Low Testosterone in Women: Signs, Causes, and When to Seek Advice

Signs, Causes, and When to Seek Advice

Noticing a persistent dip in your sex drive? Feeling less like yourself, with energy that does not quite recover the way it once did? Or a quiet loss of motivation, strength or mental sharpness that is difficult to pinpoint?

For many women, these changes arrive gradually and are absorbed into everyday life, attributed to stress, a busy season, ageing or simply not sleeping well enough. What is less commonly understood is that low testosterone in women may be a contributing factor, and one that is frequently overlooked in conventional hormone conversations.

Women produce testosterone continuously throughout their lives, primarily in the ovaries and adrenal glands, where it plays a meaningful role in energy, libido, muscle maintenance, mood and overall hormonal balance. Levels begin to decline from the mid-twenties onwards, falling by around 25% between the ages of 20 and 40, with a further 10 to 20% decline over the following decade, before gradually plateauing around the age of 55  (The Pharmaceutical Journal).

These are quiet, systemic shifts. Because the symptoms they produce overlap with so many other aspects of daily life, they are easy to miss and easier still to dismiss. For women experiencing persistent fatigue, reduced drive or a change in sexual wellbeing, understanding the role of female hormones, including testosterone, can be a meaningful first step.

What Does Testosterone Do in Women?

Testosterone is produced in smaller amounts in women than in men, yet its influence on the body is significant. It circulates in the bloodstream in two forms: total testosterone, which reflects the full amount present including the portion bound to proteins; and free testosterone, the small unbound fraction, typically around 1 to 3%, which is immediately available for the body to use.

Because free testosterone is the biologically active portion, it is often the more clinically relevant marker when assessing symptoms such as low libido in women or persistent fatigue. Total testosterone provides a broader view of overall hormone production, and both markers together give the most complete clinical picture.

When testosterone is lower than optimal, its effects are felt across multiple systems. The most well-supported symptom is reduced libido, a decrease in sexual desire or arousal that can feel gradual and difficult to attribute to a single cause. Women may also notice reduced energy, a loss of motivation or drive, brain fog or difficulty with focus, lower mood or reduced emotional resilience, decreased muscle mass or strength and, over the longer term, possible changes in bone density.

A clinical assessment is important here. Diagnosis requires a clear pattern of symptoms alongside biochemical confirmation through testing. Test results should always be interpreted in the context of how someone is actually feeling and functioning, and never in isolation.

Low Sex Drive in Women: Libido, Desire and the Hormonal Interplay

Low sex drive in women is multifactorial. Testosterone plays a role, yet it does not operate in isolation. Oestrogen levels, particularly during perimenopause and after menopause, significantly influence sexual function including vaginal comfort and arousal. Cortisol, the body's primary stress hormone, can suppress sex hormone production when chronically elevated. Relationship factors, mental health and sleep quality all contribute to the picture.

This complexity shapes how low libido should be assessed. A drop in sexual desire may reflect testosterone deficiency, or it may be driven by other hormonal, psychological or relational factors. In some cases, it may be linked to a condition known as Hypoactive Sexual Desire Disorder (HSDD), characterised by persistent and distressing low desire that is not explained by another medical or relationship cause.

The Australian Menopause Society recognises that testosterone is sometimes considered in carefully selected cases of HSDD under specialist care, with evidence supporting a modest benefit for some women. A structured clinical assessment is always required before any treatment is considered. Women asking how to increase libido should be aware that a personalised, clinician-led approach, addressing the full hormonal and lifestyle picture, is more likely to be effective than any single intervention.

The Role of PCOS: When Testosterone Patterns Are More Complex

Polycystic ovary syndrome (PCOS) is worth addressing separately, as it complicates the picture in a specific and clinically important way. PCOS is typically associated with elevated androgens, the group of hormones that includes testosterone, rather than deficiency. Understanding this is relevant to accurate assessment.

Androgens are hormones produced in both the ovaries and adrenal glands that support sexual development, libido, muscle health and energy. In PCOS, androgen levels are often higher than expected, yet women may still experience symptoms that overlap with deficiency: fatigue, low mood and reduced wellbeing. This is partly because PCOS frequently involves dysfunctional hormone signalling, insulin resistance and an imbalance between total and free testosterone, even when total levels appear elevated.

A key mechanism here is sex hormone-binding globulin (SHBG), a protein produced by the liver that binds to hormones including testosterone and oestrogen, holding them in an inactive form. When SHBG levels are altered, as is common in PCOS, the proportion of free biologically active testosterone may shift in ways that do not reflect total levels alone.

