.5

    I have most of the symptoms you listed above except libido. I took the test for 3 days. On the 3rd day at 1230am I experienced vertigo. I am not sure if its related or coincidence. I am afraid to take the test now and honestly my doctors are not really helping me much. I have a friend who is an intuitive energy healer and she said my unbalanced hormones and the test was one of the causes for the vertigo. Like my body didn’t like the testosterone in my body. I am so frustrated because I weigh all my food, count macros, workout effective and hard 6-7 days a week and yet I am not as lean as I should be. I am 5’1 and 137-140 lbs.. I barely drink. I am consistent 90% of the time and yet I struggle with weight loss. Plus I feel like I am always blah and my brain can’t focus. Can you help me?? Thank you! P

  32. Hi,

    I am a 35 year old female that began noticing hormonal issues as a result of overexercise and losing weight. I continued to overexercise for a prolonged period of time not realizing that my body may have been telling me it needed rest. Hormonal acne developed into me getting sick all the time and having constant injuries, which eventually lead to symptoms of endometriosis. This spanned across 1-2 years, and I have always felt it was my adrenal glands and the result of overtraining that triggered all of these symptoms.

    I just received my lab results from my endocrinologist in which my the only red flag for testing my hormones was low free testosterone. Testosterone, Serum (Total) – 19 NORMAL, % Free Testosterone (Dialysis) – 0.5 LOW, Free Testosterone, Serum – 1.0 LOW

    Could this all be a result of overtraining? Is it related to my adrenal glands? I now have ovarian cysts according to the MRI’s and ultrasounds, so I wonder if low testosterone has anything to do with my ovarian cysts. I should also add that it was VERY HARD for me to lose the weight I did. I have only lost 60 pounds in 2.5 years, but I can’t tell how much I was exercising and how healthy I was eating. The minute I take a break from that lifestyle, I almost instantly put 10 pounds back on in less than a month.

  33. What levels do you usually say is best to be at with regard to total testerone from a blood test and how much do you typically give a women to take ? I ask because I am on the cream bioidentical and my last blood test showed I was way up over 100 but when I was first tested I was 30 and they said that was too low and have increased what I first starting taking thru this process ..so what is the best 50% range you see works best to be at without it being to high or to low? I am getting tested again soon and I am.wondering if mine is too high just from the last blood test and symptoms. I have slightly decreased my amount but maybe need to again. So basically asking what is the best blood level to be at that you typically recommend and what is the most amount you give patients to take ? What symptoms also may mine may be too high and we need to.reduce the dose? Thanks

  34. Hi there,
    I’m a 46 year old pre-menopausal female that is seeing a doctor my my thinning hair. This past 2 months I’v been shedding, not feeling like-myself and often in a bad-mood. I asked my doctor to do a testosterone level on my. My results came back and she thinks this is a normal part of my age. Clearly it is not.

    Total T <3 ng/dl (normal 10-55)
    Free T 0.3 pg/dl (normal 0-4.2)

    TSH, Iron, Vit D is all within normal.
    what kind of doctor should I see about my low T?

    Thank you, Linda

    • Hi Linda,

      You’ll probably have the best luck looking for a physician who specializes in anti-aging medicine, integrative medicine or functional medicine.

  35. Hello, I enjoyed reading this. I have been getting bloodwork done trying to figure this out. I have had most symptoms of Hash, low thyroid, fibro and it’s getting worse. I have been diabetic for 40 years and am age 49 now. My endo tinks it’s in my head, however, my labs are TSH 4.34, TPO antibodies 13, Free t-4 1.0, Free t-3 300.3 Vit B 966,Vit D 36. I wanted all my hormones checked but they only checked my estridial came back normal and doctor said i’m not fully post menopausal that number is 132. I was diagnosed with fibro only because I don’t think the doc could find anything. I want to sleep 24-7. I used to never nap and did more in a day than some do in a week. Doctor thinks I’m depressed and scheduled me with a psycologist. I’m depressed because I feel like a shell of what I used to be. I need HELP. Thanks for your time. I will continue on your sight for updates. Jana

    • Hi Jana,

      The best thing you can do is seek out a physician who understands how to properly treat hormone imbalances. It may take some time and effort but it will be worth it as you should be able to start to feel like your old self.

