Hormonal balance is crucial for women's health, with testosterone and estrogen playing key roles in reproductive health, bone density, brain function, cardiovascular health, mood, and sexual function.
Understanding the impact of testosterone and estrogen on various aspects of health can help women recognize and manage symptoms of hormonal imbalances, promoting overall well-being and improving quality of life. This article explores normal levels of these hormones in women and the factors influencing these levels.
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The Role of Testosterone and Estrogen in Women
Testosterone is a sex steroid that is produced primarily by the ovaries and partly by the conversion of pre-androgens synthesized in both the ovaries and adrenal glands (22). It is a precursor to estrogen, but increasing evidence points to other benefits as well:
- Sexual function: Healthy levels of testosterone are associated with greater libido, arousal, and sexual desire (22).
- Vaginal health: Testosterone therapy has been shown to improve vaginal tissue, increase lubrication, and decrease pain during intercourse (22).
- Cardiovascular health: Studies have indicated that low testosterone is correlated with increased risk for cardiovascular disease in women. Healthy testosterone levels appear to positively affect blood vessel tone and function (22).
- Cognition: Testosterone has anti-inflammatory actions in the brain and helps to enhance verbal learning and memory (22).
- Musculoskeletal effects: Testosterone is positively correlated with bone mineral density in both the hip and the spine. It also is associated with greater lean body mass and muscle strength (22).
Estrogen is a sex hormone essential to women’s reproductive health. It is primarily produced in the ovaries and other gonadal organs, such as the placenta and corpus luteum. It is a vital hormone that affects many different body functions, including:
- Puberty: Estrogen is responsible for the development of breast tissue and mammary ducts during puberty (24).
- Reproductive health: Estrogen levels rise during the follicular phase of the menstrual cycle to help grow and prepare the uterine lining for a potential pregnancy (24).
- Bone health: Estrogen helps maintain bone homeostasis, preventing excess bone breakdown and loss (24).
- Brain function: Estrogen protects against neuronal damage and enhances neuroplasticity (20).
- Cardiovascular health: Estrogen helps to promote cholesterol balance by increasing beneficial HDL levels while decreasing levels of potentially harmful LDL (24).
- Vaginal/vulvar health: Estrogen enhances mucosal health within the vaginal and vulvar tissues (24).
Normal Levels of Testosterone and Estrogen
Understanding Testosterone in Women
Testosterone production starts ramping up between the ages of 6 and 8 years due to increased production of dehydroepiandrosterone (DHEA), one of the pre-androgens that converts to testosterone. During the menstrual cycle, testosterone levels are highest mid-cycle and stay elevated for the remainder of the luteal phase. Peak concentrations are achieved in women in their 30s and start to decline thereafter, with 60% loss occurring by menopause (5).
Normal ranges of testosterone for a 30-year-old woman are as follows:
Total testosterone: 15-46 ng/dL
Free testosterone: 1.2-6.4 pg/mL
Bioavailable testosterone: 1.12-7.62 ng/dL
Reference ranges in later years, and post-menopause are not established but are likely to be lower due to the natural decline in androgens with age.
Understanding Estrogen in Women
Estrogen exists in three major forms:
- Estradiol: the most potent and abundant form of estrogen in most premenopausal women. It plays a major role in fertility and menstrual cycle function. Its levels fluctuate during the menstrual cycle, with peak levels occurring during the follicular phase (20). Normal serum levels are: some text
- Follicular phase: 12.5-166 pg/mL
- Ovulation phase: 85.8-498 pg/mL
- Luteal phase: 43.8-211 pg/mL
- Postmenopause: 0-54.7 pg/mL
- Estrone: the next most potent form of estrogen, estrone can be produced by the adrenal glands and fat cells and so becomes more dominant during and after menopause when ovarian production of estrogen declines (20).
Normal serum ranges are:
- Premenopausal adult: 27-231 pg/mL
- Follicular phase: 19-149 pg/mL
- Ovulation phase: 32-176 pg/mL
- Luteal phase: 37-200 pg/mL
- Postmenopause: 0-125 pg/mL
- Estriol: the least potent form of estrogen, estriol levels increase during pregnancy to prepare the body for labor and breastfeeding (20). Estriol levels fluctuate during pregnancy but generally, in non-pregnant women, are < 0.22 ng/mL.
