Signs and Symptoms of Low Testosterone in Women: What to Know

Testosterone is often discussed exclusively in the context of men's health but it plays an equally important role in women's wellbeing. In women, testosterone influences sexual desire, energy levels, mood, cognitive function, muscle tone, and bone density. When levels fall below what the body needs, the signs and symptoms of low testosterone in women can be wide-ranging and easy to mistake for other conditions.

This article explores what research says about these symptoms, how they change across different life stages, and what causes this hormonal shift

‍The Role of Testosterone in Women's Health‍

In women, testosterone is produced by the ovaries (approximately 50%) and through peripheral conversion of androgens secreted by the adrenal glands and ovaries  primarily dehydroepiandrosterone (DHEA) and androstenedione (Davis et al., J Sex Med, 2019). Although present in much smaller amounts than in men, testosterone is physiologically active in multiple organ systems.

Research indicates that testosterone in women is associated with (Islam et al., Lancet Diabetes Endocrinol, 201930189-5)):

• Sexual desire and arousal the most extensively studied function

• Energy and vitality

• Mood regulation including protection against depression and anxiety

• Cognitive performance  attention, memory, and processing speed

• Muscle mass and physical strength

• Bone density testosterone has bone-protective effects

• Skin and hair health

‍How Testosterone Declines With Age in Women‍

Unlike the relatively abrupt hormonal shift of menopause, testosterone levels in women decline gradually and continuously from approximately the third decade of life onward. This decline is driven primarily by age-related changes in ovarian and adrenal function not by menopause itself (Cappola AR et al., J Clin Endocrinol Metab, 2023).

Key milestones in this decline include:

• By age 40, circulating testosterone may have fallen to approximately half of peak reproductive levels

• Levels continue declining through the 50s, reaching a nadir around age 58-59

• After that point, levels may modestly increase as estrogen declines further and SHBG (sex hormone-binding globulin) levels change

• At menopause, the adrenal glands become the primary source of testosterone, as ovarian androgen production diminishes

This gradual, age-driven decline means that women in their 40s and 50s are particularly likely to experience the effects of lower testosterone often without a clear hormonal explanation from standard blood panels.

Signs and Symptoms of Low Testosterone in Women‍

The signs and symptoms of low testosterone in women span several body systems. They are often gradual in onset and can overlap with symptoms of other hormonal changes, thyroid dysfunction, or mood disorders.

Sexual Health:

• Reduced libido (hypoactive sexual desire)  the best-evidenced symptom; loss of interest in sexual activity is considered the primary clinical indicator of androgen insufficiency in women (Davis et al., J Sex Med, 2019)

• Decreased genital sensitivity and reduced arousal

• Vaginal dryness (often in combination with estrogen decline)

• Difficulty reaching orgasm

Energy and Physical Function:

• Persistent fatigue and low energy that is not explained by lifestyle factors

• Reduced muscle strength and mass

• Decreased exercise capacity or slower recovery

‍Mood and Mental Health:

• Low mood, depression, and anxiety  evidence suggests testosterone may have anti-inflammatory and neuroprotective effects on mood circuits (Glynne et al., Arch Womens Ment Health, 2024)

• Irritability and emotional lability

• Reduced motivation and sense of drive

Cognitive Function:

• Brain fog difficulty concentrating, poor memory, reduced verbal fluency

• Approximately 47% of women in one retrospective cohort study reported improved mood and 39% reported cognitive improvement with transdermal testosterone therapy (Glynne et al., 2024)

Physical Changes:

• Thinning hair (scalp or pubic/axillary)

• Loss of bone mineral density  research indicates a positive association between testosterone levels and lumbar bone density in postmenopausal women up to ~30 ng/dL (Yang et al., Int J Endocrinol, 2022)

• Changes in body composition, including increased fat mass

Signs of Low Testosterone in Women Over 40‍

For women in their 40s, low testosterone often coincides with the perimenopause transition  a period when estrogen levels begin to fluctuate, but testosterone has already been declining for a decade or more. Common signs at this stage may include:

