Understanding Testosterone in Women: Its Role, Balance, and Impact on Health

Abstract

Testosterone, commonly associated with male physiology, plays a critical yet often overlooked role in women’s health. Produced in smaller amounts, it supports energy, libido, mood, bone density, and muscle strength. This article examines the biological function of testosterone in women, the causes and effects of imbalances, and modern approaches to diagnosis and management.

1. Introduction

While testosterone is typically labeled a "male hormone," it is also a vital androgen in the female body. Produced by the ovaries and adrenal glands, testosterone contributes to multiple physiological functions in women. Optimal levels are essential for metabolic health, reproductive function, and emotional well-being. Yet, imbalances—whether deficiency or excess—can lead to significant symptoms and health challenges.

2. How Testosterone Works in Women

In women, testosterone is synthesized in:

• The ovaries (25%)

• The adrenal glands (25%)

• Peripheral tissues (50% through conversion of other hormones like DHEA)

Despite circulating at one-tenth the level found in men, testosterone significantly influences:

• Sex drive (libido)

• Muscle mass and strength

• Fat distribution

• Bone mineral density

• Cognitive function and mood

• Ovarian function

3. Low Testosterone in Women

Causes:

• Aging / Menopause: Natural decline in ovarian hormone production

• Oophorectomy: Surgical removal of ovaries

• Adrenal insufficiency

• Chronic stress or illness

• Use of oral contraceptives (which can suppress androgens)

Symptoms of Low Testosterone:

• Fatigue

• Low libido

• Muscle weakness

• Depressed mood or irritability

• Loss of motivation

• Bone loss or increased risk of fractures

Low testosterone is particularly common during perimenopause and menopause, when ovarian function declines.

4. High Testosterone in Women

Causes:

• Polycystic Ovary Syndrome (PCOS): Most common endocrine disorder in women of reproductive age

• Congenital adrenal hyperplasia

• Insulin resistance or obesity

• Certain tumors or adrenal disorders

Symptoms of High Testosterone:

• Acne and oily skin

• Hirsutism (excess facial/body hair)

• Scalp hair thinning (female-pattern baldness)

• Irregular or absent periods

• Infertility

• Mood changes (e.g., aggression, irritability)

High androgen levels can disrupt ovulation and long-term hormonal balance.

5. Testing and Diagnosis

Evaluation typically includes:

• Total and free testosterone levels (best tested in the morning)

• DHEA-S, LH, FSH, estrogen, SHBG (sex hormone-binding globulin)

• Ultrasound or imaging if PCOS or adrenal abnormalities are suspected

Reference ranges vary by lab, but clinicians focus on symptom correlation, not just numbers.

6. Treatment & Lifestyle Management

For Low Testosterone:

• Lifestyle changes: strength training, sleep optimization, stress reduction

• Nutrition: healthy fats (e.g., omega-3s), zinc, and protein

• Bioidentical hormone therapy (in select cases): low-dose testosterone gels, creams, or pellets (under medical supervision)

• Address root causes: adrenal health, postmenopausal decline, medication effects

For High Testosterone:

• PCOS management: diet (low-glycemic), exercise, weight loss

• Insulin regulation: metformin, inositol supplements

• Hormonal therapy: combined oral contraceptives, anti-androgens (e.g., spironolactone)

• Stress management and sleep support

7. The Importance of Balance

Testosterone isn't inherently "good" or "bad"—what matters is balance. Both deficiency and excess can impair physical, emotional, and reproductive health. Proper evaluation, lifestyle alignment, and, when needed, medical support can restore harmony and improve quality of life.

8. Conclusion

Testosterone is a vital hormone for women, playing roles far beyond reproduction. Understanding its influence, recognizing the signs of imbalance, and adopting targeted strategies for regulation are essential components of women’s health and aging well.

References

• Davis, S.R., et al. (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Journal of Clinical Endocrinology & Metabolism, 104(10), 4660–4666.

• Azziz, R., et al. (2016). Polycystic Ovary Syndrome. Nature Reviews Disease Primers, 2, 16057.

• Traish, A.M. (2018). Testosterone and Women: A Comprehensive Review. Current Sexual Health Reports, 10, 110–120.