Low testosterone in women: 9 symptoms

Low testosterone in women is linked to one symptom with serious research behind it: reduced desire for sex. The other complaints on lists like this are attributed to it too, from fatigue to low mood. But they turn out to be hard to tie to your blood level.

That distinction is the point of this article. There is no cutoff value that establishes a testosterone deficiency in women. An international consensus statement from sixteen professional societies puts it plainly: no measured circulating androgen level distinguishes women with and without sexual dysfunction (Davis, 2019). The Endocrine Society and the International Menopause Society are among them.

What strikes me about the pages written on this topic: almost all of them list eight to twelve symptoms. Almost none mention that a blood test cannot confirm those symptoms. Below are the nine complaints named most often. For each one you get what the research does and does not say.

Does low testosterone in women exist?

Not as a defined condition, in the way it exists for men. There is no recognised disorder called female testosterone deficiency with an agreed threshold. Women produce testosterone in their ovaries and adrenal glands. That level declines gradually over the years. But a low reading on its own says little about how you feel.

Part of the confusion comes from the measurement itself. The common direct assays are unreliable in the low female range (Davis, 2019). Two laboratories can report different numbers from the same tube of blood. That spread is widest at the bottom of the range.

None of this means testosterone is irrelevant in women. It means the number does not explain your complaints, and that a symptom list is not a diagnosis.

9 symptoms attributed to low testosterone in women

Below are the nine complaints you meet most often, each with what is known from research. Two of them have usable trial data, one is a genuinely androgen-dependent feature, and for the rest the link with your blood level is missing.

1. Reduced desire for sex

This is the only symptom where testosterone treatment shows a clear effect in randomised research. A meta-analysis of 36 trials involving more than 8,000 women found a modest improvement in sexual desire in postmenopausal women (Islam, 2019).

The consensus statement therefore calls this the only evidence-based indication, and specifically in postmenopausal women assessed as having a desire disorder (Davis, 2019). One important detail: that assessment happens in a conversation, not with a tube of blood.

2. Less arousal and harder to reach orgasm

The same meta-analysis found improvements in arousal, orgasm and sexual satisfaction (Islam, 2019). These complaints belong to the same picture as point 1 and are usually assessed together.

The same caveat applies, from an Australian study of more than a thousand women: testosterone levels in women with and without these complaints overlapped completely (Davis, 2005). Low values were just as common in women without complaints.

3. Persistent fatigue

Fatigue appears on almost every list, but the available trials show no effect of testosterone on general wellbeing (Davis, 2019). That makes fatigue a weak reason to have this particular value measured.

Fatigue also has causes that do show up well in blood, such as an underactive thyroid or low iron stores. More on that in blood test hormones women: which values are tested.

4. Flat or low mood

The available data show no effect of testosterone on depressed mood (Davis, 2019). The association you meet online rests mainly on observation rather than randomised research.

During perimenopause it is mainly estradiol that fluctuates, and mood complaints more often follow that pattern than your testosterone level.

5. Loss of muscle strength

Clinical trials have so far shown no clear positive effect on musculoskeletal health (Davis, 2019). Losing strength over the years is real, but it does not trace back to a single hormone value.

An earlier Endocrine Society appraisal reached the same conclusion: outside the sexual domain, the evidence to use testosterone in women is lacking (Wierman, 2014).

6. Trouble concentrating

There is insufficient evidence to use testosterone to enhance cognitive performance or to delay decline (Davis, 2019). Brain fog around menopause is more often linked to sleep and to falling estradiol.

7. Less pubic and underarm hair

This is one of the few signals on this list that is genuinely androgen-dependent. Pubic and underarm hair respond to androgens, and losing it occurs in conditions where production in the adrenal gland or pituitary has actually failed.

Those are distinct clinical pictures, not the ordinary variation between women. If you notice this alongside other signs of hormone failure, that is a reason to raise it with your GP.

8. Bone loss

The available data do not support an effect of testosterone treatment on bone mineral density (Davis, 2019). Bone loss after menopause is mainly linked to falling estrogen rather than to androgens.

