Key takeaways
Testosterone plays a vital role in women's health, affecting muscle function, mood, and sexual health.
Symptoms of testosterone imbalance can range from fatigue, low libido, to mood changes.
Increased research is drawing attention to conditions like Polycystic ovary syndrome (PCOS) associated with high testosterone.
Treatment options and lifestyle changes can help manage testosterone levels, but more research is needed.
Testosterone is often described as a predominantly “male” hormone, yet it also plays an important and multifaceted role in women’s health. Although women naturally produce testosterone in much smaller amounts than men, fluctuations outside typical physiological ranges may influence physical, emotional, metabolic, and sexual wellbeing.
Public discussions surrounding women’s hormones frequently focus on estrogen and progesterone, while testosterone receives comparatively less attention. However, growing clinical interest and emerging research are increasing awareness of testosterone’s role in muscle function, mood regulation, bone health, energy levels, and sexual health throughout a woman’s lifespan.
As understanding of hormonal health evolves, researchers and clinicians continue exploring how both low and elevated testosterone levels may affect women differently across various stages of life.
Understanding Testosterone in Women
In women, testosterone is primarily produced by the ovaries and adrenal glands. Although classified as an androgen—a category of hormones commonly associated with male physiological traits—testosterone contributes to several essential biological functions in women.1
These functions may include:
● Supporting muscle strength and lean body mass.
● Contributing to bone density and skeletal health.
● Influencing mood, motivation, and energy levels.
● Playing a role in sexual desire and arousal.
Women generally produce substantially lower testosterone levels than men, often estimated at approximately one-tenth to one-twentieth of male concentrations.2 Despite these lower levels, testosterone remains biologically significant for many aspects of female health.
Hormonal imbalance—whether involving testosterone deficiency or excess—may contribute to symptoms that are often subtle, nonspecific, or mistakenly attributed to stress, aging, or lifestyle factors.
Symptoms and Causes of Low Testosterone
Low testosterone in women has been associated with a range of physical and emotional symptoms, although diagnosis remains complex because symptoms frequently overlap with other hormonal or medical conditions.
Commonly reported symptoms may include:
● Persistent fatigue or reduced energy.
● Difficulty maintaining muscle tone or strength.
● Reduced sexual desire.
● Low motivation or diminished sense of wellbeing.
● Mood changes or emotional “flatness.”
Several factors may contribute to declining testosterone levels in women, including:
● Aging and menopausal transition.
● Surgical removal of the ovaries.
● Adrenal insufficiency.
● Pituitary disorders.
● Chronic illness or endocrine dysfunction.
Research suggests testosterone levels may begin gradually declining as early as a woman’s 20s and continue decreasing with age.3 However, the true prevalence of clinically significant testosterone deficiency in women remains uncertain because standardized diagnostic criteria are limited.
The Impact of Elevated Testosterone
High testosterone levels can also contribute to important health concerns.
One of the most recognized conditions associated with elevated androgens is polycystic ovary syndrome (PCOS), a common endocrine disorder affecting women of reproductive age.4
Symptoms associated with elevated testosterone and PCOS may include:
● Irregular menstrual cycles.
● Acne.
● Increased facial or body hair growth.
● Scalp hair thinning.
● Fertility challenges.
Beyond reproductive symptoms, PCOS has also been associated with increased risks of:
● Insulin resistance.
● Type 2 diabetes.
● Obesity.
● Cardiovascular disease.
Epidemiological estimates suggest PCOS may affect approximately 6% to 12% of reproductive-age women, making it one of the most common endocrine disorders in this population.4
Diagnostic Challenges and Hormone Testing
Diagnosing testosterone imbalance in women remains nuanced and often requires consideration of both laboratory findings and clinical symptoms.
Unlike male testosterone deficiency, there are currently no universally standardized reference ranges defining “normal” testosterone levels for women across all age groups and physiological stages.
Laboratory evaluation commonly includes:
● Total testosterone.
● Free testosterone.
● Sex hormone-binding globulin (SHBG).
● Additional endocrine markers such as thyroid, cortisol, estrogen, or pituitary-related hormones.
Experts often recommend morning blood testing because testosterone levels may fluctuate throughout the day.5 However, laboratory methods and interpretation can vary substantially.
Because symptoms may overlap with thyroid dysfunction, depression, perimenopause, adrenal disorders, or metabolic disease, comprehensive clinical evaluation remains important.
Testosterone Therapy: Current Evidence and Debate
Interest in testosterone therapy for women has increased in recent years, particularly regarding sexual health, fatigue, and quality-of-life concerns.
At present, however, testosterone therapy is not broadly FDA-approved in the United States for most female indications.6
Some clinicians prescribe testosterone off-label using compounded formulations, transdermal gels, or patches for carefully selected patients with symptoms potentially related to androgen deficiency.
Professional societies including the Endocrine Society generally recommend cautious and individualized use, primarily in postmenopausal women experiencing hypoactive sexual desire disorder after exclusion of other contributing factors.7
Potential adverse effects associated with testosterone therapy may include:
● Acne.
● Increased hair growth.
● Voice deepening.
● Mood changes.
● Alterations in lipid profiles.
Long-term safety data regarding cardiovascular risk, breast health, and metabolic effects remain limited, reinforcing the importance of careful monitoring and evidence-based prescribing.
Lifestyle Approaches and Future Directions
In many cases, broader lifestyle interventions may support hormonal balance and overall endocrine health.
Factors that may positively influence testosterone regulation include:
● Regular resistance and aerobic exercise.
● Adequate sleep.
● Stress management.
● Balanced nutrition.
● Healthy body composition.
Researchers continue investigating testosterone’s broader role in female health, including possible effects on cognition, mood, metabolism, and healthy aging.
At the same time, there is growing recognition that symptoms such as chronic fatigue, low libido, and mood changes in women should not automatically be dismissed as inevitable consequences of aging or stress alone.
Many patients report that simply having hormonal concerns acknowledged and evaluated thoughtfully can be clinically meaningful.
As research evolves, greater emphasis is likely to be placed on personalized hormonal assessment, individualized risk-benefit evaluation, and more nuanced understanding of women’s endocrine health across the lifespan.
This article is for informational purposes only and is not medical advice. Always consult your healthcare provider regarding any questions or concerns about your health or treatment options.
References
1. Davis SR, Wahlin-Jacobsen S. Testosterone in women—the clinical significance. Lancet Diabetes Endocrinol. 2015;3(12):980-992. doi:10.1016/S2213-8587(15)00284-3
2. Burger HG. Androgen production in women. Fertil Steril. 2002;77(suppl 4):S3-S5. doi:10.1016/S0015-0282(02)02985-0
3. Cleveland Clinic. Low testosterone in women. Accessed May 8, 2026. https://my.clevelandclinic.org/health/diseases/24897-low-testosterone-in-women
4. Centers for Disease Control and Prevention. Polycystic ovary syndrome (PCOS). Updated May 15, 2024. Accessed May 10, 2026. CDC PCOS overview
5. Rosner W, Auchus RJ, Azziz R, Sluss PM, Raff H. Utility, limitations, and pitfalls in measuring testosterone: an endocrine society position statement. J Clin Endocrinol Metab. 2007;92(2):405-413. doi:10.1210/jc.2006-1864
6. U.S. Food and Drug Administration. FDA issues class-wide labeling changes for testosterone products. Published February 28, 2025. Accessed May 10, 2026. https://www.fda.gov/drugs/drug-alerts-and-statements/fda-issues-class-wide-labeling-changes-testosterone-products
7. Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(10):3489-3510. doi:10.1210/jc.2014-2260