- Unhealthy Testosterone Levels In Women: Causes and Symptoms
- Female Testosterone Levels
- Testosterone in Women: What It Does
- Symptoms of Low Testosterone in Women
- Hypoactive Sexual Desire Disorder and Low Testosterone in Women
- What causes low female testosterone levels?
- Symptoms of High Testosterone in Women
- What causes high female testosterone levels?
- How can women naturally decrease high testosterone levels?
- Why Aging Women Need Testosterone
- The Reality behind Testosterone Therapy
- Low Testosterone in Women
- Role of Testosterone in Women
- What Level Is the Right Level?
- Testosterone and Women’s Health
- What Impact Does Testosterone Have on Women’s Bodies?
- What Happens When a Woman’s Testosterone Levels Are Low?
- What Happens When A Women’s Testosterone Levels Are Too High?
- Testosterone Therapy: When Should Women Consider It?
- Signs of High Testosterone in Women
- Attention women: Low sex drive? Testosterone won’t help
- But TV and internet ads say testosterone works for women!
- If it doesn’t work, why did my doctor give it to me?
- Side effects of women taking testosterone
- So how can we treat low sex drive in women?
Unhealthy Testosterone Levels In Women: Causes and Symptoms
Learn about: Testosterone in Women: What It Does | Symptoms of Low Testosterone in Women | Hypoactive Sexual Desire Disorder and Low Testosterone | What causes low testosterone in women? | Symptoms of High Testosterone in Women | What causes high female testosterone levels? | How can women naturally decrease high testosterone levels?
It’s possible for a woman’s testosterone levels to be too high or too low. And because testosterone is a key hormone in the body – in women and men alike – a testosterone imbalance can have quite an impact on your health and well-being.
So keep reading to learn more about unhealthy testosterone levels in women – including causes and symptoms. (And don’t forget: you can check your testosterone from the comfort of home with EverlyWell’s Testosterone Test.)
Female Testosterone Levels
Though testosterone is often thought of as a “male hormone,” it’s actually an incredibly important hormone for women as well. In fact, women usually have higher testosterone levels than estradiol levels. (Estradiol is the body’s main form of estrogen, which is commonly viewed as a “female hormone.”)
Testosterone in Women: What It Does
Here are a few key roles testosterone can play in a woman’s health:
- Maintenance and growth of bones
- Increases muscle mass
- Decreases body fat (in post-menopausal women)
- Supports a healthy libido or sex drive
- May help decrease vaginal atrophy (which occurs most often in post-menopausal women)
- May help support cardiovascular health
So as you can see, normal testosterone levels in females can have many beneficial effects. But too much or too little of this hormone can have less-than-positive effects on the body.
Let’s start by discussing low testosterone symptoms.
Symptoms of Low Testosterone in Women
What are some low testosterone symptoms in women? If you have low T:
- Your hair may begin to thin
- Your skin may become drier
- Your sex drive may be dampened (one reason why some women with low testosterone choose to undergo testosterone therapy)
- You might lose muscle tone, too (which means that low testosterone levels aren’t exactly compatible with #summerbeachbodygoals)
- An increase in body fat, as well as mood changes (including greater anxiety), can also stem from lower-than-healthy testosterone levels
- Sexual dysfunction, bone loss, and overall loss of strength are some other possible low-T symptoms
Hypoactive Sexual Desire Disorder and Low Testosterone in Women
Because testosterone plays a role in libido, women with lower-than-normal testosterone levels can experience hypoactive sexual desire disorder – or HSDD.
HSDD is considered the most widespread sexual health problem among women, and estimates suggest it occurs in 8% to 19% of women. It’s marked by fewer (if any) sexual fantasies and a lack of interest in sexual activity – along with a lot of personal distress, frustration, sadness, and decreased self-confidence and self-worth. Depression and fatigue often occur with HSDD.
Researchers have yet to pin down the exact causes of HSDD. The extent to which testosterone levels contribute to HSDD is also not well-understood. Low testosterone levels are, however, linked with less sexual desire, and testosterone therapy can boost sexual desire in both pre-menopausal and post-menopausal women. But there isn’t an exact T level that can be used to diagnose HSDD.
What causes low female testosterone levels?