This is why a full hormone panel is essential in any meaningful assessment. Evaluating testosterone without also looking at SHBG, oestrogen, insulin and other relevant markers risks misinterpretation, both in women with PCOS and in those presenting with broader concerns around hormone balance.

What Causes High Prolactin and How Does It Affect Testosterone?

Prolactin is a hormone best known for its role in breast milk production, and also a meaningful marker in broader female hormone health that is frequently under-assessed.

When prolactin levels are higher than expected, it can interfere with the body's normal hormonal signals. Elevated prolactin suppresses the production of gonadotropin-releasing hormone (GnRH), which in turn reduces output of oestrogen and testosterone. The result can include reduced libido, menstrual irregularities, fatigue and, in some cases, fertility challenges.

The causes of elevated prolactin vary. Chronic stress is a common and often under-recognised contributor. Certain medications, including SSRIs, antipsychotics and some blood pressure medications, can raise prolactin as a side effect. In rarer cases, a benign pituitary adenoma may be responsible, which requires imaging to assess appropriately.

The Endocrine Society recommends that prolactin be assessed as part of a comprehensive hormone evaluation in women presenting with low libido, menstrual disruption or unexplained reproductive concerns. It is a marker that adds important clinical context, particularly when other hormones appear within range yet symptoms persist.

Low Testosterone Causes in Women: Beyond Ageing Alone

Ageing and the menopause transition are the most widely recognised drivers of declining testosterone in women, and they are rarely the complete picture. For many women, the underlying causes are functional, shaped by lifestyle, metabolic health and other clinical factors, rather than fixed or irreversible.

Biological and medical factors include the natural decline in ovarian production with age, surgical menopause following oophorectomy, adrenal dysfunction where the body's stress-regulating glands are not working optimally, and chronic illness or systemic inflammation.

Lifestyle and metabolic factors play a significant and often modifiable role. Chronic stress leads to elevated cortisol, which can suppress sex hormone production. Poor or disrupted sleep affects hormonal regulation across multiple systems. Women asking why they are always tired may find that disrupted sleep and hormonal imbalance are closely connected. Under-eating or very low-fat diets have been associated with reduced testosterone, as has excessive exercise without adequate recovery. Alcohol, particularly at higher intake levels, can disrupt hormone signalling and production through mechanisms including increased stress response and oxidative stress.

Medications deserve particular attention. Oral contraceptives increase SHBG levels, which reduces the amount of free testosterone available in the body, an effect that can persist even after stopping the pill. Antidepressants, particularly SSRIs, may also influence libido and hormonal function indirectly. Awareness of these interactions is an important part of thorough clinical assessment.

The relationship between testosterone and metabolic health is bidirectional. Insulin resistance, body composition and inflammatory burden all influence hormone levels, reinforcing the importance of assessing testosterone within a broader clinical and metabolic context. This is central to female longevity: hormone balance, metabolic health and lifestyle factors work together to shape long-term outcomes.

How to Balance Hormones Naturally: Nutrition, Lifestyle and Supplements

Clinical assessment and, where appropriate, medical treatment form the foundation of managing low testosterone. Alongside this, lifestyle factors can meaningfully support hormonal balance and are always worth addressing.

A balanced whole-food diet that includes adequate protein, healthy fats and carbohydrates provides the nutritional foundation for hormone production and metabolic health. Very low-fat diets have been associated with reduced testosterone levels, and ensuring sufficient dietary fat is a clinically relevant consideration. Avoiding extremes, both chronic undereating and overeating, helps to maintain hormonal stability over time. Focusing on nutrient-dense minimally processed foods is a practical starting point for women looking to support their hormone health through diet.

Vitamin D and testosterone in women have a meaningful relationship. Insufficiency is common, particularly in the UK, and safe sun exposure or supplementation under clinical guidance may be appropriate where levels are suboptimal. Zinc and testosterone in women show a similar pattern: zinc may play a supportive role in hormone health, particularly in individuals with low baseline levels, and can be considered as part of a personalised supplementation protocol following advice from a qualified clinician.

Supplements for hormone balance in women, including zinc and vitamin D, may be considered where clinically appropriate, though they are best used as part of a wider plan rather than as standalone interventions. Regular physical activity, particularly resistance training and higher-intensity exercise, has been associated with short-term increases in testosterone and supports muscle mass, body composition and metabolic health more broadly. Managing stress, prioritising consistent high-quality sleep and moderating alcohol intake all contribute to a hormonal environment that supports overall wellbeing.

