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"Understanding the Role of Testosterone in Women's Health: What You Need to Know"

by Cynthia Lombard, WHNP-BC


Testosterone is the primary male sex hormone, but it is present in women as well. It plays an important role in drive, muscle mass, bone density, and mood in both men and women.


While low testosterone (also called hypotestosteronemia) is common in aging men, it can occur in women as well. Estimates vary, but some research suggests that up to 20% of women over age 50 may have low testosterone levels. This condition becomes more common after menopause when the ovaries produce less testosterone.


Having adequate testosterone levels is important for women’s health. Testosterone helps maintain lean muscle mass and strong bones while regulating sex drive and mood. Low testosterone has been associated with depression, fatigue, low libido, difficulty concentrating, and emotional lability in women. Keeping testosterone levels within an appropriate range can help women feel their best and optimize physical and mental health.



Natural Causes:

The most common natural causes of low testosterone in women are:

Aging/menopause - As women age, their ovaries gradually produce less estrogen and testosterone. The most dramatic drop in hormone levels occurs during menopause.

Oophorectomy/hysterectomy - Surgical removal of the ovaries causes an abrupt drop in testosterone (as well as estrogen). Removal of the uterus alone does not cause low testosterone.

Pituitary disorders - The pituitary gland in the brain produces hormones that signal the ovaries to make testosterone. Any disorder of the pituitary, like a tumor, can disrupt this signaling.

Adrenal gland disorders - The adrenal glands also produce small amounts of testosterone. Problems with the adrenal glands, like adrenal insufficiency, can cause low testosterone.

Chronic illness - Certain chronic medical conditions are associated with low testosterone in women, like rheumatoid arthritis, diabetes, HIV/AIDS, and chronic kidney or liver disease. Both the illness itself and its treatments can impact hormone levels.




Lifestyle Factors:

There are several lifestyle factors that can contribute to low testosterone in women.

Poor Diet. Eating a diet that is low in nutrients and high in processed foods can negatively impact hormone levels. Not getting enough healthy fats, proteins, and micronutrients can disrupt endocrine function.

Being Overweight. Carrying excess body fat, especially in the abdominal region, is associated with lower testosterone levels in women. Adipose tissue contains an enzyme called aromatase that converts testosterone into estrogen. The more fat tissue, the more conversion occurs.

Excess Alcohol. Drinking alcohol heavily and regularly can reduce testosterone production. Alcohol toxicity impairs Leydig cell function in the ovaries, which are responsible for secreting testosterone.

Smoking. Smoking has been shown to decrease serum testosterone levels in women. Tobacco smoke contains toxic chemicals that impair hormone function. Quitting smoking can help restore normal testosterone levels.

High Stress. Chronic stress takes a toll on the adrenal glands, which produce DHEA, a testosterone precursor. Prolonged cortisol elevation from stress disrupts the HPA axis and hormone synthesis. Reducing stress through lifestyle changes can support healthy testosterone levels.

Medications. Certain medications can lower testosterone levels in women. The main culprits include:

Oral contraceptives. Birth control pills that contain estrogen and progestin can decrease total and free testosterone levels. This effect is reversible once the medication is stopped.

Opioids. Opioid pain medications like morphine, oxycodone and fentanyl can suppress GnRH production, leading to reduced luteinizing hormone and testosterone. This is especially pronounced with long-term use.

Glucocorticoids. Corticosteroid drugs like prednisone and dexamethasone that are used to treat inflammatory conditions can decrease testosterone synthesis. This effect is dose-dependent.

SSRIs. Selective serotonin re-uptake inhibitors that are used as antidepressants may increase sex hormone binding globulin. This binds up testosterone, reducing bioavailable levels.


Other medications associated with lowered testosterone include anti-seizure drugs, chemotherapy agents and certain anti-fungal and high blood pressure medications. It's important for women experiencing symptoms like low libido, fatigue and mood changes on any medication to get hormone levels tested. Dose adjustments or alternative therapies may be required.


Symptoms: Women with low testosterone may experience a variety of symptoms, including:


Low libido. Low testosterone is a common cause of low libido or reduced sex drive in women. This means having less desire for sexual activity, as well as less frequent or unsatisfying sexual encounters. Physical intimacy may become uncomfortable or unappealing.

Fatigue. Chronic fatigue is a key sign of low testosterone in women. You may feel drained, sluggish, and unable to complete daily tasks. Even minor physical exertion can be exhausting. Rest and sleep do not resolve the fatigue.

Depression. Low testosterone can contribute to depression in women. Symptoms may include sadness, irritability, lack of motivation, withdrawal from social activities, changes in appetite and sleep patterns, and difficulty concentrating.

Loss of muscle mass. Declining testosterone reduces muscle mass. You may notice muscle weakness, particularly in the upper body. Weight training becomes more challenging. Muscles appear smaller, even with regular exercise.

Increased body fat. Low testosterone is linked to increased body fat in women, especially around the abdomen. This leads to a redistribution of body fat away from the hips and thighs. Weight gain may occur despite no change in diet or exercise. Losing weight becomes more difficult.


Diagnosis:

Diagnosing low testosterone in women involves a medical evaluation consisting of:

Blood tests. A blood test is done to measure the amount of testosterone in the blood. In women, normal testosterone levels range from 15 to 70 nanograms per deciliter (ng/dL). Levels below 15 ng/dL indicate low testosterone.


Other helpful blood tests include:


Complete blood count (CBC) - to check for anemia and other blood abnormalities

Thyroid tests - to rule out an underactive thyroid, which can cause similar symptoms

Prolactin level - to check for tumors of the pituitary gland


Medical history: The doctor will ask about symptoms, medical conditions, surgeries, and medications that could affect testosterone levels. Information about menstruation, pregnancy, and menopause is important.

Physical exam: A physical exam allows the doctor to look for signs related to low testosterone. This includes evaluation of body hair growth, muscle mass, breast development, and genitals. Pelvic and breast exams may be done.

Symptom evaluation: The doctor will ask about symptoms associated with low testosterone like low sex drive, fatigue, difficulty concentrating, and depression. Rating symptom severity can help determine appropriate treatment.


The combination of blood tests, medical history, physical exam, and symptom evaluation allows for an accurate diagnosis of low testosterone levels in women. Further testing may be needed to determine the underlying cause.


Contact Essential Woman LLC today to schedule your body analysis and improve your health.

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