What symptoms are associated with low testosterone in an adult woman?

Symptoms of Low Testosterone in Women

Low testosterone in adult women primarily manifests as diminished sexual desire and reduced sexual responsiveness, along with persistent fatigue and decreased sense of well-being.

Sexual Symptoms

The most specific and well-documented symptoms of low testosterone in women are sexual in nature:

• Reduced libido (decreased sexual desire) is the hallmark symptom of testosterone deficiency in women, representing the most common form of female sexual dysfunction when it causes personal distress 1, 2
• Decreased sexual receptivity and pleasure during sexual activity, with reduced response to sexual stimulation 1, 3
• Reduced frequency of sexual activity and masturbation, reflecting the overall decline in sexual interest 1
• Delayed or absent orgasm, though this is a less specific finding 2

These sexual symptoms are particularly pronounced in surgically menopausal women (those who have undergone bilateral oophorectomy), where approximately 50% experience significant decreases in sexual desire due to the abrupt loss of ovarian testosterone production 1, 4.

Physical and Psychological Symptoms

Beyond sexual dysfunction, testosterone deficiency in women presents with broader symptoms:

• Persistent, unexplained fatigue that does not improve with rest or other interventions 1, 2, 3
• Decreased sense of personal well-being, often described as a general malaise or lack of vitality 1, 2
• Blunted or diminished motivation to engage in daily activities 1
• Reduced anxiety and depression are associated with adequate testosterone levels, suggesting that deficiency may worsen mood symptoms 1

Diagnostic Considerations

The diagnosis of female androgen insufficiency syndrome requires both clinical symptoms and biochemical confirmation:

• Low circulating bioavailable testosterone must be documented, either through a low total testosterone/SHBG ratio or free testosterone in the lower one-third of the female reproductive range 1, 3
• Sufficient plasma estrogen levels must be present, as testosterone deficiency symptoms should not be attributed to estrogen deficiency alone 1
• Exclusion of other contributing factors such as relationship problems, psychiatric disorders, or medications that could explain the symptoms 2, 3

Populations at Highest Risk

Certain groups of women are particularly vulnerable to testosterone deficiency:

• Surgically menopausal women (bilateral oophorectomy) experience approximately 50% decline in testosterone and androstenedione levels, making them the population most likely to experience clinically significant deficiency 1, 4
• Women taking oral estrogen therapy experience increased SHBG production, which reduces free testosterone and can precipitate or worsen deficiency symptoms 1
• Women in their late 30s and 40s may develop age-related androgen insufficiency, as testosterone levels decline by approximately 50% from the early 20s to mid-40s in normal women 3
• Women with premature ovarian failure are at increased risk due to loss of ovarian androgen production 1

Important Clinical Caveats

• The symptoms of testosterone deficiency in women are non-specific and overlap significantly with other conditions including depression, chronic fatigue syndrome, and relationship problems 3
• No standardized clinical or biochemical definitions of testosterone deficiency in women have been established by major medical societies, making diagnosis challenging 1
• Testosterone measurement in women requires sensitive and reliable assays, as standard testosterone assays designed for men are often inadequate for the lower ranges seen in women 3
• Oral contraceptives and oral estrogen therapy increase SHBG and reduce free testosterone, potentially causing or exacerbating symptoms even when total testosterone appears normal 1, 3

The diagnosis should prioritize sexual symptoms (particularly low libido causing personal distress) combined with biochemical evidence of low free or bioavailable testosterone in an estrogen-replete woman, after excluding other medical and psychosocial causes 1, 2, 3.