Testosterone in Women: What Blood Tests Reveal About Androgens

Quick answer

Women make testosterone from three sources. The ovaries make about 25%. The adrenal glands make about 25%. The rest comes from converting another hormone called DHEA. Testosterone drops with age. It can drop sharply after surgery that removes both ovaries. Low testosterone causes low sex drive, tiredness, low mood, and weaker muscles and bones. High testosterone, mostly from PCOS, causes acne, extra hair growth, and scalp hair thinning.

Why women need testosterone

Female testosterone supports:

• Sex drive and sexual function.
• Energy and motivation.
• Mood.
• Muscle and bone strength.
• Clear thinking.
• Heart health, when your level sits in a healthy range.

This hormone matters for daily life. It is not just for athletes or rare medical cases.

The tests that matter

Total testosterone

Normal range for women: 8 to 60 ng/dL.

This is the standard test. Like in men, the total number alone does not tell the full story. You also need SHBG to make sense of it.

Free testosterone

Doctors calculate this from total testosterone, SHBG, and a protein called albumin. Sometimes labs measure it directly. This is the active form your body can actually use. It matters more for symptoms than the total number.

SHBG (sex hormone binding globulin)

Normal range for women: 18 to 144 nmol/L. This range shifts with age and with birth control pill use.

Birth control pills raise SHBG a lot. Higher SHBG locks up more testosterone. This can lower your free testosterone and your sex drive. Always tell your doctor if you take birth control pills before testing.

DHEA-S

Normal range: this depends heavily on your age.

DHEA-S is an adrenal hormone. Your body can turn it into testosterone. It is a useful extra piece of the puzzle.

Free Androgen Index (FAI)

Doctors calculate this from your total testosterone and SHBG. It reflects how much active testosterone you likely have.

Low testosterone in women

What causes it

• Normal aging. Testosterone drops gradually through your adult years.
• Surgery that removes both ovaries. This removes a major source at once.
• Chemotherapy treatment.
• Long-term birth control pill use. This raises SHBG and lowers free testosterone.
• Adrenal gland problems.
• Pituitary gland problems.
• Long-term illness of any kind.

Symptoms to watch for

• Low sex drive. This is often the most noticeable symptom.
• Low energy levels.
• Low mood or motivation.
• Trouble building or keeping muscle.
• Ongoing brain fog.
• Less sexual sensation or arousal.

How doctors check for it

• They confirm your symptoms first.
• They test total testosterone, free testosterone, and SHBG.
• They also test estradiol, FSH, thyroid, and ferritin, to rule out other causes.

What treatment looks like

Testosterone therapy for women is not approved everywhere. But low-dose treatment has a role in a few cases:

• Women after menopause with low sex drive that will not improve. This has the strongest evidence.
• Women whose ovaries were both removed with major symptoms.
• Always guided by a doctor. Doses run far lower than a man's dose.

High testosterone in women

What causes it

• PCOS. This is the most common cause. Read our full PCOS guide for the full pattern.
• A rare adrenal condition called non-classical congenital adrenal hyperplasia.
• A rare hormone-producing tumor. Watch for symptoms that worsen quickly.
• Taking testosterone from an outside source.
• Insulin resistance in your body.

Symptoms to watch for

• Acne and oily skin.
• Hirsutism, meaning extra hair growth on the face or body.
• Thinning hair on the scalp.
• A deeper voice. This is rare and suggests a high level.
• Irregular menstrual periods.

How doctors check for it

• They test total testosterone, free testosterone, SHBG, and DHEA-S.
• They test 17-OH progesterone, to rule out the rare adrenal condition.
• They test prolactin, to rule out a different cause.
• They may order a pelvic ultrasound to check the ovaries.
• For fast-worsening symptoms or very high testosterone, they check for a tumor.

What treatment looks like

• For PCOS: lifestyle change, metformin, and birth control pills. Sometimes spironolactone too, a medicine that blocks extra androgens.
• For the adrenal condition: steroid replacement medicine.
• For a tumor: surgery.

Curious where your own testosterone stands? Book your &you Labs panel. See your full hormone picture, with a doctor's notes.

Testosterone through life stages

Before menopause

Testosterone peaks in your 20s, then drops slowly. Low symptoms can overlap with stress, low iron, or thyroid problems. A broader workup helps sort out the real cause.

Perimenopause

Testosterone drops here too, but estrogen drops much faster. The mix of changes creates a wide range of symptoms.

After surgery that removes both ovaries

This removes about 25% of your testosterone supply at once. Combined with the sudden loss of estrogen, symptoms can hit hard. This is where testosterone therapy has its strongest evidence.

After natural menopause

Testosterone drops, but your adrenal glands keep making some. Some women stay fine. Others develop real low-testosterone symptoms.

How &you Labs handles this

A &you Labs panel checks total testosterone, free testosterone, SHBG, and DHEA-S as part of your female hormone results. Your report reads these together. It can point to PCOS, age-related decline, or another pattern. A doctor adds written notes too.

Frequently asked questions

Is testosterone therapy safe for women?

Low-dose testosterone for postmenopausal women with low sex drive has decent evidence. It is used in many countries, though not formally approved for this use everywhere. Doses stay far below a man's dose. It should always be guided by a doctor.

Will testosterone make me more masculine?

At the right dose, no. Masculine effects, like voice changes or extra hair growth, need doses far above a normal replacement dose. The goal is to bring you back to a normal female range.

Can I have low testosterone even with a normal total number?

Yes. If your SHBG runs high, often from birth control pills, your free testosterone can sit in the bottom range. This happens even with a normal total number. This happens even when your total number looks fine. Test both numbers together.

Does the birth control pill lower sex drive?

For some women, yes. Birth control pills raise SHBG, which lowers free testosterone. This can lower sex drive in some women. Talk to your doctor if you notice this.

Should young women test testosterone regularly?

Routine testing in healthy young women without symptoms is not standard. Test when you notice low sex drive or ongoing tiredness. Also test for mood changes, persistent acne, or extra hair growth.

Key takeaways

• Women make testosterone from their ovaries, adrenal glands, and by converting DHEA.
• Low testosterone causes low sex drive, tiredness, low mood, and weaker muscles and bones. High testosterone causes acne, extra hair growth, and scalp hair thinning.
• Test total and free testosterone, SHBG, and DHEA-S together for the full picture.
• Birth control pills raise SHBG, which can lower free testosterone and sex drive.
• Low-dose testosterone therapy has its strongest evidence here. This applies to postmenopausal women with low sex drive. It should always be a doctor's decision.