Female Low T: How to Spot It and Fix It

Testosterone and Women

Millions of women have low testosterone levels, resulting in low sex drive, low energy, and difficulty in putting on muscle or burning fat.

Female athletes, trial lawyers, and CEOs all probably have it. Women in the gym who put on muscle or lose fat more easily than other women probably have it, too. But women who don’t have it might lack ambition. They might not want sex as often or experience much satisfaction from it. They probably find it difficult to lose fat or gain muscle.

The “it” I’m talking about is high, or at least normal, levels of testosterone. While testosterone replacement for men is big business, no one pays much attention to the role testosterone plays in women, at least not in pre-menopausal women.

Studies show that the percentage of women between 18 and 59 suffering from “sexual dysfunction” is around 50%. This dysfunction is commonly diagnosed as underlying depression, but more scientists are starting to point the finger at female testosterone deficiency. After all, testosterone plays a huge role in the physiology, psyche, and sexuality of women as well as men.

Female Testosterone: The Facts

Women just don’t manufacture much testosterone, and therein lies one of the reasons the whole issue is so misunderstood. Sure, men make 8 to 10 times more testosterone than women every day, but that doesn’t mean the average healthy man is 8 to 10 times more masculine than the average healthy woman. Nope, in women, testosterone is only a part of a complicated chemical profile that results in them being far more sensitive to its effects than men. As such, a little goes a long way.

Conversely, while women are considered to be “all estrogen,” the testosterone levels in healthy women are 10 times greater than their estrogen levels. Obviously, the hormonal picture is complicated.

About one-quarter of a woman’s testosterone production comes from her ovaries; another quarter is manufactured in her adrenal glands. The remaining half is produced in peripheral tissues from various chemical precursors produced in the ovaries and adrenals. The main precursor is androstenedione. A lot of this androstenedione is converted to estrone, a form of estrogen, but some of it is converted to testosterone.

Without proper levels of testosterone (and its precursors), women might suffer diminished energy levels and even a loss of sense of well-being, regardless of age.

Low testosterone also plays a role in weight gain and the ability to put on muscle, and it also plays a big role in libido. In fact, one of the surest signs of low female testosterone is HSDD, or Hypoactive Sexual Desire Disorder, which is characterized by “recurrent deficiency or absence of sexual thoughts and fantasies and/or desire for sexual activity causing personal distress or interpersonal difficulties.”

One of the earliest studies showing an association between female sexual desire and decreased testosterone was published in 1959, but acceptance was slow. Luckily, the association between testosterone and female sex drive is well established now.

Studies show that a woman’s testosterone levels rise during ovulation and there’s a corresponding rise in frequency of intercourse during this time. While ovulating women might not always initiate sex, they’re at least more receptive to sexual advances. Consider too that behavioral endocrinologists note that women who are ovulating often dress a little more sexily, allegedly to attract sexual partners, but it’s probably done on a subconscious level.

Unfortunately, there’s not much data on what constitutes “normal” female testosterone levels. Still, our current best guess is that a total plasma level of under 25 ng/dl in women under 50 years old is considered deficient. The trouble is, docs don’t typically measure the testosterone level of females.

Things are starting to change, though, and it’s high time as the number of women with decreased libido is now estimated to be between 10 and 15 million, and not all of them are in their forties or beyond; many are in their 20s and 30s. If true, it certainly constitutes an epidemic of low testosterone. But what caused it?

The Birth Control Pill Problem

The first birth control pill, Enovid, was developed in 1950. It liberated women sexually, but paradoxically, it also did a lot to kill the female libido, and it muted or nullified orgasms. While women were sexually free, they didn’t take much advantage of that freedom.

A side effect of the birth control pill is that it decreases ovarian production of testosterone, along with causing a tenfold increase in a chemical named steroid hormone binding globulin. SHBG “binds up” much of the remaining testosterone, making it unavailable for use. The result is a low sex drive and possibly other symptoms of low T.

The pill might even have long-lasting effects on female libido. In a study of 125 young women participating in a sexual dysfunction clinic, those who’d been off the pill for a year still had SHBG levels 7 times higher than non-users.

Roughly 11 million American women use the pill, but there are plenty of other drugs that affect testosterone levels, too. Doctors rarely mention low testosterone as a possible side effect of these drugs, especially when given to women. These drugs include anti-depressants (SSRIs), antihistamines, blood pressure medications, antibiotics, stomach and intestinal meds, and sleeping pills. (Alcohol can also reduce T levels.)

Often, women taking these drugs report delayed or absent orgasms, but many are likely suffering from some of the other repercussions of low T. But there are non-pharmaceutical causes of low T in women, too, some of which stem from a surprising source: diet.

Soy Milk and Vegetarian Diets

There are chemicals in soy milk known as isoflavones that mess with women’s (and men’s) hormones. While soy might have some beneficial effects on menopausal women, some research shows that, like birth control pills, soy elevates levels of SHBG and negatively affects testosterone levels in younger women.

Likewise, vegetarian diets, whether they contain soy or not, also affect T levels. Some of this low T might also be a result of the zinc deficiencies seen in a lot of vegetarians. Low levels of the mineral often correlate with low levels of the hormone.

