From the Guidelines
Very low testosterone in menstruating women should be evaluated for underlying causes such as polycystic ovary syndrome (PCOS) or other reproductive endocrine disorders before considering testosterone replacement therapy. Women with very low testosterone often experience symptoms like fatigue, decreased libido, muscle weakness, and mood changes, as noted in a study published in the New England Journal of Medicine 1. According to a study published in the Journal of Neurology, Neurosurgery and Psychiatry 1, the diagnosis of PCOS involves the investigation of women with symptoms or signs of reproductive endocrine disorder, including the measurement of serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, progesterone, testosterone, androstenedione, and dehydroepiandrosterone sulphate (DHEAS).
- Key symptoms to look out for include:
- Diminished energy, sense of vitality, or sense of well-being
- Increased fatigue
- Depressed mood
- Impaired cognition
- Diminished muscle mass and strength
- Diminished bone density
- Anemia, as mentioned in a study published in the New England Journal of Medicine 1
- Treatment should be monitored by a healthcare provider with blood tests every 3-6 months to ensure levels remain within the appropriate range for women (15-70 ng/dL), and lifestyle modifications such as strength training exercise, adequate sleep, stress management, and a balanced diet rich in healthy fats and proteins can also help alleviate symptoms.
- It is essential to note that PCOS is a common cause of irregular periods in women, affecting approximately 4-6% of women in the general population, and its prevalence is higher in patients with temporal lobe epilepsy, ranging from 10% to 25% 1.
- Testosterone replacement therapy should be considered only after a thorough evaluation and diagnosis of the underlying cause of low testosterone, and under the guidance of a healthcare provider.
From the Research
Causes of Low Testosterone in Menstruating Women
- Testosterone deficiency in women can result from various conditions, including oophorectomy, adrenalectomy, adrenal disease, pituitary disease, HIV infection, premature ovarian failure, Turner's syndrome, and the use of high-dose corticosteroids and some estrogen preparations 2.
- Simple aging and natural menopause may also contribute to testosterone deficiency in some women 2.
Normal Testosterone Levels in Women
- Healthy young women produce approximately 300 microg of testosterone per day, with about half derived from the ovaries and half from the adrenal glands 2.
- The reference interval for testosterone in women is 0.30-1.69 nmol/L (8.7-48.7 ng/dL) for ID-LC-MS/MS and 0.50-2.00 nmol/L (14.4-57.7 ng/dL) for a 2nd generation immunoassay 3.
Testosterone Fluctuations During the Menstrual Cycle
- Testosterone concentrations in normally cycling women are elevated around the time of ovulation, but a peak is not discernible in each individual 3.
- The elevation of mid-cycle testosterone concentrations is statistically significant, although not clinically relevant since day-to-day variation is higher and independent of the menstrual cycle 3.