Medical summary
Women naturally produce and use testosterone. Circulating testosterone comes from the ovaries and adrenal glands and from conversion of androgen precursors in other tissues.[1]
A testosterone result in a woman must be interpreted with the laboratory method, life stage, symptoms, medicines and other hormone results. There is no blood cut-off that diagnoses a general “female testosterone deficiency syndrome”, and total testosterone should not be used to diagnose hypoactive sexual desire disorder (HSDD).[2][3]
High androgen results are assessed differently from low sexual desire. Polycystic ovary syndrome (PCOS) is the most common cause of androgen excess in women of reproductive age, but rapid virilisation or severe biochemical elevation requires prompt specialist investigation for less common causes.[1][4]
Where women’s testosterone comes from
Women and men both make androgens, but in different concentrations and patterns. In women, the ovaries and adrenal glands contribute directly, while peripheral tissues convert precursors such as androstenedione and DHEA into more active androgens.[1]
Most circulating testosterone is bound to proteins, especially sex hormone-binding globulin (SHBG). Only a small fraction is unbound. SHBG can change with oral oestrogen, thyroid status, insulin resistance, liver disease and some medicines, so total testosterone does not always tell the full biochemical story.
Testosterone can also be converted within tissues to dihydrotestosterone or oestradiol. Female androgen biology is therefore part of a wider endocrine network rather than a separate “male hormone” system.
What testosterone does in the female body
Androgen receptors are present in many tissues. Testosterone is associated with sexual function and participates in normal ovarian, adrenal, skin, bone and muscle physiology. However, a biological role does not mean that adding testosterone improves every related symptom.
This distinction is important. International consensus concludes that the only evidence-based indication for systemic testosterone therapy in women is HSDD in appropriately assessed postmenopausal women. Randomised trials have not established treatment benefits for cognition, mood, energy, bone density or muscle outcomes at physiological doses.[2]
Symptoms such as fatigue, brain fog, low mood or reduced strength are real but non-specific. They require assessment for other causes rather than being attributed automatically to a testosterone value.
How testosterone changes through life
Female androgen concentrations generally decline with age. The pattern is gradual and is influenced by ovarian and adrenal function, illness, medication and surgery. Menopause does not create a single predictable testosterone threshold for every woman.[1]
Removal of both ovaries can cause a more abrupt change in ovarian androgen contribution. Hormonal contraception and oral oestrogen can raise SHBG and change calculated measures. Pregnancy and postpartum physiology require separate interpretation.
A laboratory result should therefore be compared with the reporting laboratory’s appropriate female reference interval and interpreted in clinical context. Internet charts and male ranges should not be substituted for the laboratory report.
Low results do not diagnose a syndrome
A low total testosterone result alone does not establish the cause of tiredness, low mood, reduced sexual desire or another symptom. The global consensus statement and ISSWSH guidance do not support using a testosterone concentration to diagnose HSDD or predict who will respond to treatment.[2][3]
Where distressing low sexual desire is associated with menopause, NICE recommends considering testosterone only if HRT alone has not been effective.[5] Assessment should consider relationship factors, pain, vaginal symptoms, medication effects, mental health, sleep and other medical causes.
For a fuller discussion, read our clinical guide to low testosterone in women and the separate guide to testosterone products for women.
What high testosterone can mean
High testosterone may be found with PCOS, ovarian or adrenal conditions, severe insulin resistance, some medicines or exposure to another person’s testosterone product. Symptoms can include acne, increased facial or body hair, scalp hair loss and irregular periods.[1][4]
Rapid progression, voice deepening, clitoral enlargement or marked muscle changes are red flags. These features are unusual in PCOS and need prompt medical assessment for severe androgen excess.[1]
High testosterone should not be treated as a cosmetic issue without considering the cause. See our guide to high testosterone in women for the assessment pathway.
How female testosterone is tested
Testing depends on the clinical question. For suspected androgen excess, current guidance recommends total testosterone and assessment of free testosterone, with accurate assays that perform well at female concentrations. Liquid chromatography–tandem mass spectrometry is preferred where available.[1][4]
SHBG is often measured because it affects calculated free testosterone. DHEAS, androstenedione, 17-hydroxyprogesterone and other tests may be added when a clinician is investigating adrenal, ovarian or PCOS-related causes.[1]
For women receiving testosterone therapy, BMS and ISSWSH guidance use total testosterone primarily for baseline and safety monitoring. Free testosterone or free androgen index should not be treated as a diagnostic target for HSDD.[3]
Why reference ranges vary
Female testosterone concentrations are low relative to male concentrations, which makes assay quality especially important. Reference intervals vary by method, laboratory and population. Age, SHBG and hormonal medicines also influence interpretation.
A value flagged outside one laboratory’s interval should be confirmed and reviewed rather than compared with an unrelated online chart. An unexpectedly high result may also require repeat analysis using a more specific method to exclude assay interference.[1]
When to speak to a clinician
Seek assessment if you develop persistent distressing low sexual desire, irregular periods, new facial hair, severe acne, scalp hair loss or an unexpected hormone result. Request prompt review for rapidly progressive symptoms, voice deepening, clitoral enlargement or other signs of virilisation.[1]
Take a list of medicines and supplements, including hormone creams used by you or someone in your household. Accidental transfer of testosterone gel or cream can affect another person.[1]
Frequently asked questions
Do women produce testosterone naturally?
Yes. The ovaries and adrenal glands produce testosterone and androgen precursors, and other tissues convert precursors into active hormones.[1]
Is testosterone only related to sexual desire?
No. Testosterone participates in wider physiology, but treatment evidence is much narrower. Systemic therapy is evidence based for HSDD in appropriately assessed postmenopausal women, not as a general treatment for energy, mood, cognition, bone or muscle.[2]
Can a blood test diagnose low testosterone in women?
No universal blood cut-off diagnoses a female deficiency syndrome or HSDD. A result is interpreted with symptoms, life stage, medicines, assay and other possible causes.[2][3]
What is the most common cause of high androgens?
PCOS is the most common cause in women of reproductive age, although diagnosis considers menstrual or ovulatory features and ovarian findings as well as androgen excess.[4]
What high-testosterone symptoms need urgent review?
Rapidly progressive hair growth, voice deepening, clitoral enlargement or other virilising changes require prompt specialist assessment.[1]
Is free androgen index always useful?
No. Its interpretation depends on SHBG and the clinical question. For HSDD treatment monitoring, current BMS guidance prefers total testosterone and clinical response rather than treating FAI as a diagnostic or dosing target.[3]
References
[1] Elhassan YS, Hawley JM, Cussen L, et al. Society for Endocrinology Clinical Practice Guideline for the Evaluation of Androgen Excess in Women. *Clin Endocrinol*. 2025;103(4):540–566. View source
[2] Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. *Climacteric*. 2019;22(5):429–434. View source
[3] British Menopause Society. Testosterone replacement in menopause. May 2026. View source
[4] Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS. *J Clin Endocrinol Metab*. 2023;108(10):2447–2469. View source
[5] National Institute for Health and Care Excellence. Menopause: identification and management. Recommendation 1.5.32. View source