These measures form a meaningful foundation and in cases where testosterone decline is driven primarily by lifestyle and metabolic factors, addressing these areas can sometimes support hormone levels without medical intervention. A clinician can help determine which approaches are most relevant given individual circumstances.

When to Seek Advice: Getting the Assessment Right

Because the symptoms associated with low testosterone in women are non-specific, overlapping with thyroid dysfunction, iron deficiency, low mood, early menopause symptoms and perimenopause fatigue and brain fog, a careful and structured assessment is essential before drawing any conclusions.

A thorough clinical evaluation begins with a conversation. A detailed review of symptoms, medical history, medications, lifestyle and menstrual cycle patterns provides the context needed to interpret hormone results meaningfully. For pre-menopausal women, cycle timing matters: at Reborne, hormone testing is conducted on days 19 or 20 of the menstrual cycle to ensure results reflect the appropriate hormonal phase.

Blood tests are used to support and confirm the clinical picture. A full female hormone panel typically includes total and free testosterone alongside SHBG, oestrogen, progesterone, prolactin, thyroid function and adrenal markers, providing a systems view of hormonal health rather than a single number in isolation. Metabolic markers including fasting glucose, HbA1c and a lipid panel are often included to assess the wider context.

For women wondering how to check hormone levels in the UK, the most clinically useful route is a structured, clinician-led pathway where results are interpreted alongside symptoms and medical history. Self-referral to a private longevity clinic in London such as Reborne provides access to this kind of comprehensive, personalised assessment outside of standard NHS pathways.

A Clinical Approach to Female Hormone Health at Reborne Longevity

At Reborne Longevity, female hormonal health is assessed within a fully integrated clinical framework that looks beyond individual hormone levels to understand how hormones are produced, metabolised and cleared. This reflects a growing recognition in the medical literature that two individuals with similar test results may experience very different symptoms, and that meaningful improvements often require addressing the wider system.

The Female Hormone Consultation (£600 | 60 minutes, with 30-minute follow-up), which takes place at our Mayfair medical clinic, is designed to build this complete picture. It supports women across three broad life stages: the reproductive years (approximately 25 to 45), perimenopause (40 to 55) and menopause and beyond (50+).

The consultation includes a comprehensive hormonal assessment covering sex hormones (oestrogen, progesterone, testosterone and DHEA), thyroid function (TSH, Free T3, Free T4, reverse T3 and antibodies), adrenal function (cortisol patterns and DHEA-S) and metabolic hormones including insulin and leptin. Where indicated, this is extended to include metabolism and detoxification analysis, examining liver detoxification pathways, methylation status and oestrogen metabolism, alongside nutrigenomic analysis of genetic variants affecting hormone metabolism such as MTHFR, COMT and CYP450 enzymes.

Where treatment is clinically appropriate and following thorough assessment, options may be discussed including bioidentical hormone replacement therapy (HRT) using compounded formulations tailored to individual metabolism, alongside evidence-based supplementation, lifestyle protocols and metabolic optimisation strategies. All treatment decisions are evidence-led, governed by clinical judgement and subject to ongoing monitoring and regular reassessment of both symptoms and biomarkers. Any intervention is tailored to the individual and discussed within a carefully governed clinical framework.

Additional services available include diagnostic testing from basic blood panels to advanced investigations depending on complexity, imaging including DEXA scans and pelvic ultrasound from £300, and specialist referrals within Reborne at discounted rates. All consultations include direct ongoing communication with your clinician, ensuring continuity of care throughout.

This consultation may be particularly relevant for women with PCOS, endometriosis, thyroid disorders or unexplained hormonal symptoms, as well as those seeking to support bone health, cardiovascular risk or cognitive function, or those who have not found clarity through conventional approaches. It is not intended for emergency gynaecological or obstetric care. As with all services at Reborne, clinical suitability is assessed on an individual basis.

Moving Forward: Your Next Step in Women's Hormone Health

Low testosterone in women is a clinical variable, one that interacts with oestrogen, cortisol, metabolic health, sleep and lifestyle in ways that are specific to each individual. Recognising that it may be a contributing factor to how you are feeling is a meaningful first step.

Guided by P4 medicine, predictive, preventive, personalised and participatory, every journey at Reborne Longevity begins with where you are now. If you have noticed persistent changes in libido, energy, mood or motivation, a structured Female Hormone Consultation can provide a considered starting point. The aim is to understand the broader physiology that shapes how you feel, function and move through each stage of life, and to develop a plan that is grounded in your individual clinical picture.

