Medical summary
There is no single universal “normal testosterone level” for every woman. Results vary with the assay, reporting laboratory, age, SHBG, medicines and the clinical question. Female concentrations are low enough that method accuracy matters, and an unexpected result may need confirmation by liquid chromatography–tandem mass spectrometry.[1][2]
A low testosterone result does not diagnose hypoactive sexual desire disorder (HSDD) or a general female deficiency syndrome. For women receiving testosterone therapy, total testosterone is primarily a baseline and safety-monitoring measure, not a target to maximise.[3][4]
A high result is assessed differently. PCOS is the most common cause of androgen excess in women of reproductive age, while severe elevation, rapid progression or virilisation requires prompt specialist investigation.[1][2]
Why online range charts are unreliable
Testosterone assays and reference populations differ. A numerical range from another laboratory, country or age group may not apply to your result. Hormonal contraception, oral oestrogen, thyroid status, liver disease and insulin resistance can change SHBG and therefore the relationship between total and free testosterone.
Use the interval printed on the original laboratory report and ask how the result was measured. A clinician should interpret the number with symptoms, medicines, reproductive stage and other tests. This is more reliable than comparing it with a generic age chart.
Total testosterone
Total testosterone measures the hormone circulating in both bound and unbound forms. It is usually the starting point for investigating androgen excess and is the measure favoured for safety monitoring during testosterone treatment for women.[1][3]
At female concentrations, some direct immunoassays have limited accuracy. Society for Endocrinology and PCOS guidance prefer liquid chromatography–tandem mass spectrometry for total testosterone where available, particularly when the result is unexpectedly high or does not fit the clinical presentation.[1][2]
SHBG, free testosterone and FAI
SHBG binds most circulating testosterone. When SHBG is high, total testosterone may appear relatively preserved while calculated free testosterone is lower. When SHBG is low, the free fraction may be higher.
For suspected biochemical hyperandrogenism in PCOS, current international guidance recommends total and free testosterone using accurate assays or validated calculations.[2] Free androgen index may be used in some laboratories, but it is influenced strongly by SHBG and is not a universal stand-alone diagnosis.
For HSDD and women’s testosterone treatment, the question is different. Total testosterone should not be used to diagnose HSDD, and BMS guidance favours total testosterone and clinical response over using free testosterone or FAI as a treatment target.[3][4]
Do testosterone levels fall with age?
Classic androgens, including testosterone and several precursors, generally decline with age, but the pattern is gradual and individual. Menopause is not a switch that creates one predictable value for all women.[1]
Ovarian surgery, adrenal or pituitary disorders, medicines and changes in SHBG can alter the pattern. The available evidence does not justify a simple decade-by-decade treatment table or a universal age-adjusted cut-off for “low testosterone”.
What can cause a low result?
A low result may be seen with ageing, surgical removal of both ovaries, some pituitary or adrenal disorders, severe illness, undernutrition and certain medicines. Oral oestrogen can raise SHBG and influence calculated measures.
The result does not prove that testosterone is causing fatigue, low mood, brain fog, reduced strength or another non-specific symptom. International consensus does not support testosterone treatment for cognition, mood, energy, bone or muscle outcomes in women.[4]
Where distressing low sexual desire is associated with menopause, NICE recommends considering testosterone only when HRT alone is not effective.[5] Diagnosis and treatment are based on a biopsychosocial assessment, not a low number alone.
What can cause a high result?
High testosterone or other biochemical hyperandrogenism can occur with PCOS, ovarian or adrenal disorders, severe insulin resistance, medicines or accidental exposure to another person’s testosterone gel or cream.[1][2]
Common features include hirsutism, acne, scalp hair loss and irregular periods. Rapidly progressive symptoms, voice deepening, clitoral enlargement or marked biochemical elevation need prompt specialist investigation for severe androgen excess.[1]
Read our separate guide to high testosterone in women for the investigation pathway.
Testing for suspected androgen excess
A clinician may request:
| Test | Why it may be used |
|---|---|
| Total testosterone | First-line biochemical assessment and severity. |
| SHBG and calculated free testosterone | Helps interpret hormone availability, particularly when SHBG is altered. |
| DHEAS and androstenedione | May help assess adrenal and ovarian androgen patterns. |
| 17-hydroxyprogesterone | Used when non-classic congenital adrenal hyperplasia is a possibility. |
| LH, FSH, oestradiol and prolactin | Added according to menstrual, fertility, pituitary or menopausal context. |
| Metabolic testing | PCOS and severe insulin resistance may require glucose, lipid and wider risk assessment. |
The exact panel depends on the history. Severe or inconsistent results may need repeat analysis using a more specific assay before imaging or other investigations.[1]
Monitoring testosterone treatment
Before treatment, total testosterone is measured to exclude an unexpectedly high baseline and establish a reference. During treatment, the aim is to remain within the reporting laboratory’s female physiological range while assessing symptom response and androgenic side effects.[3]
BMS guidance recommends reassessment after treatment begins and ongoing review at intervals determined by the prescriber; stable patients are commonly monitored every 6–12 months.[3] A result should not be pushed to the top of a range in pursuit of energy, mood or body-composition effects.
If there is no meaningful improvement in the licensed indication after an adequate trial, treatment should be stopped. For AndroFeme, the MHRA product information specifies stopping if there is no improvement after six months of optimised therapy.[6]
When a result needs prompt review
Seek prompt medical assessment when a high result is accompanied by rapid facial or body-hair growth, voice deepening, clitoral enlargement, severe acne, rapid muscle change or new postmenopausal virilisation.[1]
Also contact the prescriber if androgenic symptoms develop during testosterone treatment. Do not adjust the dose or change products without advice.
Questions to ask about your result
Ask the clinician or laboratory:
- Which assay was used?
- What is this laboratory’s female reference interval?
- Could SHBG, medication or HRT affect interpretation?
- Does the result need confirmation?
- Is the test investigating androgen excess, monitoring treatment or assessing another condition?
- Which symptoms or red flags change the next step?
Frequently asked questions
What is a normal testosterone level for a woman?
Use the reference interval supplied by the reporting laboratory. A universal online range may not apply because assays, age groups and populations differ.[1][2]
Does a low level diagnose HSDD?
No. Total testosterone is not a diagnostic cut-off for HSDD and does not predict treatment response. HSDD requires a biopsychosocial assessment.[3][4]
Should free androgen index be used to set a treatment dose?
Not as a universal target. BMS guidance favours total testosterone, clinical response and assessment of androgenic effects for treatment monitoring.[3]
What method is most accurate at female levels?
Liquid chromatography–tandem mass spectrometry is preferred for total testosterone where available, especially for unexpected or severe results.[1][2]
Does menopause automatically cause testosterone deficiency?
No. Testosterone generally declines with age, but menopause does not create one diagnostic threshold or prove that a symptom is testosterone related.[1]
When is a high result urgent?
Rapid virilisation, postmenopausal onset or severe biochemical elevation requires prompt specialist assessment.[1]
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] 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
[3] British Menopause Society. Testosterone replacement in menopause. May 2026. View source
[4] 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
[5] National Institute for Health and Care Excellence. Menopause: identification and management. Recommendation 1.5.32. View source
[6] Medicines and Healthcare products Regulatory Agency. AndroFeme 10 mg/mL cream, PLGB 57336/0002: Summary of Product Characteristics. View source