• Noticeable drop in libido often one of the earliest and most recognized symptoms

• Persistent fatigue that does not improve with adequate sleep

• Mood instability increased anxiety, irritability, or low mood

• Gradual muscle loss reduced strength and increased difficulty maintaining body composition despite regular exercise

• Brain fog difficulty concentrating at work or in daily tasks

• Early changes in bone density important to monitor, as osteoporosis risk builds over years

At this stage, women may also be taking oral contraceptives or hormone therapy, which can raise SHBG levels and further reduce free testosterone — the biologically active fraction (Davis et al., 2019).

Signs of Low Testosterone in Women Over 50‍

For postmenopausal women, these symptoms may become more pronounced as estrogen decline compounds the effects of reduced testosterone. Key concerns at this life stage include:

• Sexual dysfunction postmenopausal women are most likely to meet criteria for hypoactive sexual desire disorder (HSDD), the only indication for testosterone therapy with established evidence (Rojas-Zambrano et al., Cureus, 2024)

• Accelerated bone loss lower testosterone is associated with reduced lumbar bone mineral density in this age group (Yang et al., Int J Endocrinol, 2022)

• Mood changes depression, loss of motivation, and anxiety may be influenced by testosterone alongside estrogen deficiency

• Increased fatigue and reduced physical capacity

• Cognitive changes memory complaints and difficulty sustaining attention

Because many of these symptoms overlap with those of estrogen deficiency, evaluation of the full hormone picture including testosterone, estrogen, and SHBG is typically necessary for accurate assessment.

Common Causes of Low Testosterone in Women‍

Several factors may contribute to lower-than-optimal testosterone levels in women:

• Natural aging  the most common cause; decline begins in the 30s and accelerates through the 40s and 50s

• Surgical menopause (bilateral oophorectomy) removal of both ovaries causes an abrupt loss of ovarian testosterone production

• Premature ovarian insufficiency (POI) cessation of ovarian function before age 40

• Oral contraceptives and oral estrogen therapy these increase SHBG, reducing the free (active) fraction of testosterone

• Hypothalamic or pituitary disorders impaired signaling that reduces gonadal hormone production

• Adrenal insufficiency  the adrenal glands contribute significantly to androgen production

• Chronic illness or significant physiological stress‍

How Is Low Testosterone Diagnosed in Women?

Diagnosing low testosterone in women is more complex than in men. There is currently no universally agreed threshold that defines "low" testosterone in women, and the 2019 Global Consensus Position Statement explicitly recommends against using testosterone levels alone — without symptoms — to diagnose deficiency (Davis et al., J Sex Med, 2019).

Current recommendations include:

• Measuring free testosterone (rather than total testosterone) using mass spectrometry, as immunoassays are not sufficiently accurate at the low concentrations found in women

• Assessing symptoms alongside laboratory values a clinical diagnosis, not purely biochemical

• Evaluating SHBG, which can significantly affect bioavailable testosterone

• Ruling out other potential causes of symptoms (thyroid dysfunction, depression, vitamin deficiencies)

If you are experiencing symptoms consistent with low testosterone, a hormone evaluation with a qualified provider is the recommended first step.

‍Key Takeaways

• The signs and symptoms of low testosterone in women include reduced libido, fatigue, mood changes, brain fog, muscle loss, and decreased bone density

• Testosterone begins declining gradually from the third decade of life well before menopause

• Women in their 40s often experience fatigue, libido changes, mood instability, and early muscle loss as testosterone continues its gradual decline

• Women in their 50s and beyond may notice more pronounced changes, particularly in sexual function and bone health

• There is no single universally agreed "low" testosterone threshold for women diagnosis requires symptom assessment alongside testing

• Common causes include natural aging, oophorectomy, oral contraceptive use, and adrenal or pituitary conditions

‍Frequently Asked Questions‍

What are the most common signs of low testosterone in women?‍

The most commonly reported symptoms are reduced sexual desire (hypoactive sexual desire disorder), persistent fatigue, low mood or depression, and difficulty concentrating. These often occur gradually and may be attributed to other causes before testosterone is considered (Islam et al., Lancet Diabetes Endocrinol, 201930189-5)).

