Testosterone deficiency in women: symptoms & causes

Testosterone is considered a male hormone, but it also plays an important role in women's energy, libido, muscle mass, and mood. A deficiency often goes undiagnosed because the symptoms are diffuse and rarely directly associated with testosterone. This article explains how to recognize a testosterone deficiency, what causes it, and what really helps.

Key takeaways

Women produce testosterone in the ovaries and adrenal cortex; approximately 0.1 to 0.4 ng/ml of total testosterone is considered normal.
Typical symptoms: persistent fatigue, loss of libido, muscle loss, depressive mood, concentration problems, and dry skin.
Most common causes: menopause, birth control pills, chronic stress, hypopituitarism, and PCOS after discontinuing the pill.
Diagnosis requires more than just total testosterone: Free testosterone, SHBG, and DHEA-S together provide the complete picture.
Natural approaches: Zinc, strength training, sleep, and stress reduction can measurably support testosterone levels.

Fatigue, loss of libido, the feeling of no longer being fully in tune with one’s body: Testosterone deficiency in women often goes undiagnosed for years because the symptoms are diffuse and no one thinks of it. Yet it affects women of all age groups, not just during menopause.

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Energy

Persistent fatigue, lack of drive despite sufficient sleep

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Libido

Lack of sexual interest, reduced arousal

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Body

Muscle loss, weight gain despite unchanged diet

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Mood

Depressive mood, concentration problems, irritability

What is testosterone in women and why do we need it?

Testosterone is not strictly a male hormone. Women produce it in the ovaries and the adrenal cortex, in significantly smaller amounts than men. It influences energy, libido, muscle mass, bone density, mood, and cognitive function. A level that is too low is measurable and treatable.

The normal total testosterone range for women is between 0.1 and 0.8 ng/ml, depending on the laboratory, with levels fluctuating throughout the day and the cycle. However, the deciding factor is not just the total testosterone, but the free testosterone, i.e., the portion that is actually biologically active. The rest is bound to SHBG (sex hormone-binding globulin) and is therefore inactive. A high SHBG level can lead to a functional deficiency despite normal total testosterone.

Symptoms: How testosterone deficiency manifests in women

The symptoms are often nonspecific and are frequently attributed to stress, exhaustion, or depression. This makes diagnosis difficult. This combination should be a red flag:

Symptom area	Typical complaints	Frequency
Energy & Drive	Chronic fatigue, lack of motivation, exhaustion after minor exertion	Very common
Sexuality	Loss of libido, reduced arousal, difficulty reaching orgasm	Very common
Body composition	Muscle loss, difficulty building muscle, weight gain especially around the abdomen	Common
Psyche & Cognition	Depressive mood, irritability, concentration problems, brain fog	Common
Skin & Hair	Dry skin, brittle nails, thinning pubic hair	Less common
Bones	Increased long-term risk of osteoporosis, joint and muscle pain	Long-term

Diagnosis: Which blood values are truly relevant

A single testosterone value is not enough. For a meaningful assessment, you need free testosterone, SHBG, and ideally DHEA-S — together, they provide a complete picture of the androgen situation.

Marker	Reference range woman	Why relevant
Total testosterone	0.1 to 0.8 ng/ml	Starting point, but of little significance on its own
Free testosterone	0.3 to 1.9 pg/ml (lab-dependent)	The biologically active portion, the most important value
SHBG	20 to 130 nmol/l	High when on the pill: binds up testosterone
DHEA-S	65 to 380 µg/dl	Shows adrenal function, precursor to testosterone
LH / FSH	Cycle-dependent	Shows whether ovaries are being stimulated

Important: Blood should ideally be drawn in the morning between 8 and 10 a.m., as testosterone reaches its daily low in the afternoon. For women with a cycle, measure as early as possible in the follicular phase (cycle days 2 to 5).

The most common causes of testosterone deficiency in women

Menopause and perimenopause

Testosterone production declines continuously from the age of 30. With the onset of perimenopause and the decline in ovarian function, testosterone levels can drop to a third of what they were in youth. This is the most common cause and is often overlooked due to the dominant discussion surrounding estrogen.

Combination pill and high SHBG

The pill increases the liver's production of SHBG three- to fourfold. This binds up free testosterone and leads to a functional deficiency. The problem: SHBG can remain elevated even months after stopping the pill, known as the post-pill SHBG phenomenon. Read more about this in the guide to stopping the pill.