What’s behind low testosterone levels in women? Here are a few possible causes:
- Long-term use of various methods of birth control – such as oral contraceptive pills and contraceptive patches
- Ovarian failure – where your ovaries stop functioning correctly – can lead to low testosterone levels. Possible causes of ovarian failure include chemotherapy, radiation treatment, and eating disorders, but the most common cause of ovarian failure is menopause – which happens to every woman as she ages.
- Using certain medications – such as anti-hypertensives and opiates
- Thyroid disease
- Tumors on various glands in the body – such as the pituitary gland – can also cause low T levels in women
Symptoms of High Testosterone in Women
Signs of high testosterone levels in women can include:
- Excess acne
- Abnormal hair growth throughout your body (such as on your chest)
- Male pattern baldness
- A deeper voice
- An enlarged clitoris and smaller breast size
- Menstrual irregularities are another sign of high testosterone
- And if you put on pounds super easily, you might want to get your testosterone levels checked: high testosterone contributes to weight gain
Too much testosterone in women is also linked with an increased risk of obesity and infertility. Post-menopausal women with high testosterone are also at an increased risk of insulin resistance, which can make diabetes more likely.
What causes high female testosterone levels?
- Ever come across the acronym “PCOS”? It stands for Polycystic Ovary Syndrome, and it’s a hormonal disorder that can fill your blood with too much testosterone.
- Steroid use and abuse – can hike up your testosterone levels.
- Adrenal disorders (like congenital adrenal hyperplasia) can also be at fault for high T levels. These disorders are genetic and often found at birth or during puberty.
How can women naturally decrease high testosterone levels?
Several herbs and other plant-based foods may be able to naturally decrease T levels in women:
- Licorice – The root of a legume plant native to the Middle East (and nearby regions like southern Europe), licorice may lower testosterone levels when taken daily.
- Green tea – Aside from being an all-around delicious tea, green tea may also be able to block testosterone from turning into a hormone called DHT – which is similar to testosterone but has much stronger effects on the body.
- Spearmint – Often consumed in tea form, spearmint may decrease levels of free testosterone in the bloodstream. (Read more: Know the difference between free T and total T)
If your hormone levels fall outside a healthy, normal range, then your health and well-being may be at risk. That’s certainly the case for testosterone – whether you are a woman or man. That’s why it’s a good idea to check your testosterone levels (EverlyWell’s Testosterone Test makes this easy to do) – giving you accurate information on a key part of your hormonal health, which you can discuss with your healthcare provider.
Learn More About Testosterone
Unhealthy Testosterone Levels In Men: Some Causes And Symptoms
Why Weight Loss Can Boost Your Testosterone Levels
Measure Your Free Testosterone Level with EverlyWell’s At-Home Test
To the Editors:
I recently read the article “Estrogen in Men” in the November–December issue by Erik Wibowo and Richard Wassersug. The subject appealed to me immediately, although I was left with a few unanswered questions at the end.
I never knew that men had estrogen, let alone considered the role it had in the male body. As interesting as this subject was, the article left me curious about the role of testosterone in females.
The authors state that it is the enzyme aromatase that transforms testosterone into estradiol. I’m curious to know whether females also have a type of enzyme that would convert estradiol into testosterone, or is it naturally produced in their tissues? I’m also curious to know how much levels of testosterone and estrogen need to decrease or increase in order to cause side effects. What are the ways that the body tries to cope with decreasing or increasing levels of these hormones?
I congratulate Drs. Wibowo and Wassersug on writing an intriguing article and also on making the article easy to understand for people, like myself, who don’t have a background in biochemistry or endocrinology.
Ottawa, Ontario, Canada
Drs. Wibowo and Wassersug respond:
We thank Ms. Fortin for her kind comments. To answer her first question, testosterone is indeed present in women, produced primarily in their ovaries and adrenal glands. Although testosterone can be converted to estradiol, the reverse does not happen. Testosterone, however, is not the main androgen (hormones that promote male characteristics) in women. Instead, dehydroepiandrosterone-sulfate (DHEA-S), dehydroepiandrosterone (DHEA), and androstenedione are the more common androgens in women. These three compounds may then be converted to testosterone to produce masculinizing effects.
