Fatigued? Depressed? This is Often Overlooked in Women

Testosterone is a natural hormone that both men and women need, for some of the same reasons and some that are completely different. It’s made from cholesterol and belongs to a group of hormones called androgens.

In women, most testosterone comes from the adrenal glands and ovaries, with smaller amounts made in other body tissues from precursor hormones. In the ovaries, much of that testosterone is converted into another important hormone, estradiol. Some testosterone, however, remains active and circulates throughout the body.

When testosterone levels drop too low, women may notice a lower sex drive, fatigue, mood changes, decreased strength, and an overall dip in quality of life. Low levels are often caused by a mix of natural aging, changes in ovarian or adrenal function, certain health conditions, medications, or lifestyle factors.

Chronic stress and genetics can also play a role. Additionally, removing the ovaries, chemotherapy, birth control pills, and chronic illnesses (including some autoimmune diseases) can all contribute to low testosterone (1,2,3,7).

Mood, well-being, and motivation

• Low testosterone in women is associated with diminished sense of well-being, dysphoric mood, and loss of motivation (1).

Energy and fatigue resistance

• Persistent, unexplained fatigue and lethargy are common signs of low testosterone in women (1).

Muscle mass and physical strength

• Testosterone helps women build and maintain lean muscle and strength, even though levels are much lower than in men. Strong muscles protect bones, boost metabolism, and improve endurance.
• Testosterone doesn’t increase muscle mass in women the way it does in men because women naturally have much less of it circulating in their bodies (2,3,6).

Bone density and fracture protection

• Supports bone health, leading to fracture protection. Low testosterone levels in women are associated with a 1% decline in bone density per year. (4)

Cognitive function and mental clarity

• Some studies suggest that testosterone may help support certain brain functions—such as memory and focus—especially in postmenopausal women (1,2,3).

Sleep quality and recovery

• Low testosterone can make it harder to recover from activity and may contribute to fatigue and poor-quality, non-restorative sleep (5).

Cardiometabolic and vascular health

• Normal testosterone levels can help keep blood vessels healthy, support good circulation, and maintain healthy inflammation levels (2,4).

Ovarian, reproductive, and blood health

• The ovaries and adrenal glands produce testosterone, which works alongside estrogen to keep the female reproductive system functioning smoothly (1,3).
• Testosterone also helps produce red blood cells, which improve oxygen delivery, energy levels, and physical performance (4).
• It plays a key role in female libido and sexual responsiveness.
• It helps maintain healthy vulvar and vaginal tissues, which can improve comfort and sexual pleasure (3).

Important cautions

Major endocrine societies emphasize that there is no universally accepted lab cutoff or syndrome definition for “androgen deficiency” in healthy women, and they caution against routine use. Consult with a qualified healthcare practitioner for personalized evaluation and guidance.

References

1. Braunstein GD. Androgen insufficiency in women. Growth Horm IGF Res. 2006 Jul;16 Suppl A:S109-17. doi: 10.1016/j.ghir.2006.03.009. Epub 2006 Apr 24. PMID: 16631401.
2. Safarinejad, M. R. (2006). Female sexual dysfunction in a population-based study in Iran: Prevalence and associated risk factors. International Journal of Impotence Research, 18(4), 382–395. https://doi.org/10.1038/sj.ijir.3901440
3. Uloko, M., Rahman, F., Puri, L. I., & Rubin, R. S. (2022). The clinical management of testosterone replacement therapy in postmenopausal women with hypoactive sexual desire disorder: A review. International Journal of Impotence Research, 34(7), 635–641. https://doi.org/10.1038/s41443-022-00613-0
4. Davis, S. R., & Wahlin-Jacobsen, S. (2015). Testosterone in women—The clinical significance. The Lancet Diabetes & Endocrinology, 3(12), 980–992. https://doi.org/10.1016/S2213-8587(15)00284-3[3]
5. Cleveland Clinic. (2025). Low testosterone in women: Causes, symptoms & treatment. https://my.clevelandclinic.org/health/diseases/24897-low-testosterone-in-women
6. Handelsman, D. J., Hirschberg, A. L., & Bermon, S. (2018). Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance. Endocrine reviews, 39(5), 803–829. https://doi.org/10.1210/er.2018-00020
7. MedlinePlus. (2024, July 21). Hypogonadism. U.S. National Library of Medicine.
8. https://medlineplus.gov/ency/article/001195.htm

Written by Brooke Lounsbury