What happens if a woman has low testosterone levels?

The most consistent effect linked to low testosterone in women is reduced sexual desire and arousal. Low energy, low mood, brain fog, and loss of muscle and strength are commonly blamed on it too, but research has not confirmed testosterone as the cause of those symptoms, and testosterone therapy has not been shown to fix them. Many of those complaints overlap with low estrogen, thyroid problems, poor sleep, and the normal aging of muscle.

How does a woman know if she has low testosterone?

You cannot know from symptoms alone, because the symptoms overlap with so many other things. A blood test measures total testosterone, but standard assays are unreliable at the low concentrations found in women, and there is no agreed level that defines deficiency. A doctor diagnoses based on the full picture (symptoms, other hormone levels, and ruling out other causes), not a single number.

What depletes a woman's testosterone?

Age is the main driver: testosterone declines gradually from your 20s onward, so a woman in her 40s has roughly half what she had two decades earlier. Removal of the ovaries (surgical menopause) drops it sharply. Oral estrogen, including some birth control and oral HRT, raises a protein called SHBG that lowers free testosterone. Glucocorticoid medications, opioids, and adrenal or pituitary problems can also lower it.

Can low testosterone cause weight gain in women?

Testosterone helps maintain muscle, and less muscle means a lower resting metabolism, so very low levels can make it slightly easier to gain fat and harder to hold muscle. But low testosterone is rarely the main reason women gain weight in midlife. Falling estrogen, lost muscle mass, less activity, and changing sleep play larger roles. Resistance training and adequate protein address the muscle side directly.

Can low testosterone cause hair loss in women?

It can contribute to thinning body and pubic hair. Scalp hair is more complicated: both low and high androgen activity are linked to hair changes in women, and scalp thinning in midlife is more often tied to genetics and the shift in the estrogen-to-androgen balance after menopause. If hair loss is your main concern, see a dermatologist rather than assuming testosterone is the cause.

What is considered low testosterone in women?

There is no firm cutoff. Total testosterone in adult women runs roughly 15 to 70 ng/dL depending on the lab and your age, and levels drop with age, but no specific number reliably diagnoses a deficiency syndrome. Major medical societies state plainly that there is no blood level that defines female testosterone deficiency, which is why diagnosis relies on the whole clinical picture.

Low Testosterone in Women: Signs, Symptoms, and What Helps

If you are a woman in your 40s or 50s and you have been told, or have started to suspect, that low testosterone is behind your fatigue, your flat mood, your shrinking muscles, or your missing sex drive, this is the honest version of that story. It is not the version a testosterone clinic will sell you, and it is not the version that treats one hormone as the answer to everything.

Testosterone matters for women. It is also the hormone most surrounded by overselling, bad testing, and treatments marketed well past the evidence. Here is what the symptoms actually are, what counts as low, what the research supports, and what you can do today regardless of what your bloodwork says.

The short version

Yes, women need testosterone. It circulates in your blood at higher concentrations than estrogen and supports libido, energy, muscle, bone, and mood.
The one symptom research firmly ties to low testosterone is reduced sexual desire and arousal. Fatigue, low mood, brain fog, and muscle loss are commonly blamed on it but not proven to be caused by it.
There is no blood level that defines “low” in women. Standard tests are unreliable at female concentrations, and reference ranges vary by lab.
Testosterone therapy for women is off-label in the United States. No product is FDA-approved for women. The only use backed by a global consensus is low sexual desire in postmenopausal women.
The muscle and strength loss you can actually control comes through resistance training, enough protein, and creatine, with or without a prescription.
Skip over-the-counter “testosterone boosters,” compounded pellets, and at-home saliva hormone kits.

What testosterone actually does in a woman’s body

Testosterone is not a “male hormone” that women happen to carry a little of. Across a day, women produce more testosterone than estrogen by quantity, and it is active in tissue all over the body.

Your ovaries and adrenal glands make it directly, and your body also builds it from precursor hormones like DHEA. It feeds sexual desire and arousal. It helps maintain lean muscle and bone density. It plays a role in energy and mood, though that role is harder to pin down than the marketing suggests.

Here is the part most articles skip: testosterone does not fall off a cliff at menopause the way estrogen does. It declines slowly with age, starting in your 20s. By your mid-40s you have roughly half the testosterone you had at 25. Natural menopause itself causes only a modest further change, because your ovaries keep producing some. The exception is surgical menopause. If your ovaries are removed, testosterone drops by about half almost overnight.