Endogenous androgens have normal roles in female biology. For example, they promote pubic and axillary hair growth. A growing body of literature on effects of hormones in women and female-to-male transsexuals indicates that testosterone therapy can enhance to some extent aspects of sexual function (for example, libido and vaginal lubrication), improve memory, strengthen bone, reduce fat mass, and increase lean body mass. However, as noted in our American Scientist article, some of these effects may be due to estrogen produced by the aromatization of their testosterone. The extent to which testosterone affects women’s sexual desire is not fully understood, as S. Wahlin-Jacobsen and colleagues discussed in a 2014 article in the Journal of Sexual Medicine.
Ms. Fortin’s last question relates to how much change in testosterone or estrogen is needed to cause side effects. Various factors (for example, dose, duration, and individual differences) determine whether one may experience side effects from any hormonal treatment. As noted above, low-dose testosterone treatment may help raise libido for some women, but it can also cause facial hair to grow. In contrast, when testosterone is administered at constantly high doses (equivalent to male levels), it can have major masculinizing effects: It can lead to baldness, can cause the pitch of one’s voice to deepen, and may increase the risk of cardiovascular diseases—all features of males.
Why Aging Women Need Testosterone
Numerous studies show that maintaining youthful testosterone levels in males confers powerful anti-aging effects. Testosterone-deficient men develop abdominal obesity (pot bellies) and diminished muscle mass, along with a loss of sexual interest and performance ability. Low testosterone is also associated with heart attack, Alzheimer’s disease, osteoporosis, and depression.
While doctors are slowly recognizing the benefits of testosterone therapy for aging men, evidence that women also become testosterone deficient is largely ignored. Controlled studies show that slightly increasing testosterone levels in aging women restores sexual drive, arousal, and frequency of sexual fantasies. In fact, low testosterone levels in women of all ages seem to suppress libido and cause sexual dysfunction. Restoring youthful testosterone in women has been shown to improve mood and well being, and to provide many other health-enhancing benefits.
What you need to know
It is well known that women depend on estrogen and progesterone hormones, however, the benefits of their testosterone levels have been largely ignored by mainstream doctors. In women, low levels of testosterone can decrease sexual drive and stamina and may increase the risk of heart disease and breast cancer. Natural approaches can be implemented to bring testosterone to modest levels, such as endurance and resistance exercise. Supplementing with DHEA, the precursor to testosterone and estrogen, is an excellent adjunctive method as well. Clinical studies show that DHEA supplementation reverses the side effects of low testosterone by raising it to healthy levels. Clinical studies in both pre- and postmenopausal women have shown the restoration of sexual function with DHEA supplementation. Learn more about the importance of testosterone and DHEA for women in this article.
While expensive testosterone drug patches for women are available by prescription, safe and inexpensive natural approaches also can increase testosterone levels in women.
Testosterone in Men and Women
While it is well known that a surge in testosterone production in the testes of boys brings about the changes that lead to manhood, it is not well known that women also produce testosterone (albeit at about one-tenth the level as men) in their ovaries and adrenal glands. As in men, levels of testosterone peak in women in their twenties and decline thereafter. Like men, women not only experience a decline in testosterone production, but also in hormones such as dehydroepiandrosterone (DHEA), which falls dramatically for women after menopause.
Although doctors have known that women produce testosterone, most mainstream physicians have believed that hormones like testosterone are not important for women. Only levels of the “female” hormones progesterone and estrogen were thought to have any significant bearing on a woman’s health and well being. Over the last decade, however, more and more evidence has been brought forth suggesting that testosterone is a very important hormone for women, especially in terms of staying fit, lean, and sexually active.
One of the most widely disseminated studies showing testosterone’s importance in maintaining a woman’s general well being and sexual functioning was published in 2000 in the New England Journal of Medicine.1
This randomized, double-blind, placebo-controlled study examined the effects of transdermal testosterone patches on 75 women aged 31 to 56 years who had undergone a hysterectomy and bilateral oophorectomy (removal of both ovaries). Hysterectomies, with or without an oophorectomy, significantly decrease circulating levels of testosterone. Over three consecutive 12-week periods, the women were given placebo, 150-mcg testosterone patches, or 300-mcg testosterone patches. The unequivocal result was that women who received 300-mcg patches showed significant improvement in sexual function, mood, and general well being.
