Testosterone levels in women

Reviewed by Dr Bhavini Shah

This article will explain what testosterone is, why it’s important in women, and what the standard levels are. We then talk about the symptoms of high and low levels, testing for them, and what treatment might look like.

What is testosterone?

Testosterone is the main male hormone. Is it responsible for producing male characteristics and the development of sperm cells. Women also produce testosterone. In women, it is very important for things like energy, clear thinking, sexual function and bone density. 

Premenopausal women produce almost three times as much testosterone than they do oestrogen (the female sex hormone). Despite this, its importance in women’s health and wellbeing is often overlooked.

The role of testosterone in women

In women, testosterone plays a part in:

• Libido (sex drive) – testosterone is important in having a sex drive and becoming aroused. A low libido is a symptom of low testosterone.
• Fertility – testosterone promotes the growth and maintenance of reproductive tissues. Too much testosterone is linked with infertility in severe cases.
• Healthy bones – bone health and growth are supported by testosterone. It helps prevent fractures and reduces the risk of osteoporosis (a disease which makes bones weak and fragile).
• The menstrual cycle – along with the reproductive hormones, oestrogen and progesterone, testosterone helps control the menstrual cycle.
• Mood and energy levels – testosterone supports overall wellbeing and ‘zest’ for life. 

What is the standard testosterone level for women?

A reference range commonly used is 0.7 - 2.8 nmol/L.

How do I know if my testosterone level is abnormal?

A blood test can show your testosterone levels. You can have a blood test at your GP but an at home finger prick test is also an option.

Symptoms of low testosterone in women include:

• Reduced sex drive
• Fatigue
• Less pleasurable sex (for example, it’s hard to get aroused and orgasm)
• Headaches
• Difficulty concentrating 

Levels of testosterone in women decline between the ages of 20 and 40. By menopause, levels have stopped declining and are stable.

Symptoms of high testosterone in women include:

• Obesity (in severe cases)
• Infertility (in severe cases)
• Excess hair growth on the face and body
• No periods 

In most cases, high testosterone is caused by a condition, such as polycystic ovaries syndrome (PCOS) or congenital adrenal hyperplasia (CAH). CAH is a group of genetic disorders. In rare cases, high testosterone in women can be caused by a tumour on the ovaries or adrenal glands, or an intersex condition. Intersex is an umbrella term for variations in a person’s physical sex characteristics. The variations can be to do with internal and external sex organs, chromosomes and/or hormones.

Do women need treatment for abnormal testosterone levels?

Low testosterone

Not everyone with low testosterone will need to be treated. You may not experience symptoms or feel bothered by a low libido. Low sexual desire can also be linked to things like a relationship breakdown, mental health problems, and medication. Your GP might explore these areas first before TRT.

Testosterone replacement therapy may be an option for some women (TRT). TRT is available off-licence. This means that it’s used in a different way to what’s stated in the medication licence.

Testosterone therapy for women is often prescribed as a gel in a canister or sachet. Before treatment, a doctor will usually check your levels and then again after three months. Testosterone therapy should only be considered if symptoms become a problem – it is not essential to treat. It is also recommended to complete a trial of conventional HRT before considering testosterone therapy/supplementation.

High testosterone

Depending on the cause, high testosterone can be treated with medication. Your doctor might prescribe an oral contraceptive or a hormonal therapy.

Lifestyle changes can also help. If recommended by your doctor, losing some weight can help with PCOS symptoms and lower testosterone. It might improve your fertility too.

Natural remedies for abnormal testosterone levels

It’s difficult to find credible information about how to change testosterone levels naturally. An internet search will bring up recommendations from weightlifting to supplements.

If you get an abnormal result from a test, your doctor should advise on what to do next – this might look like testosterone therapy or making lifestyle changes.

References

https://www.ncbi.nlm.nih.gov/books/NBK526128/
https://www.guysandstthomas.nhs.uk/health-information/testosterone-low-sex-drive-menopause
https://thebms.org.uk/2023/03/bms-statement-on-testosterone/
https://www.manchester.ac.uk/discover/magazine/features/rights-of-intersex-children/ 
https://www.sciencedirect.com/science/article/abs/pii/0002937879904630
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036835/
https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/reproductive-hormones
https://www.gloshospitals.nhs.uk/media/documents/Testosterone_replacement_for_women.pdf
https://www.yorkhospitals.nhs.uk/our-services/a-z-of-services/lab-med/test-directory/clinical-biochemistry/testosterone/