Low desire that causes distress is worth discussing with a clinician, and any prescription option is decided by a licensed provider after a full evaluation.
Women make testosterone because androgens are ordinary human hormones that both sexes produce, in different amounts. Two organs secrete it directly, the ovaries and the adrenal glands, and a large share of what circulates is also assembled in peripheral tissues such as fat, skin and muscle from precursor androgens including DHEA, DHEAS and androstenedione 2. Once made, testosterone acts through the androgen receptor, and part of it is converted by the enzyme aromatase into estradiol, which is why androgens and estrogens are better understood as one connected system rather than two rival ones 2.
The amounts are far lower than in men, but low is not the same as unimportant. Research suggests that testosterone is the most abundant biologically active sex steroid in women across the adult lifespan 1. The test labs run most often is Testosterone Total, which reports everything in circulation, both the portion bound to carrier proteins and the small unbound portion that can actually enter cells.
That binding matters more than most people realise. Most circulating testosterone travels attached to sex hormone binding globulin (SHBG) and to albumin, and only the free or loosely bound fraction is available to tissues 2. Two women can show an identical total result and have quite different amounts reaching their cells, simply because their SHBG differs. It is one of several reasons a single total number, read on its own, answers less than a reader expects it to.
It acts wherever androgen receptors sit, which is far beyond the reproductive tract. Research suggests that androgen receptors are present in tissues including bone, muscle, breast, skin, fat and brain, and that testosterone has roles in women that extend past sexual function 3. Some of those effects are direct, through the receptor, and some are indirect, through conversion to estradiol inside the tissue itself 2.
The part that is best characterised clinically is sexual function, specifically desire, arousal, orgasm and the distress that can come with losing them. Outside of that, the picture is less settled. Research suggests that the data supporting benefits for bone, muscle, mood and cognition in women are more limited than the biology alone would imply 3.
This gap between plausible biology and demonstrated benefit is the single most useful thing to carry into any conversation about low testosterone in women. The hormone genuinely does a lot. That does not mean every symptom that overlaps with its known functions is explained by it, and it does not mean a number on a lab report can tell you which symptom belongs to which cause. Honest framing keeps the focus where it belongs, on the symptoms that bother you, how long they have lasted, and what else could plausibly produce them.
Mostly with age, not at a single menopausal moment. Research suggests that testosterone concentrations in women decline gradually from the earlier reproductive years onward, so that a woman in her forties already has lower levels than she did in her twenties, well before her final period 1. That slow slope is different from the pattern estradiol follows.
Natural menopause itself is defined retrospectively, after twelve consecutive months without a period, and reflects the loss of ovarian follicular activity with the fall in estradiol that produces hot flushes, sleep disruption and genitourinary symptoms 4. The postmenopausal ovary is not switched off, though. It continues to produce androgens for years afterwards, and the adrenal glands keep supplying precursors, which is why androgen levels do not collapse the way estradiol does at the menopause transition 1.
Practically, this means age alone will usually explain a lower testosterone result in a woman over forty, and finding one tells a clinician very little they did not already know from her birth year. It also means that attributing midlife symptoms to a falling androgen level is rarely straightforward, because estradiol, sleep, mood, work load and general health are all changing across the same window. A good evaluation sorts the overlapping stories rather than picking the most convenient one.
It falls abruptly, because a direct source of production is gone overnight. Research suggests that bilateral removal of the ovaries causes a marked and immediate reduction in circulating testosterone, in contrast with the gradual age-related decline seen in women who go through natural menopause 1. The loss of ovarian estradiol at the same time means symptoms often arrive suddenly and with more intensity than they do in natural menopause.
Women in this situation frequently describe a change they can date precisely, which is unusual in hormone medicine. Desire that was present before surgery is absent after it. Energy, arousal and sense of wellbeing shift within weeks rather than years. That clarity of timing is clinically meaningful information, and it is worth bringing to a clinician in exactly those terms, with dates.
Surgical menopause is also one of the settings where a specialist will think carefully about hormone care as a whole, not testosterone in isolation, since the oestrogen side of the picture usually dominates the symptom burden. None of that is a self-service decision. A licensed provider evaluates the surgical history, the symptoms, the risks that apply to you personally, and whether any prescription option is appropriate at all. The same applies to women whose ovarian function ends early for other reasons, including certain cancer therapies and primary ovarian insufficiency.
The most common are low sexual desire, reduced arousal or orgasm, persistent fatigue, low mood, poor concentration, and a general sense of flattened drive or wellbeing. Some women also report loss of muscle tone or thinning hair. These are the complaints that send people searching for an androgen explanation, and they are real complaints, whatever their cause.