Benefits for Women’s Sexuality
Although most mainstream physicians now believe that testosterone replacement in women who have had hysterectomies and/or oophorectomies can enhance their mood and well being, most still scoff at the idea that testosterone replacement is of any use to women who still have their uterus and ovaries intact.
Fortunately for women all over the world, Dr. Susan Davis is one of those rare researchers who are examining the ways in which testosterone supplementation can benefit women, whether or not they have had the aforementioned surgeries. At the Jean Hailes Foundation, a not-for-profit organization in Australia dedicated to women’s health issues, Dr. Davis and her colleagues have been studying testosterone’s importance in women’s overall health. In a 1999 article in the journal Clinical Endocrinology and Metabolism, Dr. Davis offered a detailed report on testosterone replacement therapy in both pre- and postmenopausal women.2 In women who are postmenopausal or have had oophorectomies, judicious testosterone therapy has produced a direct and sustained improvement in sexual drive, arousal, and frequency of sexual fantasies. Dr. Davis acknowledged that treating women in their twenties and thirties with testosterone for low libido is controversial, but also stated that its use should not be discounted. According to Dr. Davis, testosterone supplementation can significantly benefit young and otherwise healthy women with low levels of testosterone who suffer from low libidos and sexual dysfunction.
In a more recent article published in 2001, Dr. Davis wrote that testosterone appears to be quite important in maintaining a woman’s energy level and sense of well being, regardless of her age.3 Low testosterone levels in pre- and postmenopausal women can diminish motivation, induce fatigue, and contribute to low libido. Even women in their twenties who are taking birth control pills may suffer from low testosterone and its effects, as oral contraceptives are known to lower testosterone levels. While studies show that testosterone supplementation in postmenopausal women who have not undergone hysterectomies and/or oopherectomies can significantly improve sexual drive, arousal, and frequency of sexual fantasies, no such studies have been conducted on pre-menopausal women.4 Dr. Davis states, however, that “it is the clinical experience of the author that a subset of pre-menopausal women with sexual dysfunction and reduced circulating androgen levels significantly benefits from judicious parenteral testosterone replacement.”
Effects on Strength and Fitness
Besides its psychological and sexual effects, adequate levels of testosterone play an important role in helping women maintain a healthy body composition.
While it is known that women begin to gain body fat 10 years before they experience menopause, and that many women gain weight when taking birth control pills, doctors often overlook the role that testosterone can play in helping to ameliorate this weight gain. This is likely because most doctors are uninformed about the use of testosterone replacement therapy in women. In addition, some early studies, now viewed as flawed, linked elevated testosterone levels in women with abdominal obesity (the patients involved had multiple hormonal imbalances that certainly contributed to their obesity). More recent scientific studies, such as one reported in the Journal of Clinical Endocrinology and Metabolism, have shown that obese women given low doses of synthetic analogues of testosterone (nandrolone) lost more body fat and subcutaneous abdominal fat, and gained more muscle mass, than women given a placebo.5 The study participants followed a low-calorie diet but did not change their exercise habits; after nine months, those women taking nandrolone had lost twice the body fat and gained six pounds of lean muscle mass compared to women in the placebo group.
Deficiencies May Lead to Heart Disease
Besides helping women maintain lean muscle mass and an enjoyable sex life well into their forties, fifties, and sixties, new evidence points to additional positive effects of testosterone on a woman’s health as she ages.
An intriguing report in the Journal of Women’s Health examined the hypothesis that testosterone deficiency is a key predictive factor for heart disease in aging women or women who have had hysterectomies.6 Cardiovascular disease is the leading cause of death in postmenopausal women. Women who have hysterectomies are three times more likely to develop cardiovascular disease compared to women who have not had one. Women who have hysterectomies generally receive estrogen replacement therapy but not testosterone replacement. The study author postulates that this treatment discrepancy is why the incidence of heart disease rises dramatically in these women, and concludes that “the data we have demonstrating cardioprotective effects of testosterone, together with what we know about the loss of testosterone production in both instances of oophorectomy with hysterectomy and in women whose remaining ovarian function has been compromised by hysterectomy, point to testosterone deficiency as a significant factor to the reported increased incidence of cardiovascular risk factors .”