Chronic stress and cortisol excess

Cortisol and testosterone compete for the same precursor: pregnenolone. During periods of prolonged high stress, pregnenolone is preferentially converted to cortisol, and testosterone production drops. This mechanism is sometimes referred to as "pregnenolone steal," even though the term is a simplification.

Hypopituitarism and adrenal insufficiency

If the pituitary gland or adrenal glands do not stimulate or produce enough, testosterone levels fall. This is rarer but clinically important to rule out, especially if LH and FSH levels are also low.

Underweight, restrictive dieting, and overtraining

The body requires sufficient calories and fat for hormone production. Insufficient energy, too little fat in the diet, or too much training without adequate recovery can inhibit testosterone production. This is more common than one might think, especially among competitive athletes.

Did you know?

While women have only about one-tenth as much testosterone as men, their receptors are more sensitive to it. Even small changes in free testosterone can have noticeable effects on energy, libido, and body composition. This makes the interpretation of laboratory values in women particularly complex.

What can naturally help with testosterone deficiency

Natural approaches to supporting testosterone levels are limited, but the best-researched ones work through the same mechanism: insulin sensitivity, stress reduction, and micronutrient supply.

Strength training is the strongest natural stimulus. Several studies show that resistance training acutely increases testosterone production in women and supports muscle maintenance long-term. At least 2 to 3 sessions per week with sufficient intensity are recommended.

Zinc is an essential cofactor for several enzymes in testosterone synthesis. Prasad et al. (1996) showed a direct correlation between zinc deficiency and low testosterone levels in healthy adults. Sources of zinc include pumpkin seeds, beef, legumes, and nuts.

Sleep is non-negotiable. Testosterone is primarily produced at night, especially during deep sleep phases. Chronic sleep deprivation of less than 6 hours measurably lowers testosterone levels.

Stress management works via cortisol-testosterone antagonism. Chronically high cortisol levels directly inhibit testosterone production. Breathing exercises, meditation, and targeted recovery phases help not through mystical effects but through a measurable influence on cortisol levels.

Vitamin D has receptors in Leydig cells and is involved in testosterone synthesis. A deficiency, which is very common in Germany and Austria, is associated with lower testosterone levels.

What doesn't work: specific testosterone booster supplements without evidence, short-term detox cures, caffeine excesses, or excessive cardio without sufficient recovery.

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When is medical treatment advisable?

If lab results clearly show low free testosterone levels and symptoms significantly impair quality of life, there are medical options.

Testosterone therapy for women is not officially approved for testosterone deficiency in Germany but is used off-label, particularly for persistent loss of libido after menopause. The International Menopause Society and EMAS recommend testosterone as a supplementary component to estrogen therapy in postmenopausal women with clinically relevant sexual dysfunction.

For pill-induced testosterone deficiency, discontinuing the pill is often the first step. However, this should never be done abruptly without alternative contraception and always in consultation with a gynecologist.

In cases of low DHEA-S, oral DHEA can provide the precursor from which the body can produce both estrogen and testosterone. Evidence is mixed, but for postmenopausal women, there are indications of positive effects on libido and well-being.

Important: Even a low testosterone level does not necessarily require treatment if no symptoms are present. The decision always rests with a medical professional.

Suspecting low testosterone?

Testosterone is rarely measured routinely in women, and the reference range alone says little about whether your level correlates with your symptoms. In a free initial consultation, a licensed physician will assess whether testing is worthwhile for you and what else might be causing your symptoms.

Free initial consultation

Summary of the most important points

Testosterone is an important hormone in women for energy, libido, muscle mass, mood, and bone density.
A deficiency is primarily indicated by chronic fatigue, loss of libido, muscle wasting, and depressive mood, symptoms often not associated with testosterone.
For diagnosis, free testosterone and SHBG are needed, not just total testosterone.
The most common causes are menopause, the pill, chronic stress, and restrictive diets.
Strength training, zinc, sleep, and stress reduction can naturally support levels. For clinically relevant deficiency, medical options are available.

Frequently Asked Questions about Testosterone Deficiency in Women

What are typical signs of low testosterone in women?

The most common signs are persistent fatigue despite sufficient sleep, loss of libido, difficulty building muscle, depressive moods, concentration problems, and dry skin or hair. Since these symptoms are non-specific, testosterone deficiency is often only diagnosed late. A determination of free testosterone and SHBG in the blood is necessary for a reliable diagnosis.

How is testosterone deficiency diagnosed in women?

Not only total testosterone, but especially free testosterone and SHBG are important. Since SHBG binds and inactivates testosterone, a high SHBG value can lead to a functional deficiency despite normal total testosterone. In addition, DHEA-S should be determined to assess adrenal production. A single value is often not sufficient, as testosterone fluctuates throughout the day.

