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Normal Level of Free Testosterone in Females

by Justin

Testosterone is often considered a male hormone, but females also produce testosterone in small amounts. It plays a vital role in a woman’s overall health. This article discusses what comprises normal testosterone levels in women, associated health effects, and when to seek kapeefit online ayurvedic consultation medical care for abnormal testosterone.

Understanding Testosterone

Testosterone is an androgen or sex steroid hormone produced mainly by the ovaries in women. It has important functions including:

  • Stimulating the development of female reproductive tissues and secondary sexual characteristics during puberty
  • Regulating sexual desire or libido
  • Influencing bone and muscle strength
  • Impacting red blood cell production
  • Affecting distribution of body fat
  • Involved in mood and cognitive functions

Testosterone production begins before birth and continues through the lifecycle in females. Levels start to decline after the 30s. Knowing what constitutes normal levels at different ages is important.

Total Testosterone vs. Free Testosterone

  • Total testosterone – This refers to the overall testosterone circulating in the body. About 60% is bound to proteins like sex hormone-binding globulin (SHBG) and albumin.
  • Free testosterone – Refers to the testosterone not bound to proteins, representing 2-3% of total testosterone. Free testosterone is the active form that exerts effects on target tissues.
  • Measuring both total and free testosterone provides the complete picture of androgen status.
  • The free testosterone level is a more accurate indicator of excess or deficient androgen activity as it reflects the bioavailable active form.

Normal Range of Testosterone in Females

Normal testosterone levels vary across the lifespan in females:


  • Total testosterone – Less than 32-86 ng/dL
  • Free testosterone – 0.2 – 5 pg/mL

Women of Reproductive Age

  • Total testosterone – 8-60 ng/dL (Average around 20-25 ng/dL)
  • Free testosterone – 0.1-6.4 pg/mL (Optimal 0.5-2.5 pg/mL)

Postmenopausal Women

  • Total testosterone – 10-40 ng/dL
  • Free testosterone – 2.5-9.5 pg/mL

These ranges provide general guidance. The optimal level for an individual patient depends on symptoms and other health parameters. Levels on the lower or higher end may still be normal for some women.

Symptoms of High Testosterone in Females

Elevated testosterone manifests with signs of excess androgen or “hyperandrogenism”. Symptoms may include:

  • Irregular, infrequent menstrual periods or amenorrhea (absent periods)
  • Acne outbreaks
  • Excess facial and body hair growth (hirsutism)
  • Thinning hair and hair loss from the scalp (androgenic alopecia)
  • Deepening of voice
  • Increased muscle mass and strength
  • Reduction in breast size
  • Severe premenstrual syndrome (PMS)
  • Changes in sexual desire
  • Mood changes – anxiety, irritability, depression

High testosterone can also contribute to problems like infertility, insulin resistance, obesity, and osteoporosis in some cases.

Causes of High Testosterone in Females

Some conditions that can lead to elevated testosterone levels in women include:

Polycystic Ovary Syndrome (PCOS)

PCOS causes multiple ovarian cysts and is a common cause of high testosterone in women of reproductive age. Other PCOS symptoms are irregular periods, weight gain, acne, and excess hair growth.

Adrenal Gland Disorders

Tumors in the adrenal glands can produce excess testosterone along with cortisol and other hormones. Cushing’s disease is one example.

Ovarian Tumors

Testosterone-secreting tumors affecting the ovarian cells that produce male hormones (Leydig cell tumors) may rarely occur.


The benign growth of hormone-producing cells in the ovaries increases testosterone production. Usually affects postmenopausal women.


Certain drugs like anabolic steroids, hormone replacement therapy, and glucocorticoids can elevate testosterone levels.

Idiopathic Hirsutism

This refers to excessive hair growth on the face and body in women without elevated testosterone. It may run in families.

A complete medical evaluation is needed to determine the exact cause of high testosterone.

Effects of Low Testosterone in Females

While less common than excess testosterone, low levels can also cause bothersome symptoms:

  • Reduced sex drive, vaginal dryness
  • Fatigue, low energy and endurance
  • Difficulty achieving orgasm
  • Weight gain – increase in body fat, reduced muscle mass
  • Depression, poor concentration, and memory
  • Aching joints and bones, osteoporosis risk
  • Cardiovascular risks if coexisting with early menopause

Symptoms depend on the age and vary among individuals. Postmenopausal women are more vulnerable to the effects of testosterone deficiency.