Does Testosterone Inhibit Breast Cancer?
The words “breast cancer” can produce an involuntary shudder in most women, and for good reason: breast cancer is the most common cancer in women, and despite billions of dollars spent on research and treatment since the 1970s, it has been steadily increasing in incidence. It is estimated that in 2004, approximately 300,000 American women will be diagnosed with breast cancer and approximately 46,000 will die from the disease.
Many researchers believe that high estrogen levels are a major risk factor for developing breast cancer, and some have postulated that high testosterone levels in women also may pose an increased risk for breast cancer.7 On the other hand, other researchers believe the association between high testosterone levels and breast cancer in some limited studies may reflect that testosterone and estrogen levels are highly correlated in women, as testosterone can be a precursor for estrogen synthesis. Multiple studies now show that testosterone may help guard women against breast cancer. A study in 2000 looked at the effects of testosterone and tamoxifen (a widely used chemotherapeutic agent for breast cancer) on breast cell stimulation.8 The study showed that breast cells exposed to estrogen showed cancer-like rapid growth, but showed significantly less growth when also exposed to testosterone. A more recent study published in 2003 also showed that testosterone significantly inhibits breast cell growth, leading the authors to conclude that “…androgens may protect against breast cancer, by analogy with P4 effects upon the uterus.”9
The Reality behind Testosterone Therapy
If you’re in midlife, chances are you’ve heard a lot about testosterone therapy for women. If you believe everything you read, supplementing with this hormone can improve your sex life, give you more energy, clear up your skin and help you run a four-minute mile. The reality, however, is far different. For example, testosterone therapy could cause acne, facial hair and a deeper voice.
While there is evidence that testosterone therapy can help some women with certain health-related issues, primarily sexual disorders, it most assuredly is not a wonder drug, and it is not recommended for most women.
First, a few words about testosterone. Testosterone is an androgen, or sex-related hormone. Although considered “male” hormones, androgens play important roles in a woman’s reproductive cycle and overall health. Produced in your ovaries, adrenal glands and fat cells, androgens like testosterone have more than 200 actions in women.
Learn more about the signs of high testosterone in women.
One of those actions is to contribute to your sexual arousal. This is the physical part of sex—the “tingling” feeling that lets you know your body, at least, is ready for action. Desire, however, if the part of you that determines interest and makes you want to sneak up behind your partner and begin kissing the back of his or her neck.
Because testosterone levels can fluctuate significantly and because women have relatively low levels of testosterone, testosterone tests will not necessarily indicate whether a woman’s lack of desire or arousal is related to naturally occurring testosterone. However, studies do find that supplemental testosterone, delivered in the form of a patch, improves sexual desire and responsiveness and increases the frequency of sexual activity.
Unlike estrogen, androgen levels don’t suddenly drop when you reach natural menopause. Instead, androgen production begins slowly falling in your twenties. By the time you reach menopause, you’re producing about half as much as you made at puberty. However, your ovaries may still continue to produce small amounts of androgens even after menopause. Some studies show menopausal ovaries continue to produce testosterone; other studies show they do not. One thing is for sure: if your ovaries are removed or damaged, you will go into surgical or early menopause. Some women who experience surgical menopause report a drop in sexual desire and drive.
We’re still not quite sure whether the reduced androgen levels that occur with aging are responsible for the loss of sexual drive some women experience as they age. What is clear, however, is that supplemental testosterone therapy improves some women’s ability to become aroused and the intensity of their orgasms after menopause, particularly women thrust into sudden menopause.
If your health care professional thinks you might benefit from androgen therapy—also called testosterone therapy—you will likely be started on a very small dose and monitored carefully.
Keep in mind, however, that there is no FDA-approved form of testosterone for treating sexual disorders in women. Nonetheless, your health care professional can prescribe a testosterone product approved for other indications. Examples include compounded testosterone creams and testosterone patches, gels, creams or pills approved for use in men. They should only be given to women if doses are reduced considerably, and blood testosterone levels are closely monitored, which can be difficult to do.