  36. Good Afternoon Dr. Childs,
    I am reaching out here for some direction, in hope you can help.
    Yesterday I went to get results from blood work done as a follow up set from a year ago. My testosterone I was told was still a neg 2 to a neg 3, I have no idea what that means really. The doctor said it was very low. She wasn’t concerned. My vit. D is also extremely low, which she obsessed with. She has put me on 50K IU daily for a month. I just went through all this a year ago, and still no one is concerned with the testosterone levels. I am seeing the results of the lack of testosterone in the texture of my skin, the lack of muscle that is forming at an alarming rate. I do workout, just for toning. I am gaining weight that I can’t lose. The list goes on and on. Oh, I am beyond menopause by at least 5 or 6 years. I began menopause while I was in my late 20’s early 30’s. I am now 50.
    Thank you for any direction or help you can provide me in helping me, help myself get me back to normal.
    Torrie

  37. Where do I find a quality MD to work with me on what tests I need to have done and what to do with the results? Both my primary care and my OBGYN seem to be unconcerned or clueless, resistant to having thourough labs done. I am having many of the symptoms described in your article, and what I am hearing over and over is to just take a birth control pill and it will fix everything, which I am not willing to do because of the massive side effects. I am 46 and suspect going through peri menopause. I live in the Seattle area, any recomdetions would be appreciated. I am not even sure how to search for the right/knowledable physition.

    Thanks!

    • One way to find the right doctor is to visit a compounding pharmacy and ask for the name of a doctor that prescribes BHRT. That way you know they are familiar with hormone issues. That’s how I found mine.

  38. Hi
    I am in perimenopause for the past 5 years. Worst symptom I have is dry vagina with horrible itchiness and burning one week in cycle. Other symptoms include spotting, bleeding during sextile, skin issues, bad hair loss, extremely sore inflamed gums, etc. I have had 2 hormonal tests done over the past 4 years and always low estrogen and real low testosterone. All the doctors tell me to go on the pill or ring. I have tried that half dozen times and makes me extremely depressed and sick like morning sickness. My brother is a compounding pharmacist and he is convinced all I need is a vaginal gel with 1mg estriol and 1mg testosterone. Is this what you would recommend? Why is it so difficult to find help?

  39. I am 36 and started rapid and sudden hair loss roughly 4 years ago following a 6-month long intense illness. I saw sudden weight gain with no change in diet around the same time. I went to endocrinologist and pcp, but neither would check my hormone levels. Fast forward to this week when I finally got results from an extensive lab order from a dermatologist. My Testosterone, Total is 22, Free Testosterone is .07 and DHEA Sulfate is 27. My hair has been shedding horribly for the past four years and is especially bad right now. Also, my ANA came back borderline positive at 1:40. Do you think I would be a good fit for testosterone replacement therapy? I’m going to a follow-up with a new pcp on Friday and I have no idea what to expect or how to advocate for them to pay attention to my hormones given physicians’ past dismissiveness. Thanks!

  40. Hello Westin.
    Short story long: suffered lyme disease for years, seem to be healed but now my pituitary doesn’t work anymore as before, I’m 25 and a female.
    My reason to test for testosterone was fibromyalgia, lack of energy, weak muscles and being nervous easy, a bit low self esteem or at least no trust in myself.
    My doctor tested my free testosterone on my question, and this came back with 0,65 n/mol, reference papers are saying between 0.35 and 1.67 n/mol here.
    How do you see the correct range with free testosterone in n/mol?
    Its a bit a maze for me with ranges, my doctor told me it isn’t high and she agreed with trying androgel! 🙂
    I got androgel and I, use -yes measured- 3,1 mg and I have read that max 5 mg should be fine to get no side effects.
    But I can imagine that this compares to bodyweight, and here is the point:
    I’m 54 kg and 1,71, my thyroid is fine and I could not gain weight before, and kept muscle issues, even swimming was too much.
    Since I use androgel, now ten days I’m improving great!
    I can swim again and train twice a week 20- 30 minutes into a pool with power excersises and swimming, goal is to revalidate. 🙂
    But, my big question is how low dose testosterone, max 5 mg gel, handles normally in women who are 55 kg or less, or at least thin without healthy muscles?

