Androgens, such as testosterone and dehydroepiandrosterone (DHEA), are steroid hormones produced in the female body by the ovaries and adrenal glands. Although present in smaller concentrations than in men, androgens serve important physiological functions. They act as precursors for estrogen production and exert independent effects on female health. Maintaining adequate levels supports bone density, preserves muscle mass and strength, and influences energy and overall well-being. When production drops below the optimal range, symptoms affecting physical and psychological health can arise, a condition sometimes called female androgen insufficiency.
Recognizing the Signs of Deficiency
The symptoms of reduced androgen levels are varied and often overlap with other health conditions, making diagnosis challenging. A primary sign is a significant decrease in sexual function, particularly a diminished libido or interest in sex. This often includes reduced sexual desire, arousal, and satisfaction.
Physical changes often accompany the hormonal shift, manifesting as persistent, unexplained fatigue and a noticeable loss of muscle strength and tone. Because androgens maintain lean body mass, their decline can contribute to sarcopenia, the age-related loss of muscle. Another physical sign is a reduction in bone mineral density, increasing susceptibility to bone loss and fractures.
Psychological effects are also commonly observed, affecting the emotional and mental state. Women may report a depressed mood, a generalized lack of motivation, and a reduced sense of vitality. This can translate into a feeling of malaise or a diminished sense of overall well-being.
Primary Causes of Reduced Androgen Production
Causes of low androgen levels range from natural biological processes to specific medical interventions or underlying endocrine disorders. The most common cause is aging, as production begins to decline in a woman’s 20s and can decrease significantly by menopause. This decline is primarily due to reduced output from the ovaries and adrenal glands.
Surgical interventions, such as bilateral oophorectomy (removal of both ovaries), cause a sudden and severe drop in androgen levels. Since the ovaries account for approximately half of a woman’s circulating testosterone, their removal eliminates a major source of production. Certain medications also suppress androgen activity, including long-term use of high-dose oral contraceptives and chronic glucocorticoid therapy.
Oral estrogen therapy, often used in hormone replacement, can reduce biologically active testosterone. It does this by increasing the liver’s production of sex hormone-binding globulin (SHBG), a protein that binds and deactivates testosterone. Endocrine disorders are another cause, such as Primary Adrenal Insufficiency, where the adrenal glands fail to produce sufficient hormones, including the androgen precursor DHEA. Hypopituitarism, where the pituitary gland does not produce enough regulatory hormones, can also lead to secondary failure of androgen production.
Diagnosis and Evaluation Methods
Diagnosis of low androgens requires specialized laboratory testing combined with symptom assessment, as symptoms alone are non-specific. Blood tests measure circulating androgens, including Total Testosterone, Free Testosterone, and DHEA-S (Dehydroepiandrosterone sulfate). Measuring Free Testosterone is important because it represents the hormone amount that is unbound to proteins and biologically active.
The timing of the blood draw is a consideration, as testosterone levels fluctuate. For premenopausal women, testing is often recommended during the middle third of the menstrual cycle. For all women, the sample is ideally collected in the morning, when androgen levels are typically at their peak.
Interpreting results can be complex because standard reference ranges for androgens in women are broad and vary significantly between laboratories. A laboratory value alone is insufficient for diagnosis. Instead, a provider must correlate a low-normal or below-normal lab result with the patient’s persistent symptoms, such as fatigue, low libido, or mood changes.
Management and Therapeutic Approaches
For women with a confirmed deficiency and corresponding symptoms, therapeutic approaches focus on restoring hormone levels to a physiological range. The primary medical strategy involves hormone replacement therapy (HRT), often using low-dose testosterone formulations. Currently, no testosterone product is specifically approved by the U.S. Food and Drug Administration for female androgen deficiency, meaning prescriptions are often compounded or used off-label.
Transdermal preparations, such as creams or gels, are the preferred delivery method because they bypass the liver and maintain stable hormone levels. The goal of treatment is to alleviate symptoms, particularly hypoactive sexual desire disorder in postmenopausal women, which is the only evidence-based indication for this therapy. Treatment requires regular monitoring to ensure levels do not become excessively high, which can lead to side effects like acne or excess body hair growth.
Another therapeutic option is DHEA supplementation, which the body converts into both testosterone and estrogen. This approach is relevant for women with Primary Adrenal Insufficiency, where DHEA production is severely compromised. Non-medical strategies include targeted resistance exercise, which helps mitigate the effects of low androgens on muscle and bone density. Women considering hormone supplementation should proceed with caution and only use medically prescribed, regulated products, as high-dose or non-prescription supplements carry significant risks of adverse side effects.