That timeline matters, because it means the dramatic hormone event of midlife is the estrogen drop, not a testosterone collapse. A lot of what gets blamed on low testosterone is actually low estrogen, poor sleep, an underactive thyroid, or the normal loss of muscle that comes from not training it.

Signs and symptoms of low testosterone in women

The honest symptom list is shorter than the one you will see on a clinic’s website, because most of those lists mix the one well-supported symptom in with a dozen plausible-but-unproven ones.

Signs and symptoms of low testosterone in women can include:

Lower sexual desire (the best-supported sign)
Reduced arousal and difficulty reaching orgasm
Persistent fatigue and low energy
Flat or low mood, reduced sense of wellbeing
Loss of muscle mass and strength
Thinning body or pubic hair
Brain fog and trouble concentrating
Possible loss of bone density over time

The one symptom that research consistently links to low testosterone is sexual: low desire that bothers you, a condition clinicians call hypoactive sexual desire dysfunction. The others are real complaints that women experience, but the evidence that low testosterone causes them, or that raising testosterone fixes them, is weak. We will come back to why that distinction is the most important thing on this page.

Why these symptoms are easy to misread

Fatigue, low mood, brain fog, weight gain, and disrupted sleep are also the symptoms of low estrogen, low progesterone, an underactive thyroid, iron deficiency, depression, and ordinary sleep loss. Several of these usually overlap at once in your 40s and 50s.

That overlap is exactly why you cannot diagnose low testosterone from how you feel, and why a good clinician looks at the whole picture instead of pinning everything on one number. If your main symptom is exhaustion rather than low libido, perimenopause fatigue and its more common causes deserve a look first.

What causes low testosterone in women

A few specific things lower testosterone, and knowing which applies to you changes what to do about it.

Age. The gradual, lifelong decline described above. This is the most common reason levels are lower at 50 than at 25.
Surgical menopause. Removal of both ovaries cuts production roughly in half right away. This is the clearest cause of a true, sudden drop.
Oral estrogen. Estrogen taken by mouth, including some birth control pills and oral hormone therapy, raises a carrier protein called sex hormone binding globulin (SHBG). More SHBG binds up more testosterone, leaving less of the free, active form. Switching to a transdermal (patch or gel) estrogen affects SHBG less.
Adrenal or pituitary problems. Conditions like adrenal insufficiency or hypopituitarism reduce the hormones your body uses to make testosterone.
Certain medications. Long-term glucocorticoids (such as prednisone) and opioids can suppress it.

If none of those apply to you, your testosterone is probably doing what it does in most women your age: declining slowly and predictably, which is not the same as a deficiency that needs treatment.

What counts as “low”? Testing and the numbers

This is where the testing gets honest and a little uncomfortable.

A blood test can measure total testosterone, and in adult women it typically runs somewhere around 15 to 70 ng/dL, varying by lab and by age. But two problems make a single number nearly useless on its own.

First, the standard assays most labs use were built and validated for the much higher concentrations found in men. At the low levels normal for women, they are imprecise. Second, and more important, major medical societies state outright that there is no blood testosterone level that defines deficiency in women. Cleveland Clinic, whose overview of low testosterone in women is one of the most-read on the topic, makes the same point: there is no agreed threshold.

Total versus free testosterone

Most of your testosterone is bound to SHBG and albumin and is not available to tissues. The fraction that is unbound, called free testosterone, is the active part. Because SHBG changes with estrogen, thyroid status, and insulin, two women with identical total testosterone can have very different free testosterone. A thorough workup looks at both, often alongside SHBG, rather than a single total reading.

The practical takeaway: a testosterone test is one input a clinician weighs against your symptoms and your other hormones. It is not a verdict. Be skeptical of any provider who hands you a number and an immediate prescription.

Treatment: what the evidence actually supports

Here is the section the supplement ads and the optimization clinics would prefer you skip.

In 2019, an international panel of medical societies published a Global Consensus Position Statement on testosterone therapy for women. After reviewing the full body of evidence, they reached a narrow conclusion: the only use of testosterone in women supported by quality data is treating hypoactive sexual desire dysfunction in postmenopausal women. For every other proposed use, including fatigue, mood, cognition, bone density, and general wellbeing, the panel found the evidence does not support it.