    I feel that I’m improving every day on 3 mg, and on pictures there is a impressive difference already and I’ using the gel now since 10 days.
    My arms and legs are getting less thin, and my breasts are lifted from a C to a D!
    I don’t have a oily skin at all and feel really fine, but into my head 3-4 mg testosterone gel feels like a huge amount.
    In 5 weeks my doctor wants to test again, but I’m thinking about how big the chance could be that I’m getting a too high testosterone from this dosage?
    Specially with this weight?

    My doc told me to test how much I need to feel good, and again a test in 5 weeks.
    I feel perfect, so no worries but I’m really curious about the change in women with lower weight and below 20% fat on a low dose of testosterone?
    Just some things I’m curious about, if neccesairy I will contact my doctor, but I’m really, really curious about ‘reviews’ about other women with my kind of weight/fat.
    Most info online is about weight loss and fat burning..
    Thanks for reading, and I hope you can give some answers.

  41. Hello,
    I recently found out that I have a very low testosterone level. The Doctor has recommended a gel for me to use. However, he said that the gel will convert some testosterone into estrogen and that will increase the risk of breast cancer.
    I am 43 and in menopause. I am conflicted about why I should take the gel as prescribed or find a more holistic or natural way to increase my levels. Please advise. 🙂 thank you

  42. I’m trying to lower my very high TPO’s (660) and my last TSH was 5.076 and T3 was 2.71 and T4 was 1.00 so I was diagnosed with a autoimmune thyroiditis. My endocrinologist is just doing the wait and see, rechecking my labs every 3 months. I want to be proactive so I’ve started supplementing with Vit D3/K2, iodine, selenium, zinc, probiotics, liquid iron and magnesium. I spoke with my primary MD today and she’s ordering some labs for me to check my testosterone levels but she is concerned about some research that points to higher cardiac risk in women taking testosterone supplements. What is your thought on this? Do the results out weight the risks? Also she is testing me for any intolerances for main food groups like eggs, milk, soy, and wheat. She thinks I’m doomed to eventually get a thyroid condition but is supporting my wanting to be proactive. Any thoughts and your input on cardiac risk and taking testosterone? Thanks! W.S.

  43. Hello, I am a 34 year old woman and I have been experiencing all of the symptoms of low testosterone searching the internet for a cure when I stumbled across a low T article and asked my Gynecologist if she could test me for it. She was reluctant at 1st but she did test me and the test results reveal that I do suffer from low testosterone. I was so relieved to have a diagnosis for my symptons until she told me that she doesn’t treat for low testosterone she told me that I should take vitamin D supplements, depression medication and I should balance my diet with more healthier foods. My question is where do I go, what do I do to find a doctor that will take this more serious? I’m desperate my symptoms are Infertility, Irregular periods (I don’t believe that I ovulate), weak muscles, libido (unable to orgasm), depression, lack of energy (all the time), mood swings, my hair is thinning and falls out be the hand fulls, weight gain. Please help.

    • Hi Jessica,

      Based on your set of symptoms it seems that you are probably suffering from more than just low testosterone, but you would need a full evaluation to be sure. Your best bet would be to seek out a provider who practices integrative, functional or anti-aging medicine as they are probably your best bet in managing your hormones. If it turns out you do need testosterone make sure to use bio-identical testosterone!

  44. Hi I am 34 years old female, I had my hormones tested on my own. And I’m confused by the results my free testosterone was below 0.3 which on the chart with the test shows low,but my total testosterone was listed as below 0.20 and looks to be noormal based on the graph.Actual total testosterone looked to be about 0.2. My Shbg is listed as 1.3 and is showing as lo w.everything I’ve read speaks to low shbg causing free testosterone to be high and vice versa,but I can’t find any reason for both to be low. Any insight you could give would be appreciated it. My Dhea is listed as normal but is on the low side of normal at 36.9 I don’t knoiw if this matters. Thank you for your assistance.

