Low Testosterone in Women: Why It Happens and What to Do
Most people learn about testosterone as a male hormone, and that framing shapes everything that follows, including which conversations doctors have, which symptoms get investigated, and which treatments get offered. Women produce testosterone too, and their bodies depend on it for more than most people realize.
To understand why testosterone drops in women and what drives that drop, you need to understand the production system first.
Women make testosterone in two places. The ovaries contribute a significant share, and the adrenal glands, which sit just above the kidneys and are best known for producing cortisol, contribute the rest. Both sources matter, and both can be disrupted by different things. The ovarian contribution is linked to reproductive aging, and the adrenal contribution is tightly connected to stress. Those are two separate pathways to the same problem.
Starting with the ovarian side: testosterone production from the ovaries follows a consistent downward trajectory that begins surprisingly early. Research shows that testosterone levels in women peak in the early twenties and then decline steadily year after year, not just at menopause. By the time a woman reaches her mid-thirties, she may have testosterone levels that are meaningfully lower than they were at twenty-five, even with regular menstrual cycles and no obvious signs of hormonal disruption. Menopause accelerates this process sharply because the ovaries stop their normal hormonal output, but the slope was already heading downward long before that transition.
This is where the common understanding is partially right but incomplete. The belief is that testosterone becomes a concern at menopause. That part is correct, menopause does produce a significant drop. But the correction is that the decline was already happening across the entire decade before menopause, which means symptoms can appear in women in their thirties and early forties who have no reason to suspect their hormones are the source.
The adrenal side of the equation is where stress enters the picture, and this pathway is less well understood even by people who follow hormone health closely.
The adrenal glands produce cortisol, which is the primary stress hormone, but they also produce something called DHEA, which stands for dehydroepiandrosterone and functions as a precursor, meaning it is the raw material the body converts into other hormones including testosterone. When the adrenal glands are under sustained demand, primarily from chronic psychological stress, poor sleep, or prolonged physical strain, the balance between what they produce can shift. The system prioritizes cortisol because cortisol is the acute stress response, and over time the production of DHEA and the downstream androgens it feeds can be compromised.
Think of the adrenal glands like a factory that makes two products on the same production line. When there is a surge of demand for one product, the factory redirects its resources toward that one. Cortisol is the product that gets prioritized when stress is high, and DHEA and testosterone are the products that get deprioritized. That is the mechanism.
This is why a woman dealing with chronic work stress, disrupted sleep, and poor recovery can show up with low testosterone levels even at thirty-five, even with intact ovarian function. Her adrenal system is in a state where it is chronically tilted toward cortisol output, and the androgen production is suffering as a result. Research on cortisol and testosterone coupling in adolescents has shown mixed but real evidence that stress conditions do affect how these two hormones interact, and in clinical practice the relationship is well established enough to inform treatment decisions.
The symptoms that tend to surface when testosterone is low in women center heavily on sexual function. Reduced libido is the most common complaint, followed by decreased satisfaction during intercourse and difficulty reaching orgasm. Data from the Australian Women's Midlife Years Study found direct associations between testosterone and pre-androgen levels and multiple measures of sexual function in women, which supports what clinicians see regularly in practice. These are not vague quality of life complaints. They are measurable functional changes tied to measurable hormonal shifts.
Beyond sexual function, low testosterone in women can show up as fatigue, mood changes, reduced motivation, and difficulty maintaining muscle mass and strength, though the evidence for those connections is stronger in some areas than others.
When it comes to what to do about it, the simplest intervention depends on the cause.
If the driver is adrenal stress, the most direct path is reducing the cortisol load on the system, which means improving sleep quality, managing psychological stress, and giving the body adequate recovery time. These are not vague lifestyle suggestions. They are directly targeting the upstream cause of the adrenal imbalance. Some research has looked at adaptogens, specifically ashwagandha, as a tool for reducing perceived stress and cortisol output, with one randomized controlled trial showing reductions in cortisol alongside improvements in reported stress and wellbeing, though testosterone levels were not the primary outcome measured.
If the driver is ovarian decline, particularly in perimenopause or postmenopause, the conversation shifts toward hormone therapy, and testosterone replacement for women is an option that exists even though it is not routinely offered. The hesitation on the prescribing side often comes down to the long-standing framing of testosterone as a male hormone, which has made clinicians slower to reach for it in women. That framing does not reflect the biology.
DHEA supplementation has also been studied as an indirect approach since it can be converted to testosterone in the body, and a Cochrane review examined the evidence for DHEA in peri and postmenopausal women, finding some support for effects on sexual function, though the evidence was described as not sufficiently robust to recommend it broadly. It is an option with real but limited evidence behind it.
The thing worth sitting with here is that women's testosterone has been an afterthought in medicine not because it does not matter, but because the framing of the hormone as male meant the research and clinical attention went elsewhere. The physiology was never in question. Women have always made testosterone, always needed it, and always experienced the effects of losing it. The decline starts in the twenties, the adrenal glands connect it directly to chronic stress, and by the time a woman reaches her forties and asks why things feel different, the hormonal shift has often been underway for a decade.
The hormone was always part of the picture. The question was only ever whether anyone thought to look.
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