Testosterone is not just a hormone for men. Optimized levels are important for a sense of well-being, energy, maintaining muscle mass, supporting healthy body composition, reproductive function, and libido in both sexes. In women, testosterone is secreted by both the ovaries and the adrenal glands.
A functional medicine approach to low female testosterone focuses on addressing potential underlying factors rather than just managing symptoms. This article will discuss low testosterone in females and its possible causes, review some functional medicine labs that can be useful, and explore options that may help support healthy testosterone levels.
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Low Female Testosterone Signs & Symptoms
Low testosterone levels are associated with persistent unexplained fatigue, a decreased sense of personal well-being, and low libido in women. Additional symptoms may include muscle weakness, low mood, and changes in body composition. Additionally, low levels have been linked to the following:
- Bone health concerns
- Muscle changes
- Weight management challenges
- Mood changes
- Heart health
- Breast health
Low Female Testosterone Possible Causes
The following are possible factors that may contribute to low testosterone in women:
Age
In women, androgen levels decline by 50% from the early 20s to the mid-40s. Age-related changes in androgen levels commonly occur in women in their late 30s and 40s and post-menopausally.
Ovary Removal
In healthy women, the primary hormones produced by the ovaries are estrogens and progesterone, but they also produce testosterone both before and after menopause. When women undergo bilateral oophorectomy (removal of ovaries), their serum testosterone levels may decrease significantly.
Medications
Birth Control Pills
Approximately one out of four sexually active women in the United States uses some form of hormonal contraceptive method. Birth control pills may influence testosterone levels by raising sex hormone binding globulin (SHBG), a protein that binds to sex hormones in the body and controls the amount in circulation. A systematic literature review of 42 studies suggests that oral contraceptives may decrease circulating levels of total T and free T and increase SHBG concentrations.
Statins
In a meta-analysis of 29 studies, statins in their cholesterol-lowering function were shown to influence testosterone levels in both men and women.
Other Meds
Additionally, medications such as ketoconazole have been demonstrated to affect testosterone levels.
High Sugar Diet
Processed sugar can influence genes responsible for regulating testosterone and estrogen in men and women, potentially leading to imbalances in these essential sex hormones.
How does this happen? When we consume high amounts of processed sugar, the liver is forced to convert it into lipids. Increased lipid production may reduce the amount of SHBG (sex hormone-binding globulin) protein in the blood.
SHBG plays a crucial role in controlling the amount of testosterone and estrogen available throughout the body. Therefore, high levels of sugar may be associated with lower levels of SHBG, potentially affecting the regulation of estrogen and testosterone.
Endocrine Disruptors Chemicals (EDC)
EDCs are chemicals that can disrupt the endocrine balance of the human body. These chemicals may influence steroid hormone synthesis by interfering with natural hormone production. Moreover, EDCs, especially in pesticides, can affect the concentration of hormones by influencing their synthesis, transport, metabolism, and elimination.
Chronic Stress
A study done by The University of Texas at Austin suggests that cortisol and testosterone may work against each other to regulate certain behaviors. This means when cortisol is high, testosterone may decrease.
Low Vitamin D
Vitamin D deficiency is very common in women of reproductive age. Several studies have explored the relationship between lower vitamin D levels and sex steroid synthesis. In these studies, total and free 25(OH)D were inversely correlated with total testosterone and positively correlated with SHBG in reproductive-age women.
Functional Medicine Labs to Test for Low Female Testosterone
Testosterone
Serum Testosterone, both total and free, can provide insights into androgen levels. While testosterone levels can be measured on any day of the month, the timing of the test is important. Testosterone is often measured in the morning because that is when levels are typically highest.
Sex Hormone Binding Globulin (SHBG)
SHBG is a protein primarily produced in the liver that binds to sex hormones testosterone and estrogen throughout the body and controls the amount in circulation. If SHBG levels are high, fewer sex hormones may be available.
DHEAS
Dehydroepiandrosterone sulfate (DHEA-S) is produced by the adrenals and may help balance cortisol levels and convert into testosterone if levels are low.
Estradiol
Testosterone’s action in target tissues can be mediated through the androgen receptor or the estrogen receptor after aromatization to estradiol. Serum Estradiol can be used to evaluate women with symptoms that may be associated with estradiol levels, which can include changes in libido or body composition.
Adrenal/Sex Hormone Testing
The DUTCH Complete™ uses dried urine samples to evaluate sex hormones, adrenal hormones, cortisol, and melatonin, which can be useful when evaluating energy patterns. The test allows for the examination of testosterone metabolism.
Note: There is a very common genetic variant in Asian women that affects the conversion of testosterone into the water-soluble form found in urine. This variant metabolism has no known clinical impact (it is neither good nor bad but simply makes urine testosterone appear lower than it would otherwise be.) If this genetic variant is present, it may be better to test testosterone in blood serum (ideally total and free testosterone).
Gut Microbiome
A well-functioning gut is important for overall health and to help maintain hormone balance. The link between gut health and estrogen demonstrates that one of the principal regulators of circulating estrogens is the gut microbiome. Similarly, the connection between testosterone and the gut microbiome has also been explored in identifying bacteria with the potential to influence androgen levels.
Vitamin D
Vitamin D levels are associated with sex hormones, and Vitamin D is linked to several health concerns, including bone health, heart health, and immune function.
Functional Medicine Approaches for Supporting Healthy Female Testosterone Levels
Hormone Therapy
Although evidence supports the potential benefits of topical testosterone in supporting libido, well-being, and mood, several roadblocks have prevented the FDA approval of a testosterone formulation for women.
Inclusion of testosterone in hormone replacement therapy is becoming more widespread, but many physicians are improvising by prescribing either compounded testosterone or modified doses of approved male testosterone formulations.
Short-term clinical trials suggest that low-dose testosterone therapy in women appears to be effective, safe, and economical. Long-term side effects may include hirsutism, acne, and changes in body composition.
DHEA
DHEA is available as an over-the-counter supplement in the United States. It is used to support testosterone levels with the idea that if the precursor hormone is provided, it may allow the body to convert it to testosterone. However, it’s important to discuss all the pros and cons with your provider and develop a comprehensive plan that suits your needs.
Exercise
While controversy exists regarding testosterone hormone therapy, lifestyle interventions such as exercise and nutrition can support healthy testosterone levels. Research indicates that exercise affects women’s hormonal health differently compared to men. One study noted that endurance and resistance exercise may influence testosterone, estradiol, and growth hormone compared to a control group.
It’s important to note that when it comes to exercise for women, moderation is key—frequent or prolonged intense exercise can affect hormonal balance and may impact a woman’s menstrual cycle.
Balanced Diet
Estrogen, progesterone, and testosterone are all made from dietary cholesterol, a dietary fat. If you don’t absorb fat well or eat enough healthy fat in your diet, making the proper amount of hormones may be challenging.
Zinc
A 2021 study aimed to investigate the effect of zinc supplementation on testosterone levels and sexual function in postmenopausal women. Zinc supplementation in the intervention group resulted in a significant increase in testosterone levels compared to the control group.
Vitamin D
A 2021 study demonstrates the importance of vitamin D metabolites related to hormonal regulation in postmenopausal women.
Summary
Management of low female testosterone is complex and lends itself to a functional medicine approach. Because the symptoms of a testosterone deficiency could resemble those of other conditions, misdiagnosis and lack of treatment are very common.
Improved awareness of the symptoms, conclusive reference ranges for evaluation, and appropriate available options are needed.
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