There are few, if any, side effects from the small amounts of supplemental testosterone used to treat sexual desire disorders in women, although your health care professional should monitor you closely. You should also know that there is very little evidence about the effects of testosterone on women not taking supplemental estrogen, which is why your health care professional shouldn’t prescribe androgen therapy without estrogen.
Bottom line: If your lack of sexual drive is affecting your relationship and/or your quality of life, talk to your health care professional about your options.
If you would like to speak to a doctor about hormone therapy treatment options, click here.
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Low Testosterone in Women
Despite marketing that pushes testosterone as a cure-all, women must be cautious about getting more testosterone than they need.
Hear the words low testosterone (or “low T”) and you probably think “men’s health.”
But women actually need small amounts of testosterone, too, as part of the mix of hormones that keep mood, energy levels, sex drive, and bodily functions working smoothly.
Product marketing around testosterone therapy argues that low T could be a reason for low sex drive in women, and that low T in women can be easily solved with hormone replacement therapy.
How accurate are statements like these?
Chances are, if you’ve taken a birth control pill, you’ve already taken a very small dose of a testosterone derivative, points out reproductive endocrinologist David P. Cohen, MD, chief of the section of reproductive endocrinology and infertility at the University of Chicago.
“The packet information calls it progesterone, but it’s really a derivative of testosterone,” he explains.
Testosterone, part of a hormone class known as androgens, originates in your ovaries and your adrenal glands.
Even women whose ovaries have been removed probably make enough testosterone with their adrenal glands to meet their needs, Dr. Cohen says.
So while men with low T could be facing low energy, low mood, low sex drive, and changes in sleep patterns, women don’t face the same dire effects.
“Low testosterone is not much of a concern for women,” he points out.
This is important to know because women can be persuaded by advertisements for testosterone creams and other products that slathering on testosterone will cure low sex drive or a “blah” mood.
Role of Testosterone in Women
Testosterone does play a role in women, though. Healthy testosterone levels help a woman:
Maintain sex drive: After menopause, women might experience a dip in their sex drive. This low sex drive could be the result of lowering testosterone levels. In some women, testosterone patches have been found to revive sex drive. Cohen cautions, however, that treating reduced libido requires more than just testosterone. Therapy and creativity could also help improve your sex life.
Keep bones healthy: The correct balance of testosterone furthers and supports the growth and strength of healthy bones, while too much or too little can harm bones. Testosterone replacement after menopause could help some women maintain healthy bones.
Manage pain levels: According to research in the journal Pain, women who take birth control pills and have levels of testosterone that are out of balance with levels of estrogen might have less ability to manage their pain response.
Preserve cognitive health: Changes in cognition and cognitive fatigue may be related to changing hormone levels. Correcting testosterone levels might help prevent cognitive fatigue, according to research in Gynecological Endocrinology.
What Level Is the Right Level?
Some women may benefit from very small amounts of testosterone, says Cohen, but the side effects of excess testosterone can be worse than the reasons you might want to try hormone replacement therapy in the first place.
These side effects include male pattern hair loss, acne, male pattern hair growth (such as facial hair), changes in menstrual cycles, clitoromegaly (an abnormally enlarged clitoris), and a deepening of one’s voice.
Some of these changes, such as clitoromegaly and a deeper voice, could be permanent, Cohen warns.
Women who use testosterone continuously also run the risk of developing lipid profiles similar to those of men, which means an increased risk for heart disease.
In fact, women are more likely at risk for conditions such as polycystic ovarian syndrome (PCOS), in which they might have too much testosterone (or androgens) compared with levels of other hormones, than they are for conditions such as low T.
That said, Cohen says that he does prescribe very small doses of testosterone for some women if it’s medically appropriate to do so, but the doses are so small that he hasn’t seen a clear dose-response relationship.
Dosing is very individualized, he adds, if hormone replacement therapy proves to be needed. “You don’t titrate to a specific number — you titrate to symptoms,” he says.
If you feel better, it’s the right dose. If you start to see some of the side effects, such as male pattern hair loss, your doctor will stop or reduce the amount of testosterone.
So, if you’re wondering whether the blue mood, lack of energy, and lack of desire you’re struggling with is related to low T, talk with your doctor.