At what age does testosterone start declining in women?‍

Testosterone begins to decline gradually from approximately age 30 onward, driven by age-related changes in ovarian and adrenal function. By the 40s, levels may already be at approximately half of earlier peak values. This decline is driven primarily by aging, not by menopause itself (Cappola et al., J Clin Endocrinol Metab, 2023).

Can low testosterone cause fatigue in women?

Yes persistent, unexplained fatigue is one of the most commonly reported hormonal deficiency symptoms in women with low testosterone. Testosterone is associated with energy regulation, and reduced levels may contribute to fatigue that does not respond to lifestyle interventions (Islam et al., 201930189-5)).

How is low testosterone diagnosed in women?‍

Diagnosis involves a combination of clinical symptoms and laboratory testing. Free testosterone measured by mass spectrometry is the preferred method. There is no single agreed threshold for "low" in women, so results must be interpreted in the context of individual symptoms and clinical presentation (Davis et al., J Sex Med, 2019).

What causes low testosterone in women over 40?‍

The primary cause is natural age-related decline in ovarian and adrenal androgen production. Contributing factors include use of oral contraceptives or oral estrogen (which raises SHBG and lowers free testosterone), beginning perimenopause, chronic illness, and physiological stress (Davis et al., 2019).

Does low testosterone affect bone density in women?‍

Research indicates a positive association between testosterone levels and lumbar bone mineral density in postmenopausal women. Women with lower testosterone may be at greater risk for bone density reduction, adding to osteoporosis risk in the postmenopausal years (Yang et al., Int J Endocrinol, 2022).

What are the treatment options for low testosterone in women?‍

The only currently evidence-supported indication for testosterone therapy in women is hypoactive sexual desire disorder. For broader symptom management, treatment must be individualized and guided by a qualified provider. To explore evidence-based [testosterone replacement therapy for women](/blog/trt-benefits-women) or learn more about comprehensive hormone optimization at Humanaut Health, connect with our care team.

Take the Next Step With Humanaut Health‍

If you recognize these symptoms in yourself, a personalized hormone evaluation may provide clarity. Explore hormone health and optimization at Humanaut Health as part of a comprehensive, concierge longevity care partnership.

References‍

1. Davis SR, Baber R, Panay N, et al. "Global Consensus Position Statement on the Use of Testosterone Therapy for Women." J Sex Med. 2019;16(9):1331-1337. DOI: 10.1016/j.jsxm.2019.07.012‍

2. Islam RM, Bell RJ, Green S, Page MJ, Davis SR. "Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data." Lancet

3. Glynne S, Kamal A, Kamel AM, Reisel D, Newson L. "Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study." Arch Womens Ment Health. 2024. DOI: 10.1007/s00737-024-01513-6‍

4. Rojas-Zambrano JG, Rojas-Zambrano AR. "Effects of Testosterone Hormone on the Sexual Aspect of Postmenopausal Women: A Systematic Review." Cureus. 2024;16(8):e68046. DOI: 10.7759/cureus.68046‍

5. Yang J, Kong G, Yao X, Zhu Z. "Association between Serum Total Testosterone Level and Bone Mineral Density in Middle-Aged Postmenopausal Women." Int J Endocrinol. 2022. DOI: 10.1155/2022/4228740‍

6. Davis SR. "Testosterone for women: certainties and uncertainties." Climacteric. 2023;26(1):21-24. DOI: 10.1080/13697137.2022.2146492‍

7. Cappola AR, et al. "Hormones and Aging: An Endocrine Society Scientific Statement." J Clin Endocrinol Metab. 2023. DOI: 10.1210/clinem/dgad225‍

8. Davis SR. "Testosterone for women: certainties and uncertainties." Climacteric. 2023 - see reference 6.