The difficulty is that none of them is specific. Research suggests that blood testosterone concentrations in women do not reliably track sexual function or wellbeing, so a woman with troubling symptoms may have an unremarkable result and a woman with no complaints may sit lower 1. That is an uncomfortable finding if you want the lab report to be the answer, and a liberating one if you would rather spend the appointment on what is actually happening to you.
One distinction does carry clinical weight. Low desire becomes a defined clinical problem, hypoactive sexual desire disorder, when it persists and causes personal distress, not simply when it differs from a previous baseline or from a partner's expectations. Evidence suggests that this distress-based definition is the frame used when clinicians consider androgen options in postmenopausal women 7. If the loss of desire does not bother you, it is not a problem to solve. If it does, it deserves a proper evaluation rather than a supplement bought on a hunch.
Because almost everything on that list has several far more common explanations, and most of them are checkable. Fatigue, low mood and low desire sit at the intersection of sleep, iron status, thyroid function, blood sugar, mental health, relationship context, chronic pain and the ordinary load of midlife. A clinician works through that list rather than jumping to the rarest explanation first.
| Symptom | Other common explanations a clinician considers | Markers or areas often reviewed |
|---|---|---|
| Low sexual desire | Relationship context, stress, sleep debt, pain or dryness with sex, mood, medicines already prescribed | Full history, menopause status, pelvic examination, thyroid and iron markers |
| Persistent fatigue | Fragmented sleep, under-eating, anaemia, thyroid function, blood sugar patterns, low mood | Ferritin, full blood count, TSH, HbA1c, vitamin D |
| Low mood or flat motivation | Depression, anxiety, life load, perimenopausal hormone swings, alcohol intake | Mood screening, menopause status, estradiol and FSH |
| Brain fog | Night-time hot flushes, broken sleep, stress, thyroid function | Sleep review, TSH, menopause status |
| Muscle loss or weakness | Low protein intake, little resistance training, inactivity, recent illness | Body composition, dietary review, metabolic panel |
| Hair thinning | Iron status, thyroid function, pattern hair loss, postpartum shedding | Ferritin, TSH, scalp examination |
None of these rows diagnoses anything. They show why a clinician who is good at this will ask about your sleep and your week before ordering an androgen panel, and why a low result found alongside an unexamined iron level or an untreated sleep problem is a weak guide to anything.
No, there is no agreed diagnostic threshold for androgen deficiency in women. Research suggests that no blood concentration has been established that identifies women who will benefit from androgen therapy, and that a level alone should not be used to make the decision 1. International menopause guidance takes the same position, framing the decision as a clinical one based on symptoms and evaluation rather than on a laboratory cut-off 5.
There is also a measurement problem underneath the clinical one. Female concentrations sit near the bottom of what many routine assays were built to measure, and research suggests that immunoassays perform poorly at these low concentrations, with liquid chromatography tandem mass spectrometry regarded as the more accurate method 1. Direct assays for free testosterone are particularly unreliable in women, and calculating the free fraction from total testosterone together with SHBG is the approach usually preferred 1.
So a result flagged low on a woman's report may reflect her age, her SHBG, the time of day, the assay used, or genuine variation, and separating those is not something a single draw can do. Standard reference ranges vary by laboratory, method, age and sex, and the numbers for this marker are set out on its own biomarker guide. What a low figure is not is a diagnosis, and it is not a reason to start anything by yourself.
With a morning blood draw, using a sensitive method, and almost always alongside SHBG so the free fraction can be calculated. Androgens follow a daily rhythm, so a sample taken in the early part of the day is more comparable with the next one. Repeating a surprising result before acting on it is routine, because single values move.
Timing within the menstrual cycle matters for women who still cycle. Androgen levels vary across the cycle, so laboratories and clinicians generally prefer a consistent point rather than a random day, and a result taken mid-cycle is not directly comparable with one taken in the early follicular phase. For postmenopausal women that variable disappears, but the assay sensitivity problem does not.
FitScript is a labs-first membership built around 150+ biomarkers tested per year, with results interpreted by Atlas, its AI health advisor, and any treatment decision made by a licensed provider who has reviewed the member. The value of that structure for a question like this one is context. An androgen result that means little alone means considerably more beside iron status, thyroid markers, metabolic markers and a menopause history tracked over time.
One practical note. If you are comparing results from two laboratories, check whether the method was the same before concluding that anything changed. Different assays can produce different numbers from the same sample, and that difference is a laboratory artefact, not a change in your physiology.