    Althea

  45. Hi there

    I have been on birth control for almost 20years mainly to control acne. I stopped because it was causing progressive hair loss. After stopping the pill, hair loss stopped, but acne returned, which I am now successfully treating with isotretinoin.

    My problem now is that I’ve had no libido since I can remember, along with low mood and low energy, and my testosterone levels are very low, which I believe is from the birth control.

    My doctor has prescribed testosterone cream at 5mg/d. But I’m worried it will bring back the acne. How likely is that on such a low dose?

  46. Hi Dr. Child’s,

    I somehow came across this thread and have read each and every post/answer. I have recently been getting blood work done trying to figure out my hormones.

    I am 27 yrs old and I am always tired except when I lay down at night I can’t fall asleep, I have hot flashes daily, hair growth on chin, stomach and nipples (embarassing), no libido, and I have been off birth control for 2 1/2 not preventing pregnancy and have not gotten pregnant. I have been told by my dr I am just a mystery and may need to just go to an endocrinologist.
    I am showing free testosterone at 1.5 and total testosterone at 14.

    Progesterone is .8
    DHEA S is 835
    Estrogen is 110

    I was using testosterone cream on the backs of my knees every night for 6 months and results went down from 2.5 to 1.5 and 35 to 14 I had no mood or libido changes. Dr wants me on higher dose vaginal cream and back on birth control pills (lo loestrin)
    I could go on with test results but my concern is my dr doesn’t understand why I have such low testosterone and such high DHEA S if she doesn’t know I don’t know who would!
    I know this is a long shot but any advice is appreciated I am starting to think I could have premature ovarian failure. (But my cycles are regular off birth control)

  47. Hi Dr. Childs,
    Thank you so much for writing this, because it is so hard to find comprehensive information about testosterone for women online! I just got lab results back from my doctor showing my testosterone was nearly half the minimum amount. I’m going to start taking supplements, as recommended by my doctor. How soon/often do you recommend rechecking testosterone levels after a patient begins supplementation? I want to be sure I am getting the right dose, but I’m not sure how soon these take peak effect.
    Thanks!

    • Hi Meredith,

      You should be fine checking in 8 weeks or so but it can be sooner/later depending on how you respond to the hormone.

  48. Hi,
    If Total T is bottom range 378 (200-800) and Free T is 13 (1,9-15). Shbg is low 20 (41-79).
    Do I have low or high testosterone then?
    I also have low thyroid. Feel very fatigued and many problems.

    • Hi Conni,

      You need to use the combination of your symptoms plus lab results to help determine. You should also evaluate testosterone in the setting of current thyroid status.

  49. I recently had my sex hormones tested. I am a postmenopausal 51 year old female and my main concern is weight I need to lose around 50 lbs and it’s been very tough. This is what my profile says
    Estradiol 0.6
    Progesterone 24
    Pg/e2 40
    DHEAS 8.6
    Cortisol 4.6
    I made an appt with a new Dr but it’s over a month away. I was also looking into your meal plans, got the 3 day today. Any general advice for me?

  50. Hi,
    I am a 45 year old female, not in menopause yet.
    I suffer from hair loss, decrease libido, swinging mood. My Free Testosterone is 2.6 normal range (1.1 – 5.8) and my Total Testosterone is 7.11 normal range is (0-90).
    My SHBG is 15 normal range ( 9-55).
    Does low Testosterone level is the reason for my hair Loss. And if I want to take organic base liquid Testosterone how many drops should I take?
    Thank you so much for all your help.

  51. I was just informed I have 0 testosterone my dr is afraid to give me anything as I am a breast cancer survivor! I’ve been dealing with exhaustion, brain fog as well as no interest in sex and not much interest in anything else since chemo over 5 yrs ago!
    I only have Medicaid in the state of Arizona can you tell me how I might get some help with this?
    I am 61 and ready to exit this planet as living on Adderall and pain meds isn’t getting to the root. My BC was from estrogen dominance and positive for her2 as well. I’m tired of being sick and tired and have suspected testosterone deficiency for a while now….really need to figure out a way to replace it! Many blessings

    Thank you so very much,

  52. Do you think one can find balance with just bio-identical testosterone if she has had a total hysterectomy and oophorectomy?

