Testosterone and Women’s Health

Although not in the same abundance as men, women also produce the androgen hormone testosterone in their ovaries and adrenal glands. Women need small amounts of it as part of the mix of hormones that keep mood, energy levels, sex drive, and bodily functions running smoothly. (1)

What Impact Does Testosterone Have on Women’s Bodies?

Normal levels of testosterone have multiple functions on the overall health of women:

It keeps bones healthy. The correct amount of testosterone supports bone growth and strength, while too much or too little can harm them. Studies have shown that both testosterone and estrogen are essential for bone formation. (2)

It promotes cognitive health. According to guidelines published in 2014 by the Endocrine Society, testosterone has a neuroprotective effect in women. (3) One study cited by the Endocrine Society noted that post-menopausal women with Alzheimer’s disease had lower levels of testosterone and estrogen than the control group. Another found that higher testosterone levels in the plasma of premenopausal women was linked to better performance in mathematical and spatial-relations tasks.

It maintains sex drive. Testosterone is known as a male sex hormone, but women have levels of the hormone in their system as well — just as men have low levels of estrogen in theirs. The hormone is part of what drives desire, fantasy, and thoughts about sex, and even helps provide the energy for sex in women, says Aaron Spitz, MD, a urologist based in Laguna Hills, California.

What Happens When a Woman’s Testosterone Levels Are Low?

Testosterone levels decrease somewhat between the ages 20 and 40 in women, but there does not appear to be an abrupt and profound reduction (similar to that of estrogen) at the time of menopause. (3)

Still, some post-menopausal women experience lower testosterone levels that can cause a decrease in sex drive. In some women, testosterone patches have been found to improve libido. (3)

Low testosterone levels can also cause other health issues, such fatigue, and increased risk for bone loss, osteoporosis, and fractures. (3)

What Happens When a Woman’s Testosterone Levels Are Too High?

High levels of a type of androgen known as free testosterone can be associated with polycystic ovarian syndrome (PCOS), a condition that interferes with monthly periods and the body’s ability to ovulate. According to the U.S. Department of Health and Human Services Office on Women’s Health, about 10 percent of women of childbearing age are affected with this health problem. (4)

PCOS can cause the following symptoms: (4)

• Missed Periods or an Irregular Menstrual Cycle The excessive level of androgens that is associated with PCOS can make periods infrequent, irregular, or nonexistent.
• Infertility Since women with PCOS may not ovulate, they have difficulties getting pregnant.
• Excess Hair Growth The hormonal imbalances associated with PCOS can lead to hair growth on the back, chest, stomach, face, thumbs, and toes.
• Ovarian Cysts Since eggs may not be released from the ovarian follicles of women with PCOS, the immature follicles can fuse together to form large, painful ovarian cysts.
• Skin Problems Women with PCOS may experience oily skin, acne, dark patches of skin, or dandruff (scalp eczema).
• Miscarriage If they do get pregnant, women with PCOS have an increased risk for miscarrying.

High levels of testosterone in women, whether caused by PCOS or by another condition, can be associated with serious health conditions, such as insulin resistance, diabetes, high cholesterol, high blood pressure, and heart disease. (4)

Testosterone Therapy: When Should Women Consider It?

In their most recent guidance from 2019, the Endocrine Society recommends against the general use of testosterone therapy in healthy women for the treatment of the following conditions: (5)

• Infertility
• Sexual dysfunction other than hypoactive sexual desire disorder (HSDD)
• Cognitive function
• Cardiovascular health
• Metabolic syndromes
• Bone health
• General well-being

There is scientific evidence that supports the short-term effectiveness and safety of testosterone therapy for post-menopausal women with sexual dysfunction due to HSDD. Experts suggest a three-to-six month trial dose of nonoral preparations, such as transdermal patches, gels, or creams. (3)

If your doctor prescribes ongoing therapy, practitioners should test testosterone levels every six months to monitor for signs of androgen excess. If a woman hasn’t responded to treatment after the first six months of therapy, the treatment should be discontinued. (3)

Prescription testosterone products have only been given approval by the U.S. Food and Drug Administration for men who have low testosterone levels caused by certain medical conditions. Some compounding pharmacies, which make products according to a doctor’s specifications, as well as over-the-counter products, have sidestepped this restriction for women by providing personalized testosterone therapy. (6)