Several things, and not all of them change the total number. Because only the unbound fraction reaches cells, anything that raises SHBG reduces what is biologically available even when total testosterone looks unchanged 2. Thyroid status, liver status, pregnancy, body composition and several prescribed medicines all influence SHBG, which is why a clinician reviews your full medicine list rather than reading the androgen line in isolation.
Production itself can fall for structural reasons. Removal of both ovaries removes a direct source 1. Conditions affecting the pituitary or the adrenal glands reduce the signalling or the precursor supply that androgen synthesis depends on 2. Serious or prolonged illness suppresses the reproductive axis broadly.
Then there are the everyday inputs. Chronically low energy intake relative to training load, sustained sleep restriction, heavy alcohol use and unrelenting stress all press on the same axis, and they tend to arrive together in the people most likely to notice flat energy and absent desire. These are not glamorous explanations, and they are frequently the operative ones.
Age sits underneath all of it. Given the gradual lifelong decline 1, a modestly low figure in a woman in her fifties is an expected finding rather than a discovery. What makes a result worth a longer conversation is a sharp change from a known previous value, a clear surgical or medical trigger, or symptoms that are genuinely distressing.
SHBG first, because without it the total result cannot be interpreted properly 1. DHEA sulphate gives a view of adrenal androgen precursor supply, which feeds peripheral testosterone production 2. Estradiol and FSH help place a premenopausal, perimenopausal or postmenopausal woman on the transition, which changes how every other result is read 4.
Beyond the sex hormones, the markers that most often explain the symptoms people attribute to low androgens are mundane. Thyroid markers, ferritin and a full blood count, fasting glucose and HbA1c, vitamin D, and liver and kidney panels cover a great deal of the fatigue and low mood that walks through the door. Prolactin is checked when cycles are irregular or there is nipple discharge.
If a woman's complaint runs the other way, towards unwanted hair growth, acne or scalp hair loss, the same panel is read with the opposite question in mind, since androgen excess has its own evaluation and its own causes. Rapidly progressive hair growth, a deepening voice or other sudden virilising changes are worth discussing with a clinician promptly rather than at the next routine visit.
The point of a wider panel is not to collect numbers. It is that a lone androgen result in a woman carries too little information to act on, and the markers around it are what turn an observation into something a clinician can reason with.
In one well-defined situation. International menopause guidance regards testosterone as a consideration for postmenopausal women with hypoactive sexual desire disorder, after an appropriate clinical evaluation, and does not support its use for other symptoms on current data 5. Evidence suggests that the supportive data sit mainly in postmenopausal women, with the picture in perimenopausal women less well established 7.
That narrow framing disappoints people who arrive hoping an androgen will fix fatigue, body composition or mood. Research suggests that the data for those outcomes in women remain limited compared with the data for sexual function 3, which is why responsible guidance declines to extend the recommendation to them.
It also matters that the decision is never made on a number. Because no threshold identifies women who benefit 1, the evaluation turns on symptom history, distress, menopause status, what else has been excluded, and personal risk factors. Your prescriber decides whether any option fits, after reviewing you directly. No article, lab report or quiz can make that call, and anything sold to you without an evaluation has skipped the only step that matters.
For postmenopausal women with low desire, the reported benefit is specific and modest. Research suggests that testosterone compared with placebo is associated with improvements in sexual function in postmenopausal women, including desire, arousal, orgasm, pleasure and reduced sexually related distress 6. That is the outcome the data speak to most directly.
The trade-offs are reported in the same place. That review found more acne and more unwanted hair growth with testosterone than with placebo, and noted that trial durations were short, so information about longer-term safety was limited 6. Effects on lipids differed by preparation in that analysis 6, which is one of several reasons the specific product and its monitoring are a prescriber's decision rather than a consumer choice.
Monitoring is part of the package wherever an androgen option is used. Clinical guidance frames use in women as requiring evaluation before starting, review of response, and attention to keeping exposure within the female physiological range rather than above it 5. Products designed for men are not interchangeable with care designed for women.
No doses, schedules or administration details belong in an article like this one, and you will not find them here. What belongs here is the shape of the decision, so that you can have a better conversation with someone qualified to make it with you.
As a whole-person problem, with hormones as one branch of the inquiry rather than the trunk. A good evaluation establishes when desire changed, whether the change is distressing, whether arousal and orgasm changed with it, and what else was happening at the time, including sleep, mood, workload, relationship context and any new prescriptions.
Physical causes get a proper look. Pain or dryness with sex changes desire quickly and has its own management, and genitourinary symptoms are a recognised part of the menopause transition driven by falling oestrogen 4. Pelvic floor problems, untreated thyroid disease, anaemia and poorly controlled blood sugar all deserve exclusion before anyone reaches for an androgen explanation.
