A postmenopausal woman’s total testosterone typically falls between 7 and 40 ng/dL, with free testosterone ranging from about 1.1 to 6.3 pg/mL. These numbers are significantly lower than the male range (which starts around 300 ng/dL), and they sit below premenopausal levels too. But the reference range only tells part of the story, because how your body responds to testosterone matters as much as the number on a lab report.
Where Testosterone Comes From After Menopause
Before menopause, the ovaries produce a substantial share of your testosterone. After menopause, the ovaries don’t shut off testosterone production entirely, but output drops. The adrenal glands, which sit on top of each kidney, continue making testosterone and related hormones that the body converts into testosterone in tissues like fat, muscle, and skin. This combination of adrenal production and tissue-level conversion accounts for most of the testosterone circulating in a postmenopausal woman’s body.
Because two different sources contribute, an unusually high or low reading can point to different things depending on context. Elevated testosterone might originate from the ovaries (as in a rare condition called ovarian hyperthecosis, where ovarian cells ramp up hormone production) or from the adrenal glands. Distinguishing the source matters when levels fall well outside the normal range.
Why Your Lab Results May Not Be Accurate
Standard blood tests for testosterone use a method called immunoassay, which works well for the high concentrations found in men but struggles with the much lower levels in women. These tests tend to overestimate testosterone when the true value is below 100 ng/dL, which is exactly where all female results land. In some cases the discrepancy is dramatic: one clinical case found an immunoassay reading more than 85% higher than the result from more precise testing.
The gold standard for measuring testosterone in women is a technique called liquid chromatography-tandem mass spectrometry (LC-MS/MS). It separates testosterone from chemically similar hormones that can fool standard tests, giving a far more reliable number. If you’re getting tested specifically to evaluate symptoms or guide treatment, it’s worth confirming that your lab uses this method. Not all do, and the difference in accuracy can change clinical decisions.
What Low Testosterone Feels Like
There’s no universally agreed-upon cutoff that defines “too low” in postmenopausal women, partly because symptoms don’t track neatly with a specific number. Some women with levels at the bottom of the range feel fine. Others with levels that look normal on paper experience reduced sexual desire, lower energy, or diminished sense of well-being.
The symptom most clearly linked to testosterone levels is low sexual desire. When this becomes persistent, causes personal distress, and isn’t explained by relationship issues, medications, or other health conditions, it may meet the criteria for hypoactive sexual desire disorder (HSDD). The pattern needs to last at least several months and occur frequently, though it can fluctuate in severity. Testosterone is the primary sex hormone involved in regulating sexual desire in women, which is why this connection is so well-established.
Beyond libido, testosterone plays a role in maintaining bone density and lean body mass. A study of over 2,100 women aged 40 to 60 found a positive association between testosterone levels and bone mineral density in the lumbar spine, even after accounting for factors like age, weight, and whether the women used hormone therapy. Women in the highest quarter of testosterone levels had meaningfully stronger bone density than those in the lowest quarter. Higher testosterone has also been linked to greater lean body mass and total fat mass in older women.
What High Testosterone Looks Like
Levels above 40 ng/dL deserve investigation. The hallmark signs of excess testosterone in women include new or worsening facial hair growth (coarse, dark hair on the upper lip, chin, or jawline rather than fine “peach fuzz”), thinning hair on the scalp in a pattern similar to male baldness, persistent acne, and a deepening voice. These changes tend to develop gradually when the elevation is mild but can progress more quickly with higher levels.
Possible causes of elevated testosterone after menopause include ovarian hyperthecosis (a non-cancerous condition where ovarian tissue overproduces hormones), androgen-secreting tumors of the ovary or adrenal gland, congenital adrenal hyperplasia, and Cushing disease. A sudden, sharp spike in testosterone is more concerning for a tumor than a gradual rise. Your provider can check a related hormone called DHEAS alongside imaging to help pinpoint whether the ovaries or adrenal glands are the source.
Testosterone Therapy for Postmenopausal Women
A 2019 international consensus panel concluded that the only evidence-based reason to prescribe testosterone to women is for treating HSDD after a thorough evaluation. The panel emphasized that other contributing factors, including relationship difficulties, stress, depression, and medication side effects, need to be addressed first. There are currently no approved testosterone products specifically formulated for women in most countries, so prescribing typically involves using a fraction of a male-dose product.
In practice, this means using roughly one-tenth of a standard testosterone gel sachet per day (about 5 mg), applied to the skin. The goal is to restore testosterone to levels that approximate the premenopausal range rather than exceeding it. Clinical trials of transdermal testosterone in postmenopausal women with HSDD found an average increase of about one additional satisfying sexual event per month compared to placebo, along with improvements in desire, arousal, orgasm, and a reduction in sexual distress. The effect is moderate but consistent.
Short-term side effects at physiological doses are few and mostly mild, like skin irritation at the application site or slight increases in body hair. The more important caveat is that long-term safety data on cardiovascular health, breast cancer risk, and cognitive effects simply don’t exist yet. Most studies have only followed women for six months to two years. This gap in knowledge is why the international consensus recommends using the lowest effective dose and monitoring levels regularly to ensure they stay within the premenopausal physiological range, not above it.
Getting Tested and Reading Your Results
Testosterone levels fluctuate throughout the day, peaking in the morning. Blood draws for testosterone are typically done in the morning for the most consistent reading. If you’re evaluating symptoms, both total testosterone and free testosterone are useful. Total testosterone measures everything in your blood, while free testosterone measures the small fraction (roughly 1 to 2%) that’s unbound to proteins and available for your body to use.
When reviewing results, keep in mind that reference ranges vary between labs. A result of 15 ng/dL might sit in the middle of one lab’s range and at the lower end of another’s. The 7 to 40 ng/dL range for postmenopausal total testosterone is widely used, but your lab may report slightly different boundaries. What matters most is interpreting the number alongside your symptoms rather than treating any single threshold as a pass-fail line.