Low Energy, Low Libido, Low Mood

Testosterone is produced in both men and women, and in women it plays a meaningful role in energy, motivation, sexual interest, mood stability, muscle maintenance, and cognitive sharpness. It's not a hormone women have in large quantities, but it doesn't need to be present in large quantities to matter. When levels fall below the range a person's body is used to functioning at, the symptoms are real and disruptive, and they're often attributed to everything else before anyone thinks to check.

Testosterone in Women: What It Actually Does

Most people know testosterone as a male sex hormone, and technically it is: men produce roughly ten times more of it than women. But that framing misses what it actually does in the female body.

Women produce testosterone primarily in the ovaries and the adrenal glands. At its peak, which typically occurs in the mid-20s, testosterone in women contributes to:

Energy and drive. Testosterone is part of what creates the baseline feeling of having something in the tank. It supports motivation and the capacity to sustain effort, not dramatically, but in the way that makes the difference between waking up ready to engage with the day and waking up flat.

Sexual interest and response. Testosterone is the primary driver of libido in both men and women. When levels are adequate, sexual interest is a normal part of life. When levels fall, that interest can fade, often so gradually it doesn't register as a change until someone realizes it's been months.

Mood and emotional resilience. Testosterone has a complex relationship with mood. Adequate levels support a sense of confidence, stability, and the capacity to handle stress. When levels drop, some women describe a kind of blunted affect, not exactly depression, but a loss of the emotional texture that used to feel normal.

Muscle and bone health. Testosterone helps maintain lean muscle mass. As it declines, the body's ratio of fat to muscle shifts, and the metabolic effects of that shift compound over time.

Cognitive function. Research suggests testosterone plays a role in focus and mental sharpness. Low levels have been associated with brain fog and difficulty concentrating, though this relationship continues to be studied.

How Testosterone Declines in Women

Testosterone levels in women decline gradually from the mid-20s onward. The decline is slow enough through the 30s that most women don't notice it. In the 40s, as the perimenopause transition begins, the decline often accelerates, and it does so alongside drops in estrogen and progesterone that tend to capture more clinical attention.

Cleveland Clinic notes that low testosterone in women is associated with symptoms including low libido, fatigue, and mood changes, and that testosterone's role in sexual function is the most clearly established area of clinical impact. What "low" means for a given person depends on where their levels have been, not just on a universal reference range.

After surgical menopause (in women who have had their ovaries removed), testosterone can drop sharply and suddenly. This is one of the clearest scenarios for testosterone deficiency, and it's often not proactively addressed.

Other factors that can lower testosterone in women include prolonged use of oral contraceptives, which increase sex hormone binding globulin and reduce free testosterone availability, adrenal dysfunction, significant chronic stress, certain medications, and nutritional deficiencies.

What Low Testosterone Looks Like

The symptoms of low testosterone in women are easy to miss because they overlap with so many other things: burnout, stress, depression, perimenopause, thyroid dysfunction. The picture often looks like this:

Persistent fatigue that isn't fixed by sleep. Not the kind that comes from staying up too late, but the kind that's there from the moment you wake up and doesn't shift much through the day.

Loss of sexual interest. Not a temporary dip tied to stress or relationship dynamics, but a sustained drop where the interest simply isn't there the way it used to be. Reduced sensation and difficulty with arousal can accompany this.

Mood changes. Irritability, low mood, emotional flatness, or a reduced sense of pleasure in things that used to feel rewarding. This can look like mild depression and is sometimes treated as such without the hormonal piece ever being investigated.

Difficulty building or maintaining muscle. Workouts that used to produce results no longer doing so. Feeling weaker, or noticing a shift in body composition despite consistent effort.

Brain fog and reduced focus. Trouble concentrating, forgetting things more easily, a general sense that the mind isn't as sharp.

Reduced sense of confidence or drive. This one is harder to name, but some women describe it as feeling less like themselves: less motivated, less engaged, less present in their own life.

None of these symptoms are unique to low testosterone, which is exactly why it tends to get missed. The path that leads to a hormone evaluation often runs through several other explanations first.

How It's Diagnosed

Diagnosing low testosterone in women requires bloodwork, and it's worth knowing that standard hormone panels don't always include it. You may need to specifically ask for testosterone to be measured, or work with a provider who routinely includes it in a comprehensive hormone evaluation.

The relevant labs include total testosterone, free testosterone (the biologically active fraction not bound to proteins), and often sex hormone binding globulin (SHBG), which affects how much testosterone is actually available to the body. DHEA-sulfate, a precursor hormone produced by the adrenal glands that converts to testosterone, is also worth checking.

Lab results should be interpreted in context, not just against a reference range, but against the full clinical picture, the person's history, and how they're actually feeling. A number that falls within the listed normal range can still represent a significant decline from where that person has been.

What Treatment Looks Like

Treatment for low testosterone in women is not the same as testosterone therapy in men. The doses involved are small, and the goal is restoration to a physiologically appropriate level for a woman, not elevation.

Options include topical testosterone cream, applied to the skin and absorbed directly into the bloodstream, and testosterone pellet therapy. At Transitions Healthcare, we offer EvexiPEL pellet therapy, a small pellet inserted under the skin that releases a steady, consistent dose of hormone over several months. Many patients find this preferable to daily applications because the levels remain stable rather than fluctuating. Cleveland Clinic's overview of testosterone therapy for women notes that transdermal delivery is the preferred method based on available safety data and side effect profiles.

The approach used depends on the individual: their labs, their symptoms, their preferences, and what else is going on hormonally. Testosterone rarely presents in isolation, and in many cases the most effective treatment addresses it alongside other imbalances contributing to the same cluster of symptoms.

The Integrated Picture

Low testosterone doesn't usually arrive alone. In women going through perimenopause, declining estrogen and progesterone are typically part of the same picture. In women with thyroid dysfunction or adrenal issues, the same fatigue and mood symptoms can come from multiple directions at once.

This is why evaluating symptoms in isolation often leads to partial answers. Treating the estrogen while missing the testosterone still leaves patients feeling not quite right. At Transitions Healthcare, a comprehensive hormone evaluation looks at the full picture rather than chasing one number at a time.

We also address the mental health side of what we're describing. The mood and motivational changes associated with low testosterone overlap significantly with depression and anxiety, and disentangling them requires attention to both. Our mental health services are integrated with our hormone work rather than siloed from it.

If You've Been Living With This for a While

A lot of women who come in for a hormone evaluation have been telling themselves this is just how it is now: just getting older, just stress, just life being what it is. They've adjusted their expectations of how they're supposed to feel.

They're often surprised by how much of a difference it makes to actually find out what's going on.

If the symptoms described here are familiar, it's worth having the conversation. You don't need to meet some threshold of severity before you deserve to feel better.

We see patients in Mandan, Bismarck, and across central North Dakota. Call (701) 699-4052 to schedule a hormone evaluation, or get in touch through our contact page.

Learn more about our hormone optimization and pellet therapy services and meet our providers.

Medical disclaimer: This article is for educational purposes and is not intended to replace personalized medical advice. If you are experiencing symptoms that concern you, please consult a qualified healthcare provider. We would love to welcome you to our clinic.