Mental health and context are not consolation prizes here. Depression, anxiety, caregiving load, bereavement and relationship conflict are among the most frequent reasons desire disappears, and they respond to care that works. In people with a history of trauma or pain conditions, a psychosexual referral is often more useful than any laboratory result.
Only after that does the question of a prescription option become reasonable, and then only for the group where guidance supports it. Working in this order is not gatekeeping. It is how you avoid spending a year on a hormone while the actual cause goes unaddressed.
The foundations, consistently, before anything else. Clinicians usually start with sleep, because broken or short sleep flattens energy, mood and desire together, and because night-time hot flushes are a common and manageable reason for it in midlife. Addressing the thing waking you up often does more than any supplement.
Eating enough is the next one. Sustained under-eating, especially alongside heavy training, suppresses reproductive signalling and leaves women tired, cold and uninterested in sex. Adequate total energy, adequate protein and resistance training two or three times a week are the standard starting points for the muscle and strength complaints that get attributed to androgens, and they are worth doing regardless of what any hormone result shows.
Alcohol, chronic stress and unmanaged mood deserve honest review, since each independently dampens desire. For couples, scheduling, conflict and mismatched expectations often matter more than biology.
Over-the-counter androgen or hormone precursor supplements sit in a different category. They are poorly regulated, variable in content, and can raise androgen exposure without supervision or monitoring. Anything intended to change a hormone belongs with a licensed provider who can evaluate it, including whether it is appropriate for you at all.
When the symptoms persist, when they distress you, or when something changed sharply. Low desire that has lasted months and bothers you meets the threshold for a proper evaluation, and so does a clear change after surgery, after cancer therapy, or after an early loss of ovarian function. Bring dates, a medicine list and a description of what changed rather than only a lab result.
Some findings deserve a prompter conversation. Rapid scalp hair loss, a deepening voice, marked new facial or body hair, irregular or absent periods, nipple discharge, or symptoms alongside a result that is well outside the laboratory's standard range are all worth discussing with a clinician promptly. A result flagged outside the standard range is never something to ignore, and it is also never a diagnosis on its own.
If an evaluation does point towards considering a prescription option, expect an assessment first, a clear reason, and planned follow-up, since that is how guidance frames androgen use in women 5. Discuss your results, your symptoms and any treatment decision with a clinician or licensed provider who knows your history. This article is educational and not medical advice.
If low desire is the main thing you want answered, the guide to low libido causes works through the non-hormonal explanations that come up most often, and the overview of hormone care for women explains how FitScript structures hormone evaluation with a licensed provider.
Yes. Women produce testosterone in the ovaries and adrenal glands, and more of it is assembled in tissues such as fat, skin and muscle from precursor hormones. The amounts are much lower than in men, but the hormone is a normal part of female physiology rather than something borrowed.
Not on its own. There is no agreed cut-off that defines androgen deficiency in women, and routine lab methods are least accurate at the low concentrations women sit at. A result is one input alongside your symptoms, your menopause status and the rest of your panel, and a clinician interprets the whole picture.
A morning draw is standard, because androgen levels follow a daily rhythm. Women who still cycle are usually tested at a consistent point in the cycle rather than a random day, so results can be compared over time. SHBG is generally measured in the same draw, since the free fraction is calculated from both values.
Not in the way it causes the fall in estradiol. Testosterone declines gradually with age from the earlier reproductive years, so a woman is already lower in her forties than in her twenties. The ovaries continue producing androgens after the final period, which is why the androgen picture changes more slowly than the oestrogen one.
Levels drop sharply, because a direct source of production is gone immediately. Women often describe a change they can date to the surgery, affecting desire, energy and sense of wellbeing. That timing is useful information to bring to a clinician, along with the surgical date and what changed afterwards.
It might contribute, but these symptoms have several more common explanations that are easier to check and easier to address. Sleep quality, iron status, thyroid function, blood sugar, alcohol intake and mental health all produce the same picture. A sensible evaluation works through those before settling on a hormonal explanation.
SHBG is the most important, because the total result cannot be interpreted without it. DHEA sulphate, estradiol and FSH help place you on the menopause transition, and thyroid markers, ferritin, a full blood count, glucose and HbA1c cover the causes of fatigue and low desire that come up most often.
A licensed provider, after a full evaluation that covers your symptoms, your history, your other results and your personal risks. No number on a lab report makes that decision, and nothing should be started or stopped without that review. If an option is considered, expect planned follow-up rather than a one-off prescription.