Women produce testosterone in the ovaries and adrenal glands, and it circulates at approximately 5-10% of the concentration found in men. This smaller amount is still biologically significant: testosterone contributes to libido, energy, muscle maintenance, bone density, and mood in women. When female testosterone falls below adequate levels, a condition that becomes more common after menopause and in women on hormonal contraceptives, symptoms can be significant and are frequently attributed to other causes.

Normal Ranges in Women

Reference ranges for female total testosterone vary by laboratory and assay method, but typical ranges:

  • Total testosterone: 15-70 ng/dL (premenopausal)
  • Free testosterone: 1-3 ng/dL

Female testosterone levels fluctuate across the menstrual cycle, peaking around ovulation. They also decline with age, falling by approximately 50% between a woman’s 20s and 40s, and fall more abruptly at menopause as ovarian production declines.

Women on combined oral contraceptives typically have lower total and free testosterone than those not on hormonal contraceptives, because the synthetic progestins and estrogens raise SHBG, binding more testosterone and reducing the free fraction.

What Low Testosterone in Women Produces

The clinical picture of low testosterone in women is less well-characterized than in men, partly because there is no FDA-approved testosterone product for women in the United States, and partly because the diagnostic criteria are less standardized.

Symptoms associated with low testosterone in women in published literature:

  • Hypoactive sexual desire disorder (HSDD): Reduced interest in sex without a clear relationship or psychological cause. This is the most consistently studied association. Multiple randomized trials show that testosterone therapy improves sexual desire in women with documented low levels.
  • Fatigue and reduced energy
  • Difficulty building or maintaining muscle mass despite exercise
  • Low mood and reduced sense of wellbeing
  • Reduced bone density (testosterone contributes to bone maintenance in women as in men)

The challenge clinically is that these symptoms overlap substantially with estrogen deficiency, thyroid dysfunction, depression, and iron deficiency, all of which need to be ruled out before attributing symptoms to low testosterone specifically.

Hypoactive Sexual Desire Disorder: The Strongest Evidence

The relationship between testosterone and female sexual desire is the area with the most clinical trial evidence. A 2019 position statement from the International Society for Sexual Medicine reviewed the evidence and concluded that testosterone therapy is effective for HSDD in postmenopausal women. Multiple randomized trials show statistically meaningful improvements in sexual desire, arousal, and satisfaction with testosterone treatment.

The same statement noted that testosterone therapy for premenopausal women with HSDD has less trial evidence, though clinical use exists.

Why No Approved Testosterone Product for Women Exists

Despite the evidence base and despite testosterone being used off-label for women for decades, no testosterone product is FDA-approved specifically for women in the United States. Proposed products have failed regulatory approval primarily because of insufficient long-term cardiovascular and breast cancer safety data at the doses used in women, not because efficacy is disputed.

Women prescribed testosterone are typically using compounded preparations or male-formulated products at fractions of the labeled dose. Compounded testosterone creams, gels, and pellets are the most common forms.

Natural Decline With Age and Hormonal Contraceptives

The 50% decline in testosterone from the 20s to the 40s is gradual and largely unnoticed for most women. The post-menopausal decline is more abrupt, as the ovaries, which produce approximately 25% of female testosterone, stop functioning.

Combined oral contraceptives raise SHBG substantially, sometimes threefold above baseline, which reduces free testosterone even when total testosterone appears normal. Women who develop reduced libido or other low-testosterone symptoms after starting a combined oral contraceptive may be experiencing this effect. Switching to a progestin-only pill, an IUD, or non-hormonal contraception sometimes resolves the symptoms.

For more on hormonal changes at menopause that affect testosterone and other sex hormones, see Perimenopause Symptoms: What Changes, When, and Why. For the PCOS-related context where testosterone is often elevated in women, see PCOS and Hormones: What the Research Shows.