Don’t fall for over-the-counter testosterone or “bioidentical hormone” product marketing and dose yourself. The side effects could be worse than the problems you’re trying to solve.
Testosterone and Women’s Health
Women’s bodies need testosterone, too.
Women need small amounts of testosterone to help fuel energy levels, sex drive, and other bodily functions. Gillian Blease/Getty Images
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. According to a review published in November 2016 in the journal Clinical Interventions in Aging, studies show that both testosterone and estrogen are essential for bone formation. (2)
It promotes cognitive health. According to guidelines published in October 2014 in the Journal of Clinical Endocrinology & Metabolism, testosterone has a neuroprotective effect in women. (3) One study showed that postmenopausal 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, assistant clinical professor in the department of urology at the University of California in Irvine.
What Happens When a Woman’s Testosterone Levels Are Low?
According to the Endocrine Society, 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. (1)
Still, some postmenopausal women experience lower testosterone levels that can cause a decrease in sex drive. In some women, testosterone patches have been found to improve libido. (1)
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 Women’s Testosterone Levels Are Too High?
High levels of a type of androgen known as free testosterone may cause polycystic ovarian syndrome (PCOS), a condition that interferes with monthly periods and the body’s ability to ovulate. According to the Department of Health and Human Service’s 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 cause 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 guidelines, the Endocrine Society recommends against the general use of testosterone therapy in healthy women for the treatment of the following conditions: (3)
- 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 postmenopausal 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. (4)
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. (4)
Prescription testosterone products have only been given FDA approval 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. (5)
Signs of High Testosterone in Women
The word “testosterone” often conjures images of men with well-defined, chiseled muscles, deep voices and energetic libidos.
Testosterone, which belongs to a class of hormones known as androgens, is found in men and made primarily in their testicles. In addition to its effects on muscles and libido, it plays a vital role in things like mood, production of sperm and where fat is stored in the body.
But testosterone doesn’t belong only to men. The hormone is also found in women, where it’s manufactured in their ovaries and adrenal glands, though in much smaller amounts than in men.
Learn about the reality of testosterone therapy.
This mostly male hormone plays a delicate balancing act: Too much testosterone in boys can bring on premature puberty; too little can result in delayed puberty. Too little in men can result in fatigue, decreased sex drive and irritability.
Hormone levels continually change, rising and falling even by the minute. Testosterone levels typically decline with age, both in men and in women. But sometimes, the balance shifts in the opposite direction, and testosterone, rather than drop, will climb.
Excess testosterone can cause unwanted effects and troubling symptoms for women, including:
- Menstrual irregularity or absence of periods
- Excess body hair
- Hair growth on chin or upper lip (hirsutism)
- Enlarged clitoris
- Balding, especially around the hairline
- Increased muscle mass
- Changes in body shape
- Decreased breast size
- Oily skin
- Deepening of the voice or hoarseness
New research has found a possible correlation in midlife women between high levels of both testosterone and estrogen and the risk of developing uterine fibroids, which are benign tumors of the uterus.
Polycystic ovary syndrome (PCOS), which can lead to infertility, can result in high levels of testosterone. About 10 percent of women with high testosterone levels also have PCOS.
If you suspect high testosterone, talk to your health care provider, who can perform a physical examination and laboratory tests, depending on your symptoms, for confirmation.
A woman with high testosterone may choose to treat the symptoms alone (like using an anti-acne medication or a serum to boost hair growth). There are also medical treatments—depending on the cause of the excess androgen production— which include surgery, or oral contraceptives alone or in combination with antiandrogens, or other combinations of hormone therapy.
Attention women: Low sex drive? Testosterone won’t help
You know that look. The one that says your partner is ready to go, but sex is absolutely the last thing you want to do. “Not tonight, honey. I have a headache.”
If this sounds familiar, and if lack of sex is putting a strain on your relationship, you may wonder if you have a low sex drive, also known as low libido. I see women with this concern every week, and many want to try a “quick fix” they’ve heard about on TV or online: testosterone injections, patches, or pellets that corrects low sex drive in women.
But our research indicates that it doesn’t work that way. Not only is testosterone ineffective at increasing a woman’s libido, it also can cause adverse side effects that can make getting in the mood for sex even more difficult.