9. Dry skin and thinning hair

Skin and hair respond to several hormones at once, including thyroid hormone and estrogen. A specific link with low testosterone in women has not been convincingly established in research.

Which of these symptoms does a blood level confirm?

None, in the sense of a number that proves the complaint. This table sets the nine complaints alongside what the research says. Treat it as a reading aid for what you find online, not as a diagnosis.

Take two women of 46 with exactly the same result: total testosterone 0.4 nmol/l, just above the lower limit. The first has no complaints. She is on the pill, which raises her SHBG, so the free portion falls. The second has noticed for a year that her desire is gone. Same number, two very different stories. The number does not tell them apart.

Testosterone levels in women: what is normal?

In adult women, total testosterone usually sits between 0.29 and 1.67 nmol/l. Free testosterone usually sits between 3 and 29 pmol/l. For comparison, in men total testosterone runs around 8.6 to 29 nmol/l, a factor of ten to twenty higher.

Those reference values differ per laboratory and per method. That is not a detail. The bottom of the female range is exactly where the measurement is least reliable (Davis, 2019). A result just below the lower limit therefore weighs differently from a value that is clearly raised.

The relationship with SHBG is often more informative than testosterone alone. SHBG binds testosterone, so when SHBG rises, for example on the pill, the free portion falls while the total can stay the same. That mechanism is set out in SHBG in women.

Does your testosterone change during menopause?

Less than most people think. Testosterone in women declines gradually with age, not because of menopause itself. One study followed more than 1,400 women. Around the age of forty, levels were roughly half those of women in their early twenties. Natural menopause produced no additional fall on top of that (Davison, 2005).

There is one clear exception: surgical removal of both ovaries. That removes a substantial part of production at once, which is a different story from a gradual decline over twenty years.

For the complaints most women recognise in this phase, from hot flashes to poor sleep, the research points mainly to estradiol and FSH. Which values belong to that picture is covered in blood test for menopause: which hormones are tested, and the early variant in early menopause: 11 symptoms you can recognise.

When is measuring testosterone in women useful?

More often on the high side than the low. Some complaints suggest an excess of androgens: male-pattern hair growth, persistent acne or a cycle that stops. Then testosterone alongside other values can give direction. That is also the context in which it is used when assessing PCOS (Teede, 2023).

At raised values the measurement problem from the introduction matters far less, simply because you are well above the unreliable low range. If you recognise that picture, read recognising PCOS symptoms and PCOS testing: which hormones and blood values.

There are also situations where production genuinely can have failed, such as after removal of both ovaries or with a pituitary or adrenal condition. Those are assessments that belong in a consulting room, not on a symptom list.

Some women have their hormone values measured to make a conversation more concrete. At Lunara you can look at individual values such as total testosterone and SHBG, or arrange a broader hormone test for women.

When should you raise these complaints with your GP?

That is a conversation, not a fixed schedule. A few signals make it more concrete: losing pubic or underarm hair, complaints that began after your ovaries were removed, or reduced desire that you experience as distressing and that persists.

If your picture points instead to an excess of androgens, think of increasing facial or chest hair, a deeper voice or a cycle that stops, that is equally worth raising.

My advice stays sober. Write down which complaints you have and since when, and do not expect a testosterone value to provide the answer. For most complaints on this list, that number is simply not the explanation.

Sources

1. Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660-4666. PMID 31498871.
2. Islam RM, Bell RJ, Green S, et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754-766. PMID 31353194.
3. Davis SR, Davison SL, Donath S, Bell RJ. Circulating androgen levels and self-reported sexual function in women. JAMA. 2005;294(1):91-96. PMID 15998895.
4. Davison SL, Bell R, Donath S, et al. Androgen levels in adult females: changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab. 2005;90(7):3847-3853. PMID 15827095.
5. Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(10):3489-3510. PMID 25279570.
6. Teede HJ, Tay CT, Laven J, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469. PMID 37580314.

Every blood test result at Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.