    • Hi Jennifer,

      That seems unlikely considering that you will have greatly reduced levels of both progesterone and estrogen in addition to testosterone.

  53. Hi Dr. Childs,

    Thanks for the article. It was very helpful. I recently noticed changes in my sleep patterns and can relate to some other symptoms listed for low testosterone. After explaining this to my OBGYN and failing to find a solution with typical FSH and thyroid level checks, I switched doctors to see if another point of view could help. The next doctor got a full history, asked a lot of the questions your article asks about symptoms and tested for testosterone levels. Sure enough, my serum testosterone is <3 with ref range 8-48ng/dL. (All other CBC, chemistry, and lipid panels WNL). Since I just found this out, we have yet to have a consultation about it, so I'm not seeking your medical advice. I am curious about your mention of Testosterone liquid in an organic base as your preferred method. I could not find any further information for that. Do you mind elaborating? Thanks!

    Melanie

  54. So, I am 57 and just had my testosterone levels tested and they are so low that they could not measure them. I have been on estrogen (fearing) and progesterone for about a year. I have been exhausted, low to no sex drive, etc. Had my doc check the T levels and she called to say they were so low they could not measure. WTH? She suggested the Estrogen and T pellet. I have been previously competing in bike racing, but the T will make me have to quit that due to T being on the banned list. Is it really going to make things that much better?

  55. Hiya Doc,

    Female in my late 40’s. Nervous about starting testosterone supplementation but I trust my doctor implicitly. My lab work came back and everything looked good but the testosterone level was 15. I have been having hair loss and a sluggish metabolism despite eating well and getting exercise. My Dr gave me a testosterone injection today and I am a bit nervous. I did not think to ask how much as I trust her judgment. After coming home and reading on the internet, I now worry If I could have some of these side effects like acne and enlarged body parts (good grief) Will one injection wreak havoc if it wasn’t the right route to take? Thanks so much!

  56. Hi Dr. Childs,
    I just got my bloodwork done and I will be going back to Dr. next week, My Dr. sells pellets she advertises for them and I’m sure she is going to want me to do the pellets. first of all, I don’t have 400.00 every 3 months for pellets which are not covered by insurance. Second, I am scared to get them. I’m with you, what about overdoing the hormone, then I’m stuck with it for 3 months until it wears off? what a waste. How can I get the liquid organic formula if she won’t give it to me?

    • Hi Sherry,

      Your physician may be willing to try other therapies, so I would just let her know that you would prefer a cream/gel/liquid over a pellet. If that doesn’t work then you may need to seek a second opinion.

  57. I love your hormone articles. Very informative!
    I am 42 and have gained 15 lbs out of nowhere, hair clogging the drain, dry skin, brain fog, toss and turn sleep, fatigue. The thyroid is great as I’m on 300 mgs of armour. T3 and T4 at top of ranges, TSH at zero. I don’t snack between meals anymore and that dropped leptin from 32 to 5. I’m on metformin and a very light dose of Victoza. Didn’t know IR went along with low T and I also have (5) AI diseases. Reading this article, it makes sense. Despite GF, DF eating, working out 3-4 days a week, optimizing thyroid, leptin, and insulin, I cannot lose weight and my hair loss is terrifying. I just looked at my labs from 3 months ago, total and free testosterone are scraping the bottom of the ranges and SHBG is 300! Ding ding ding. Calling my doc in the morning!

  58. I’m a 50-year-old gym owner, personal trainer and figure competitor. I had a full hysterectomy in 2011 and it was a complete success. In 2015, my body, my mood, and my energy level took a complete 180 and I found myself not being myself nor did I look anything like myself. I’ve gained about 20 lbs over the course of these last 3 years and it has been absolutely impossible to lose. I’ve no energy and I have no desire to workout although I thoroughly love working out in our gym.
    I can’t use any creams or estrogen as cancer runs in my family. I think this is going to be a fantastic alternative for me. I’m doing injections and just started.
    Two questions – how long before I see the effects of a .25 mg dose and can women get a prescription.

