Is it normal for a 50-year-old postmenopausal woman to have no testosterone?

Testosterone Levels in 50-Year-Old Postmenopausal Women

No, it is not normal for a 50-year-old postmenopausal woman to have no testosterone. Women naturally produce testosterone, and even after menopause, they should maintain measurable testosterone levels, albeit lower than pre-menopause.

Normal Testosterone Production in Women

• Healthy young women produce approximately 300 micrograms of testosterone per day, with about half derived from the ovaries and half from the adrenal glands 1
• Testosterone in women influences sexual function, bone density, muscle mass, energy, cognitive function, and mood 1, 2
• Androgen levels in women decrease continuously to about 50% before menopause compared to a 20-year-old woman, but should not reach zero 3
• After surgical removal of ovaries, androgen levels can decline by approximately 70% within 24 hours, but still remain detectable 3

Testosterone Deficiency in Women

• Low testosterone levels in women are associated with:

  • Depression and mood disorders 3
  • Decreased libido and sexual dysfunction 1
  • Osteoporosis 3
  • Increased total body fat mass 3
  • Decreased energy and vitality 2

• The relationship between testosterone levels and depression in women follows a parabolic curve, with optimal mental health observed at moderate levels (approximately 0.4-0.6 ng/ml of free testosterone) 3

Causes of Abnormally Low Testosterone in Women

Several conditions can lead to abnormally low or undetectable testosterone levels in women:

• Oophorectomy (surgical removal of ovaries) 1
• Adrenalectomy or adrenal disease 1
• Pituitary disorders 1
• Premature ovarian failure 1
• Use of high-dose corticosteroids 1
• Some estrogen preparations, particularly oral formulations that increase sex hormone-binding globulin (SHBG) 3

Evaluation of Low Testosterone in Women

If a 50-year-old woman has undetectable testosterone levels, further evaluation is warranted:

• Measurement should be repeated to confirm the finding 4
• Assessment for symptoms associated with testosterone deficiency should be performed 2
• Evaluation of other hormones may be indicated, including:
  • Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to distinguish primary from secondary causes 4
  • Sex hormone-binding globulin (SHBG) levels, as high SHBG can reduce free testosterone availability 4
  • Prolactin levels if LH/FSH are low or low-normal 4

Clinical Implications

• Undetectable testosterone in a 50-year-old woman is abnormal and warrants further investigation 3, 1
• Even after natural menopause, women should maintain some measurable testosterone production, primarily from adrenal sources 1
• Complete absence of testosterone may indicate an underlying pathology affecting both ovarian and adrenal function 1
• Testosterone deficiency can significantly impact quality of life through effects on mood, sexual function, bone health, and body composition 3, 2

While testosterone replacement therapy is sometimes considered for women with symptomatic deficiency, it remains controversial and no formulation has been specifically approved for women in most countries 2. The decision to treat should be based on symptoms, confirmed low levels, and careful consideration of potential benefits and risks.