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...
Because you can replace testosterone safely and effectively with the right knowledge to help you get back to feeling "normal".
Let's dive in...
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
- 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
Menopause = age-related decline in estrogen/progesterone
Somatopause = age-related decline in growth hormone
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?
Specifically insulin resistance.
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.
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.
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.
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.
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 Testosterone 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.
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:
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:
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:
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.
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
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.
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