Factors Affecting Hormonal Balance
Causes of Fluctuations in Testosterone
There are many conditions that may cause testosterone levels to become imbalanced. These include:
- Age: testosterone declines naturally with age, starting after the age of 30. This appears unrelated to menopause (22).
- Anovulation: lack of ovulation from conditions such as primary ovarian insufficiency can lead to lower levels of testosterone (22).
- Adrenal insufficiency: low adrenal production of DHEA and other pre-androgens can lead to lower levels of testosterone (22).
- Polycystic ovarian syndrome: PCOS often leads to increased levels of androgen production including testosterone (45).
Causes of Fluctuations in Estrogen
Estrogen levels are affected by natural rhythms as well as external causes, including:
- Menstrual cycle phase: Estradiol increases naturally during the follicular phase of the cycle and is at its lowest at the end of the luteal phase.
- Low progesterone: When progesterone is insufficient, it is unable to oppose estrogen leading to overall higher estrogen levels.
- Perimenopause: Estrogen levels can fluctuate significantly during the time leading up to menopause, with periods of both high and low estrogen levels.
- Menopause: As ovarian production of estrogen declines and eventually ceases, estradiol levels drop dramatically.
- Weight changes: Underweight status can lead to low estrogen levels, while overweight status can lead to higher levels.
- Xenoestrogens: Certain chemicals can act like estrogen mimics increasing estrogen levels in the body.
Symptoms of Imbalanced Hormone Levels
When Are Testosterone Levels Not Normal?
Symptoms of high testosterone include:
- Irregular periods
- Ovarian cysts
- Acne and oily skin
- Hair growth on face, chest, and abdomen
- Fertility issues
- Weight gain
- Irritability and mood swings
Symptoms of low testosterone include:
- Low libido
- Difficulty gaining muscle
- Fatigue
- Brain fog and poor concentration
- Fertility issues
- Depressed mood
When Are Estrogen Levels Not Normal?
Symptoms of high estrogen include:
- Irregular periods
- Premenstrual syndrome
- Weight gain
- Low libido
- Sleep issues
- Headaches
Symptoms of low estrogen include:
- Irregular periods or loss of period
- Insomnia
- Vaginal dryness
- Low libido
- Osteoporosis
- Brain fog, impaired memory
- Hot flashes
- Fatigue
Managing and Treating Hormonal Imbalances
Lifestyle Changes and Natural Remedies
- Low-inflammatory and nutrient-rich diets: Diets such as the Mediterranean Diet focus on the intake of nutritious foods high in vitamins, minerals, healthy fats, and proteins that are essential to healthy hormone production and balance.
- High fiber intake: Fiber helps to foster a healthy gut microbiome, which influences hormone levels and excretes excess estrogen and testosterone metabolites.
- Exercise: daily moderate exercise can help improve estrogen and testosterone levels.
- Sleep: healthy sleep hygiene can help restore natural circadian rhythms that support hormone balance.
- Supplements and herbs: Specific supplements and herbal remedies may help restore healthy hormone levels. For example, phytoestrogens such as black cohosh and red clover can help bolster low estrogen levels, while 3,3'-diindolylmethane (DIM) can help lower excess estrogen levels by supporting estrogen metabolism processes.
Medical Treatments
Hormone replacement therapy (HRT) is often used when testosterone and/or estrogen levels are overtly and persistently low. These are synthetic or bioidentical forms of the hormone and can be taken orally, topically, or injected. A healthcare provider prescribes and monitors HRT to ensure efficacy and safety.
In cases of testosterone excess, other medications such as spironolactone may be prescribed that act as anti-androgens in the body and can reduce associated symptoms such as facial hair growth and acne.
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Key Takeaways
- Estrogen supports reproductive health, bone density, brain function, and cardiovascular health.
- Testosterone enhances sexual function, muscle strength, cognitive health, and cardiovascular function.
- Normal hormone levels are crucial for overall well-being, with testosterone peaking in the 30s and estrogen fluctuating throughout the menstrual cycle.
- Factors like age, menstrual cycle, weight, and medical conditions can influence hormone levels.
- Recognizing symptoms of hormonal imbalances helps in seeking appropriate treatments and lifestyle adjustments.
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