    Thank you in advance for any answers I may receive and THANK YOU for sharing this information. It’s a great read with a plethora of information.

  59. Dr Childs

    Can you take progesterone 0.5% and testosterone 1% once a day as a bioidentical cream in the evenings? I have estrogen dominance and am treating insulin resistance with berberine and alpha lipoic acid as per your website. I have both creams and wondered if their application would be best. I am transitioning into menopause but I really want my ovaries to keep active and not schrivel up!

    Thanks so much!

    • Hi Luana,

      There really is no “set time” that hormones can or should be taken. I will often times change up how patients take their meds depending on several factors so it’s more about the individual.

  60. Is it safe for a DES Daughter, 65 years old, to take testosterone? I have never taken any hormones or birth control pills. I have a multi nodule goiter but do not show out of range thyroid on any of the thyroid tests. I do take 10 mg lexapro which has alleviated anxiety/depression. I take no other medications.

    • Hi Ellen,

      I’m not actually sure if DES would result in a contraindication to testosterone therapy, I can’t think of a reason why it would but it’s worth looking into further to make sure.

  61. I am 49, female, have hypothyroidism that is well controlled by medication. Over the past few years, I have developed depression, insomnia, hair loss, fatigue. I recently had a total hysterectomy with bilateral salpingo-oophorectomy and Burch procedure. My libidio came to a screeching halt and I became intolerant of any activity. I slept 17 hours after sitting 4 hours listening to a band play.

    My doctor has me on oral estrogen and at my request started me on testosterone injections. I felt like my old self within a few hours. I don’t have my libido back but hopefully, amounts can be adjusted. I’m overweight and despite trying to eat right and have a moderately active lifestyle,I gain weight easily. I believe I may be starting to have insulin resistance too. My A1C has been around 5. The thought of losing even 10 to 15 lbs is encouraging. I’m 5’9 and weigh 215 lbs. I have no appetite since the surgery. Eating 1200 Kcal has been easy. If I could break this cycle I may lose weight and decrease my insulin resistance. Thank you for explaining this so well!

  62. [email protected]

    Hello Dr. Childs,

    I am a 27 year old woman and I recently had bloodwork done and the results found that my testosterone is low. After reading your description of the symptoms of low testosterone, it all makes sense.

    I have had issues the past few years gaining muscle and losing weight (I’m currently 15-20 lbs overweight). Despite the fact that I am exteremely active and health conscious. For years, I’ve worked out 5-6 days per week doing a combination of lifting and HIIT workouts in addition to training for triathalons. I also am eating healtheir than ever. I eat a whole foods diet and avoid processed sugars and carbs, gluten, and I eat minimal dairy. Yet, it seems that I cannot even lose a pound and I have poor muscle tone. In addition, I suffer from psoriasis.

    I would very much like treatment, but I’m not sure where to go. My PCP is a very holistic doctor and when I inquired with her about testing my hormones she said it wouldn’t be of help…. Therefore, I turned to a physical medicine office offering “free” assessments. They are the ones who did the bloodwork that determind my testosterone to be low. However, they seem to be a bit gimmicky and I don’t trust them. They essentially have a salesman who is not a doctor talk to you about your results and their treatment is $200/month and not covered by insurance. Do you have a recommendation for doctors located near Columbus, OH? I am desperate!

    Thanks,
    Eryn

  63. I just got a full blood work up and received a diagnosis of “depleted” testosterone. I’m 48 years old and have some of the symptoms. My testosterone level was <12. I DO NOT want to do hormone pellet therapy for this. Also libido is not an issue for me as I am not sexually active. I’m hoping to lose weight (as I have become resistant to losing weight) and be able to sleep as I have wicked insomnia. Any recommendations on dosage for using a cream and where to apply? Thanks!

    • Hi Leah,

      I can’t really give dosing specifics because that really depends on the person, but in terms of application, you can use it pretty much anywhere that won’t come into contact with others throughout the day. Inner thigh works well.

  64. Hi, I am 35 year old female. My doctor just informed me my testosterone levels came back very low. She tested all other very extensive labs and all very normal. So she’s recommending potentially testosterone replacement to help with my symptoms.
    Is this common in young very healthy females? I have two young children (1&3). Would it be safe to do treatment?