The companion systematic review and meta-analysis in The Lancet Diabetes and Endocrinology reached the same place from the data side. Testosterone improved sexual function (desire, arousal, orgasm, and satisfaction) in postmenopausal women. It did not produce reliable benefits for mood, energy, bone, or thinking. Side effects at proper doses were mild, mainly acne and a little extra hair growth, and non-oral routes did not worsen cholesterol the way oral testosterone did.

Testosterone therapy, the honest version

If you and your doctor decide low sexual desire warrants a trial of testosterone, a few facts shape what that looks like in the United States:

No testosterone product is FDA-approved for women. Clinicians prescribe a small fraction of a men’s formulation off-label, typically about a tenth of a male dose, usually as a transdermal cream or gel.
The target is the normal premenopausal range, not “high.” The goal is to restore physiologic levels, not exceed them. Blood levels are monitored so you do not drift into the supraphysiologic range, where side effects climb.
It is for desire, not for everything else. Going on testosterone hoping to fix fatigue or body composition is treating the wrong target with the wrong tool.

This is genuinely a decision to make with a doctor, ideally a certified menopause practitioner who treats women’s hormones for a living, not a walk-in testosterone clinic whose business model is the prescription.

DHEA and the supplement question

DHEA is a precursor hormone your body can convert to testosterone, and it is sold over the counter, which makes it sound like an easy fix. The evidence that systemic DHEA supplements improve low-testosterone symptoms in healthy women is weak and inconsistent, and the consensus panel did not endorse it for this purpose. (Vaginal DHEA is a separate, prescription product approved for painful sex, not a systemic testosterone treatment.) Treat over-the-counter DHEA as unproven, and tell your doctor if you are taking it, because it is still a hormone.

What you can do without a prescription

Whether or not you ever pursue testosterone therapy, one of the symptoms attributed to low testosterone is squarely in your control: the loss of muscle and strength. Testosterone supports muscle, but it is not the only lever, and it is not even the biggest one you can pull yourself.

Muscle responds to training and protein at every age. This is the part the medical pages list as a symptom and then never tell you how to address.

Lift, progressively. Resistance training two to four times a week, adding weight or reps over time, builds and preserves muscle in women through their 50s, 60s, and beyond. If you are new to it, strength training for women over 40 is the place to start.
Eat enough protein. Most women in midlife eat far less than they need to hold muscle. Aim for roughly 0.7 to 1 gram per pound of body weight per day, spread across meals. Protein for women over 50 walks through the math and the practical ways to hit it.
Consider creatine. Creatine is one of the few supplements with strong evidence for strength and lean mass, including in older women, at a simple 3 to 5 grams a day. The details are in our guide to creatine for women.

None of this requires a hormone level or a prescription. It addresses the muscle-loss symptom directly, and it is worth doing even if your testosterone is perfectly normal.

What to skip

Over-the-counter “testosterone boosters.” These are formulated and marketed to men, and there is no evidence the herbal blends inside raise testosterone in women or improve any symptom. You are buying a label.
Compounded testosterone pellets. The consensus statement specifically warns against compounded testosterone because the dosing is unpredictable and pellets often push levels well above the normal female range, which is exactly where side effects like acne, unwanted hair, and voice changes appear.
At-home saliva and “hormone panel” test kits. Saliva testing is unreliable for the low testosterone concentrations in women, and a number from a mail-in kit cannot diagnose anything. Spend the money on a real workup if you have real symptoms.
A clinic that treats fatigue or weight gain with testosterone. If your main complaint is not low sexual desire and a provider is reaching for testosterone anyway, they are prescribing past the evidence. The muscle aches and tiredness of midlife usually trace to other causes worth ruling out first.

When to see a doctor

See a clinician if low sexual desire is genuinely bothering you, if you had your ovaries removed and feel the effects, or if symptoms like deep fatigue and low mood are interfering with your life and you want them properly worked up rather than guessed at. Ask for a full picture: testosterone with SHBG, plus estrogen, thyroid, and iron, so you are treating the right thing. A certified menopause practitioner is the right kind of specialist for this conversation, and the right person to tell you when testosterone is not the answer.

The bottom line

Low testosterone in women is real, but it is narrower and harder to pin down than the clinics selling treatment let on. The one symptom the evidence supports treating is low sexual desire, and even then the therapy is off-label, modestly dosed, and best managed by a specialist. For the fatigue, the mood, and especially the muscle loss, the highest-yield moves are the ones you control: lift, eat enough protein, and stay skeptical of anyone selling a hormone as the fix for everything. You leave here knowing which symptom is worth a doctor’s visit, which number to distrust, and exactly what to do this week that does not require a prescription.