BOOK A WOMEN'S HORMONE CONSULTATION

FAQ: Understanding Low Testosterone in Women

What are the signs of low testosterone in women?

The most well-supported sign is a reduction in sexual desire or arousal, often described as a persistent low libido that feels different from previous experience. Women may also notice reduced energy, lower motivation, brain fog, changes in mood or emotional resilience and a gradual shift in body composition including reduced muscle tone. These symptoms are not exclusive to testosterone and require clinical assessment to determine their cause.

Why is my sex drive low as a woman?

Low sex drive in women is multifactorial and may be influenced by oestrogen levels, cortisol, sleep quality, relationship factors and mental health, as well as testosterone. A structured hormone assessment helps to clarify which factors are most likely contributing and what clinical options may be appropriate. Any treatment should be considered under the guidance of a qualified clinician following a thorough assessment.

Why am I always tired as a woman?

Persistent fatigue in women can have many causes, including thyroid dysfunction, iron deficiency, disrupted sleep, low mood and hormonal imbalance including low testosterone. Because these causes overlap significantly, a comprehensive clinical assessment is the most reliable way to identify what is driving the symptom and to determine the most appropriate course of action.

Does testosterone decline during perimenopause?

Testosterone levels decline gradually from the mid-twenties onwards, well before perimenopause begins. The broader hormonal shifts of perimenopause, including declining oestrogen and changes in the menstrual cycle, can affect how remaining testosterone is experienced and processed. Perimenopause symptoms including fatigue, brain fog and low mood may therefore overlap with or compound the effects of testosterone decline, which is why a full hormone panel is more informative than assessing a single marker.

How do I check my hormone levels in the UK?

In the UK, hormone testing is best carried out through a clinician-led pathway that combines symptom assessment with laboratory testing. Timing matters for pre-menopausal women: at Reborne, testing is conducted on days 19 or 20 of the menstrual cycle. A comprehensive panel assessing total and free testosterone, SHBG, oestrogen, progesterone, prolactin and thyroid function provides the most clinically useful picture. Private assessment at a longevity clinic in London can provide access to this level of detail outside standard NHS pathways.

Can lifestyle changes help low testosterone in women?

Addressing sleep quality, stress, body composition, nutrition and alcohol intake can positively influence hormone levels, particularly where lifestyle and metabolic factors are contributing to the decline. Resistance training, adequate dietary fat, and ensuring sufficient levels of zinc and vitamin D may all support hormonal balance. Where a clinical deficiency is identified, lifestyle changes alone may not fully restore levels, and clinical guidance is recommended to explore appropriate options.

What causes high prolactin in women?

Prolactin can be elevated by chronic stress, certain medications including SSRIs and antipsychotics, and in rarer cases by a benign pituitary adenoma. When prolactin is raised, it can suppress oestrogen and testosterone production, contributing to low libido, menstrual irregularities and fatigue. It is an important marker to include in a comprehensive female hormone panel, particularly when symptoms persist despite otherwise normal results.

References

Davison, S.L., Bell, R., Donath, S., Montalto, J.G. and Davis, S.R. 2005. "Androgen Levels in Adult Females: Changes with Age, Menopause, and Oophorectomy." Journal of Clinical Endocrinology & Metabolism 90 (7): 3847–53. https://doi.org/10.1210/jc.2005-0212

International Menopause Society. 2020. "Low Libido and Testosterone Therapy in Women." https://www.imsociety.org/wp-content/uploads/2020/06/low-libido-and-testosterone-therapy.pdf

Wierman, M.E., Arlt, W., Basson, R., Davis, S.R., Miller, K.K., Murad, M.H., Rosner, W. and Santoro, N. 2014. "Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guideline." Journal of Clinical Endocrinology & Metabolism 99 (10): 3489–510. https://doi.org/10.1210/jc.2014-2260

Australian Menopause Society. "Androgen Therapy in Women." https://www.menopause.org.au/hp/information-sheets/androgen-therapy-in-women

Islam, R.M., Bell, R.J., Green, S., Page, M.J. and Davis, S.R. 2019. "Safety and Efficacy of Testosterone for Women: A Systematic Review and Meta-Analysis of Randomised Controlled Trial Data." The Lancet Diabetes & Endocrinology 7 (10): 754–66. https://doi.org/10.1016/S2213-8587(19)30189-5

The Pharmaceutical Journal. "Testosterone in Women: A Clinical Overview." https://pharmaceutical-journal.com

Healthline. 2023. "8 Proven Ways to Increase Testosterone Levels Naturally." https://www.healthline.com/nutrition/8-ways-to-boost-testosterone