    Thanks for any help!

    • Hi Kris,

      I wouldn’t say it’s common but it certainly does happen. My patient sampling is somewhat biased, though, because I tend to only see people who have hormone issues.

  65. Hi, thank you for your article. I am wondering about when in my cycle would be best to test for testosterone? Should I test around ovulation to see the peak? Or will that “peak” potentially put me in the “normal range” because normal range covers high and low levels in a cycle? In other words does the “normal range” change based on where you are in your cycle? (No one has ever taken my lab results and asked me what day of my cycle I’m on to help correctly interpret where the normal range should be.) Hope that makes sense!
    Thanks for you input!

    • Hi Genica,

      I usually test for it around the mid-luteal phase but only because that’s when I also test progesterone and estradiol. Otherwise, I don’t think it matters that much.

  66. Hi there, I am 47 years old femal and my menopause panel came back with a testosterone level of 3, which my doctor said is low and should be between 7 and 48. She didn’t recommend I do anything about it because there might be unwanted side effects such as facial hair and balding. However, I have not been feeling well – very tired and moody. Does being on or off birth control pills affect the number. I was off my birth control pill (lo loestrin) for 2 weeks and 1 day when the test was run. Thank you for any help!

    • Hi Julie,

      Most physicians are clueless when it comes to hormone replacement therapy so you will most likely need to see a specialist. There’s virtually no risk of the side effects you listed if therapy is done correctly.

  67. Dr. Childs,

    My total testosterone was 18 and free was 0.2. I am 30 year old female, and I am slightly nervous to start hormone replacement therapy. My doctor states they would start me on low dose cream, but I am unsure of the long term effects of me starting so young on therapy. I also have Hashimoto’s thyroiditis and my levels seem to be okay for now, but they continue to spiral every 6 weeks.

    Do you think starting testosterone at my age will cause long term effects? I have tried supplementing with 10mg DHEA, but no change in levels when rechecked.

    Thanks!

  68. I am a 41-year-old woman who recently had all my hormones and labs drawn due to fatigue, weight gain, low libido, and acne. I’ve always eaten a healthy balanced diet of 1400-1600 calories and day and exercise 4-6 days a week (boot camp and one day dedicated to my long run of 7-10 miles). My labs showed the following (day 16 of my cycle): Testosterone 20.91, SHBG 48, Estradiol 89, Progesterone 12, DHEAS 289, Free Testosterone 0.293, vit D 42.5, HGA1c 5%, Insulin 7.8, TSH 0.69, Free t4 0.89, free t3 2.8, reverse t3 16, B12 473, ferritin 49. I was started on 0.75 gm of testosterone cream and retested in 6 weeks had had a saliva level of testosterone of 60. I also started taking 1000mg B12, 5000IU D3, Ashwagandha, and a Multi-vitamin. I also take Effexor XR 75mg/day for migraine prophylaxis. The provider increased my testosterone to 1gm/day. I am still having some fatigue and this cycle since my bump I had an acne breakout and night sweats. Also since my weight hasn’t budged I began a LCHF diet (healthy fats like olives, avocados, lots of veggies and nuts). I want to make sure I am not missing anything…any advice would be great!

  69. Hi

    I have taken hormone replacement for 4 years. One out of many symptoms I had when started, was hairloss. and that is the only symptom I have left. Total I lost 3/4 of my hair 🙁

    I started up with testosterone gel (Testim), Estradiol, Progesteron, Pregnenolone, DHEA, Thyroid, Fludrocortisone and Medrol. Unfortunately I misunderstood the doctor, so instead of taking 0,2 ml, I took 2 ml for a period of 2 month!
    I was advises to skip the testosterone for a while but every time I start up with a tiny amount, my hairloss seams worse. Then I skip again.

    I still take the rest of the hormones including a bunch of vitamins and minerals, B-complex, B-12, C, D, E, Omega 3+7, selenium, zink and magnesium.
    To prevent the hair, or trying to, I also take Finestaride.

