Optimal Testosterone Level for a 60-Year-Old Female
Obtaining testosterone levels in women in nonresearch settings is not recommended, as there is no established optimal testosterone level or proven benefit for testosterone replacement therapy in postmenopausal women. 1
Why Testosterone Testing Is Not Recommended in Women
The available guideline evidence explicitly advises against routine testosterone measurement in women outside of research contexts. 1 This recommendation reflects several key realities:
- No validated reference ranges exist for what constitutes "optimal" testosterone in postmenopausal women, making interpretation of any measured value clinically meaningless 1
- Testosterone levels naturally decline with age in women, with steep decreases occurring throughout the reproductive years and continuing into the postmenopausal period 2
- Natural menopause itself does not independently affect testosterone levels when age is controlled for, though bilateral oophorectomy does reduce levels by approximately 16-23% 3, 2
Normal Physiological Context
For context, healthy young women produce approximately 300 micrograms of testosterone daily, with roughly half from ovarian and half from adrenal sources. 4 However, in women over age 65:
- Total testosterone levels decline progressively with age until approximately age 80, after which they plateau 3
- Free testosterone levels remain relatively stable across the postmenopausal years when measured with sensitive assays 3
- Postmenopausal ovaries continue producing testosterone, as evidenced by lower levels in women with bilateral oophorectomy compared to those with intact ovaries 2
Clinical Pitfall to Avoid
The major pitfall is attempting to apply male testosterone reference ranges or treatment paradigms to women. The evidence for testosterone therapy in men (targeting 450-600 ng/dL) 5 is completely irrelevant to female physiology, where normal levels are measured in micrograms rather than the hundreds of nanograms seen in men. 4
If a 60-year-old woman presents with symptoms potentially attributable to androgen deficiency (decreased libido, fatigue, reduced bone density), the appropriate workup focuses on excluding other causes rather than measuring testosterone levels. 1 Conditions like thyroid dysfunction, depression, medication effects, and other hormonal abnormalities should be evaluated first. 1