Finally, simply being obese or avoiding exercise might also cause low levels. There are psychological and emotional correlates too, and simply failing to be in a caring relationship and/or suffering from a chronic lack of intimacy might be enough to tank T levels. Of course, there are plenty of medical causes too, some minor and some more severe, among them adrenal insufficiency, hypopituitarism, and premature ovarian failure.

How to Get Your Lady-Testosterone Back

The Pharmaceutical Approach

Treating low T in women in their 20s or 30s medically is controversial, but worth considering.

Surprisingly, the U.S. is way behind in the medical treatment of low T in women. Doctors in some countries can prescribe creams, patches, or subcutaneous pellets, but there are no approved meds in the U.S., so American doctors are limited to off-label testosterone preparations.

Still, there are plenty of possible avenues for women in the U.S., some relatively orthodox and some highly unorthodox. Despite their legal limitations, doctors, primarily gynecologists, can prescribe testosterone creams prepared specifically for women at a compounding pharmacy.

More progressive docs can give testosterone injections, but there are drawbacks to this route. The patient has to go to the doctor’s office for a shot every two to six weeks. Some women, too, metabolize the drug more quickly than others. That means while a shot every two to four weeks might work well for some women, others would find themselves dragging a bit, energy-wise, before they were due for their next shot as levels dropped back prematurely into the low range.

Dosages are also a bit problematic; there aren’t really any set standards. Some docs might inject 75 to 100 mg. of testosterone cypionate every four to six weeks, but other women can do well on as little as 15 mg. every two weeks. It would require some trial and error and cooperation between patient and doctor to figure out just how much was needed.

While there aren’t any approved testosterone cream products for women in the U.S., there are creams made for men that, while controversial, provide a possible course of action for low-T women. Androgel 1% is a colorless gel that contains 1% testosterone. The cream provides continuous delivery of testosterone for about 24 hours.

Now, it would be possible to use Androgel 1% to treat low T in women, if they used the 1% preparation (instead of stronger versions) and didn’t exceed 2.5 grams of cream a week. Like men, they would rub the cream into the skin, preferably the abdomen, after showering and drying. This would be something best decided after a conversation with a progressive doctor.

The Supplement Approach

Longjack (Eurycoma longifolia) works for men and women but in a different way. Researchers say the increase in female testosterone levels is caused by a significant decline in SHBG. The herb prevented the testosterone that women make naturally from being chemically bound up and made inaccessible by SHBG. Longjack is found in Biotest’s Omega-Man (Buy at Amazon) supplement. Just don’t let the name throw you.

Women also have the option of using DHEA. DHEA is a hormone secreted by the adrenals and a precursor to estrogen and testosterone. Levels peak in the 20s and start to decline every decade. Using an over-the-counter supplement, however, can quickly elevate flagging testosterone levels. One study on women between 35 and 55 reported increases in desire, arousal, lubrication, and orgasm in those who took 50 mg. of DHEA per day.

Similarly, an article in the World Journal of Urology suggested that women with low T start with 50 mg. of DHEA every morning. If, in 2-3 months, there’s no improvement, the dosage could be increased to 75 mg. or even 100 mg. a day, if needed. DHEA is no low-T panacea, though. It may not raise levels significantly, or the bulk of the chemical may be converted to estrogen instead of testosterone.

The Lifestyle Approach

Exercise, specifically weight training, raises T levels in women. The results seem to be transient; they only last a few hours. But even a transient rise in T, if repeated often, might have far-reaching effects.

Sex itself elevates T levels, but whether this rise is more pronounced in women who are in a caring relationship as opposed to those just having one-night stands isn’t known. It is known, however, that women in committed relationships often experience a rise in T.

There are also somewhat less clear psychological approaches to raising T in women. Men often experience a rise in T after winning a competition. Similarly, if men are living stress-free lives and feel good about themselves, T levels rise accordingly. Self-esteem seems to play a powerful role in T levels. These things are probably true of women, too.

Questions & Answers

If my testosterone levels are low, what benefits might I see from T replacement?

Generally, women who increase their testosterone might experience an increase in bone and muscle mass, loss of excess body fat, and an increase in sexual desire and satisfaction, along with more energy, ambition, and enjoyment of life.

Are there any dangers associated with taking prohormones or using testosterone?

If a female takes too much testosterone or its precursors, it can result in unwanted body hair growth and, in extreme circumstances (taking way too much testosterone over an extended period of time) result in a deepening of the voice, growth of the clitoris, acne, shrinking breast size, alopecia, and unwarranted anger.

Studies on women who replace their testosterone to clinical levels, however, generally don’t experience any adverse effects on lipid levels, carb metabolism, blood pressure, or cardiovascular health. Neither have there been any reported increases in breast cancer associated with T replacement.

Can taking testosterone impair fertility?

Only if T levels are raised well above normal for an extended time.

Are there any women who shouldn’t consider testosterone replacement?

Women who are pregnant or could become pregnant should refrain from using testosterone replacement. Similarly, those with high cholesterol, liver or heart disease, or breast or uterine cancer should avoid it. Regardless, any woman considering testosterone replacement or therapy should consult her physician.