Kann man Testosteron bei Frauen natürlich erhöhen?

Ja, in moderatem Umfang. Krafttraining ist der stärkste natürliche Stimulus für die Testosteronproduktion. Zink ist ein essenzieller Kofaktor der Testosteronsynthese und in Studien mit niedrigeren Testosteronspiegeln bei Mangel assoziiert. Schlaf ist entscheidend, da Testosteron hauptsächlich nachts produziert wird. Chronischer Stress erhöht Cortisol, das die Testosteronproduktion direkt hemmt. Diese Ansätze können helfen, sind aber kein Ersatz für medizinische Behandlung bei klinisch relevantem Mangel.

Macht die Pille Testosteronmangel schlimmer?

Ja, die kombinierte Pille erhöht SHBG deutlich, was die Menge an freiem aktivem Testosteron reduziert. Studien zeigen, dass SHBG unter der Pille um das Drei- bis Vierfache ansteigen kann. Das kann Libidoverlust, Müdigkeit und Stimmungsveränderungen verursachen. Problematisch ist, dass SHBG auch nach dem Absetzen der Pille für Monate erhöht bleiben kann, also sogenanntes Post-Pill-SHBG-Phänomen. Wer nach dem Absetzen weiter Symptome hat, sollte freies Testosteron und SHBG bestimmen lassen.

Ist Testosteron bei Frauen in den Wechseljahren relevant?

Sehr relevant. Mit dem Eintritt in die Perimenopause sinken Östrogen und Testosteron parallel. Da Testosteron die Knochendichte, Muskelmasse, kognitive Funktion und das sexuelle Wohlbefinden mitbestimmt, kann ein Testosteronmangel in den Wechseljahren diese Übergangsphase deutlich erschweren. Die internationale Menopausengesellschaft betrachtet Testosteron zunehmend als Teil einer vollständigen Hormontherapie, besonders bei persistierendem Libidoverlust.

Scientific Sources

Davis SR, Wahlin-Jacobsen S. Testosterone in women: the clinical significance. Lancet Diabetes Endocrinol, 2015;3(12):980-992.
Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: a reappraisal. J Clin Endocrinol Metab, 2014;99(10):3489-3510.
Panay N, Anderson RA, Nappi RE, et al. Testosterone therapy in women: an Endocrine Society position statement. J Clin Endocrinol Metab, 2019;104(10):4660-4666.
Goldstat R, Briganti E, Tran J, Wolfe R, Davis SR. Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women. Menopause, 2003;10(5):390-398.
Worboys S, Kotsopoulos D, Teede H, McGrath B, Davis SR. Evidence that parenteral testosterone therapy may improve endurance capacity in postmenopausal women. J Clin Endocrinol Metab, 2001;86(10):4829-4835.
Simon JA, Braunstein GD, Nachtigall L, et al. Testosterone patch increases sexual activity and desire in surgically menopausal women with hypoactive sexual desire disorder. J Clin Endocrinol Metab, 2005;90(9):5226-5233.
Fooladi E, Bell RJ, Jane F, Robinson PJ, Kulkarni J, Davis SR. Testosterone improves antidepressant-emergent loss of libido in women. J Sex Med, 2014;11(3):831-839.
Somboonporn W, Davis S, Seif MW, Bell R. Testosterone for peri- and postmenopausal women. Cochrane Database Syst Rev, 2005;(4):CD004509.
Burger HG, Hailes J, Menelaus M, Nelson J, Hudson B, Balazs N. The management of persistent menopausal symptoms with oestradiol-testosterone implants. Maturitas, 1984;6(4):351-358.
Traish AM, Vignozzi L, Simon JA, Goldstein I, Kim NN. Role of androgens in female genitourinary tissue structure and function. J Sex Med, 2018;15(3):322-344.
Hamalainen E, Adlercreutz H, Puska P, Pietinen P. Diet and serum sex hormones in healthy men. J Steroid Biochem, 1984;20(1):459-464.
Prasad AS, Mantzoros CS, Beck FW, Hess JW, Brewer GJ. Zinc status and serum testosterone levels of healthy adults. Nutrition, 1996;12(5):344-348.

About the Author

Lee Paulina Pape

Founder · MSc Psychology · Hormonic

Lee is a psychologist (MSc) and co-founder of Hormonic. As CEO, she makes women's hormonal health understandable and accessible.

This article is based on current scientific work (as of 2026). It is for informational purposes only and does not replace professional medical advice, diagnosis, or treatment.

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