    All the blood tests looks good, except for the low testosterone.
    The doctor honestly does not know what to do…..

    Do you have any suggestions what I can do to ?

    Best regards
    Birgit

  70. Thank you so much. I am 29 yr/old Female with Testosterone showing only 8. This is the only informative article for women I have found thus far in my research, and it wsa very clearly stated and well written.

  71. Dr. Westin Childs,
    Could you please recommend a doctor in the NYC Tri-State area who already ascribes to your theories and methods? It would be so much easier to go directly to someone who understands and agrees with you than to try to find a doctor and then try to convince/convert him or her to your way of thinking!
    Thank you,
    Dee
    Rye, NY

  72. Hi,

    My Dr just prescribed me bio-identical HRT with Testosterone. They are sublingual tabs. I see you say that transdermal is best. Will the sublingual still work?

    Thank you!!!

  73. I have found it difficult to find information on women and testosterone so this article was very informative! Thank you! I had lab work done recently and my free testosterone and free testosterone weekly bound were both well below the normal range, my SHBG was close to the top and my total testosterone was at the very low end of normal. It sounds like I might benefit from treatment and it’s something I’m definitely going to look into! Thanks again for the great info!

  74. Hi Dr. Childs,
    About two weeks ago I started a compounded hormone cream that contained testosterone (50mg/ml stock solution 0.01ml. I am finding myself ANGRY…just seething in a person who is normally easy going. This does not seem like a large amount of testosterone (taken to GIVE me a libido) but is it a large amount? If I am not tolerating it, is there a lower dose or another way that might work better. Or am I just out of luck. What else for libido? 200mg progesterone (stopped the cream all together) and estradiol patch 0.025.

  75. First I would like to thank you for writing these great articles on hormones!

    As my blood tests revealed very low total testosterone, free testosterone not calculable and SHBG very high my physician prescribed me transdermal Testogel/ Androgel ( for men) 0,5 mg a day. She suggested I use it on my upper arms and shoulders like men do. But I’ve read that many women use it on inner thighs or lower belly. Supposedly to have more benefits for libido? My main goal would be to have more energy and more focus, libido would just be a nice bonus.
    I’m interested in your thoughts…

  76. I’m pretty sure that’s exactly what I need testosterone level is low, my primary doctor doesn’t seem to care. Which makes me uncomfortable so I stopped seeing Dr. I currently have no Dr or gbyn. How can you help me?

  77. I had lichen sclerosis in the vagina and towards the rectum and had surgery in July 2018 and it was removed. I couldn’t have sex because it was so painful also tender to touch.
    My doctor has me on testosterone gel that I apply on my arm daily and I also use Intrarosa which is a vaginal insert and valisone cream. It seems these 3 combinations work together to keep it from coming back. I feel great with no side effects. Sex is great again. I feel good and everyone tells me I’m glowing. Can I stay on testosterone forever? It is a very low dose.

  78. Thank so much for your Article.
    I recently felt something was wrong with my hormones. I am a 38 year old female. Found out that my testosterone was not detectable.
    My doctor said it’s just not something he treats and if I want I can talk to an endocrinologist. Neither him or my general doctor seem to think anything should be done. I just don’t understand the casual behavior from md’s. They clearly know nothing about this and make me feel like I am insane.
    It’s nice to see that it’s not something that all doctor’s are afraid of touching.

    • Hi Debbie,

      Yes, most people just assume doctors know everything about health but they couldn’t be more wrong when it comes to hormones. Doctors basically receive zero training in this field and yet patients tend to believe them when they make recommendations about hormone management. It’s the entire reason my blog and website exist!

  79. Hello,
    Two years ago I was loosing my hair. I’ve got some blood test that showed low testosterone levels, after taking birth control pill for 2 months the symptoms disappeared. Now two years later I’m experiencing the same symptoms again. I’m a 53 year old female with no period for 1 year. What do you recommend?

    • Hi Wilda,

      Birth control pills only ever mask issues by shutting down the HPO axis. You need to start with a full hormone panel (off the birth control) to figure out which hormones may be contributing to your hair loss. You can also help get an idea as to what the issue is by looking at the pattern of hair loss you are experiencing.

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