But TV and internet ads say testosterone works for women!
That may be what the ads say, but there is absolutely no data to indicate that low testosterone levels in women cause low sex drive. Any positive effects claimed by participants in or data pulled from these types of clinical trials is almost absolutely a placebo effect.
The reason I can say that so confidently is because it’s been well-documented that the testosterone levels in women with low sex drives are in the same range as those of women with normal sex drives. In my opinion, there is absolutely no reason to give testosterone to premenopausal women – those in their 30s, 40s, and early 50s – to help with lack of interest in sex. It’s also been found to be ineffective for women who have already gone through menopause.
If it doesn’t work, why did my doctor give it to me?
Many physicians prescribe testosterone to help increase men’s stamina, fatigue, and sex drive. So, they assume testosterone replacement drugs will work the same way for women. But they don’t.
Doctors have an alternative to testosterone since a new drug, flibanserin, was approved by the FDA for low sex drive. But it works differently because it is an SSRI drug that affects the brain. Before prescribing flibanserin, the doctor must take a 30-minute online course, and patients who take it must avoid alcohol. Although it’s approved, it’s only slightly more effective than placebo. Recent reviews suggest that it is not effective. So women are left with no medication for low sex drive.
My team and I conducted a research study of existing literature surrounding the trend of prescribing testosterone to premenopausal women. The maximum length of the studies was 12-24 weeks, and none showed significant improvements in sex drive. In other words, testosterone prescribed to women works no better than a placebo, yet physicians continue to prescribe it because their patients demand a drug for treatment.
Even if a woman is satisfied with the placebo effect of increasing her testosterone levels, the unexpected side effects are likely to outweigh those benefits over time.
Side effects of women taking testosterone
We’ve seen a number of women who have taken testosterone to increase their sex drive but instead developed side effects that make them feel even less excited about sex. Some of these side effects include:
- Deepening of the voice
- Excessive hair growth, particularly on the face
- Enlargement of the clitoris, a part of the outside of a woman’s genitals
We know that in men the long-term use of testosterone drugs, such as anabolic steroids, causes heart attacks, high blood pressure, and other heart diseases. And it’s safe to say those risks would be at least the same in women.
However, a large clinical trial of testosterone use in premenopausal women has not been conducted. And, in my opinion, it should never be done. The health risks of the drug are just too great, the preliminary data show absolutely no benefit, and we’d never want women to take a drug like that just for the sake of science.
So how can we treat low sex drive in women?
Women and couples come to me and say, “When I first got together with my partner, everything was good. But all of a sudden I just have no sex drive. Is there something you can give me for that?”
When it comes to the female sex drive, there really is no effective treatment we can offer except couples therapy or couples sex therapy. Many women and their partners are disappointed in this answer, but it’s the simple truth.
Many of the women I’ve spoken with in my office and during research studies have said their low sex drive is not because of their relationship. They want to pin not wanting to have or instigate sex on something biological that can be fixed with a pill. This actually is a common problem in relationships, and it’s more common in women than in men.
But if they dig into their relationship and the stressors in their lives (work, school, family), they may be able to uncover the root of their hesitancy to have sex with their partners. And it’s important to keep in mind that “low sex drive” is a subjective diagnosis. There’s no way to measure it except to ask the woman what has changed.
I don’t anticipate that in the future we will have a drug treatment for low sex drive in women. Though we do have testosterone treatment for men with low sex drives, it’s a fairly rare problem in men and therefore difficult to gauge true effectiveness.
Rather, we need to start educating physicians about effective options for addressing low sex drive. At the American Society for Reproductive Medicine conference in 2009, I debated the use of testosterone in postmenopausal women – women who have already gone through menopause. My fellows and I developed and distributed information for doctors to start the discussion about why testosterone is ineffective and why it shouldn’t be prescribed to women.
We need to do a better job in general of educating women about testosterone therapy and why it’s not effective. As women live longer, healthier lives, many of them will want to continue having sex for years longer than our ancestors did. If your sex life is important to your happiness and quality of life, talk with your doctor about safe, non-testosterone therapies that could help get to the root of and potentially eliminate your low sex drive problem.
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