What Causes Low Testosterone in Females?

Some reasons women may experience low testosterone:

Primary Ovarian Insufficiency

When ovaries stop functioning normally before age 40, testosterone levels drop along with estrogen. Causes include genetics, autoimmunity, infections, toxins, or treatments like chemotherapy.


Tumors and radiation therapy to the pituitary gland situated at the base of the brain can impair testosterone production.

Adrenal Insufficiency

Disorders affecting the adrenal glands like Addison’s disease lead to deficient production of DHEA, a testosterone precursor.

Chronic Illness

Chronic inflammatory conditions like HIV/AIDS, rheumatoid arthritis, cirrhosis, etc. can lower testosterone.


Anti-seizure drugs, glucocorticoids, and GnRH agonists may reduce testosterone production.


Testosterone production starts declining naturally after 30 years of age due to reduced ovary function.

Evaluating associated symptoms and testing for possible underlying disorders help identify the cause of low testosterone.

Significance of Testosterone-Estrogen Ratio

Looking at the balance between testosterone and estrogen levels in a woman provides additional insight:

  • Increased testosterone is expected to lower estrogen levels by suppressing ovulation.
  • Low estrogen relative to testosterone indicates the likely cause is increased androgen production from ovaries or adrenal glands rather than abnormal estrogen metabolism.
  • High estrogen along with high testosterone suggests problems converting testosterone to estrogen. This includes excessive aromatase enzyme activity observed in obesity.
  • Testosterone deficiency usually corresponds to low estrogen levels as both are synthesized together in the ovaries.

Considering the testosterone-estrogen ratio along with patient symptoms gives a clearer picture of hormone status to the doctor.

Diagnosing High or Low Testosterone

Doctors diagnose abnormal testosterone levels through:

Medical History

Personal and family history of symptoms suggestive of hormone imbalance. History of any associated conditions.

Physical Exam

Signs like acne, hair changes, and muscle development indicate altered androgen levels.

Blood Tests

  • Total and free testosterone levels
  • Related hormone tests – DHEA-S, estrogen, LH, FSH, SHBG.
  • fasting glucose, lipid profile, and other metabolic tests if needed

Pelvic Ultrasound

Helps identify ovarian or adrenal gland abnormalities that can affect testosterone

Treatment for High Testosterone in Females

Treatment aims to manage symptoms by lowering testosterone to normal levels through:

Lifestyle Changes

  • Losing excess weight through diet and exercise. Obesity worsens hormonal imbalance.
  • Stress management. High stress increases testosterone.
  • Avoiding smoking and alcohol intake.


  • Oral contraceptives – Helps reduce testosterone levels and regulate menstrual cycles.
  • Spironolactone – Blocks effects of testosterone on hair follicles and skin.
  • GnRH agonists – Help lower testosterone when other treatments fail.
  • Metformin – For PCOS patients to improve insulin resistance.

Topical Creams

  • Eflornithine hydrochloride cream – Can slow facial hair growth in women.

Hair Removal Treatments

  • Laser therapy and electrolysis can remove excess hair growth on the body and face.


  • Ovarian wedge resection, ovarian drilling – minimally invasive surgical options to lower testosterone in PCOS.
  • Removal of tumor if present.

Doctors personalize combination treatment based on the underlying cause, age, health status, patient goals regarding fertility, etc.

Treating Low Testosterone in Females

Kapeefit online ayurvedic consultation for Low testosterone levels in females is treated through:

Treating Underlying Conditions

Correcting any primary disorders like hypopituitarism, autoimmune disease, etc. can help restore normal testosterone balance.

Testosterone Replacement

  • Testosterone creams, gels, patches, pellets, or injections can provide low doses of testosterone.
  • Well-tolerated and effective for improving sex drive and energy.
  • Long-term safety requires careful monitoring.

Estrogen Therapy

Postmenopausal women may be given supplemental estrogen to control symptoms if coexisting with testosterone deficiency.


Depo-testosterone injections may help women who have undergone surgical removal of ovaries. DHEA supplements can increase testosterone levels to some degree in adrenal insufficiency.

Alternative Therapies

Acupuncture, diet changes, and stress reduction techniques may provide some relief from low testosterone symptoms in milder cases.

Doctors monitor therapy closely to keep testosterone levels within the normal premenopausal range in women.

Monitoring Response to Treatment

Women on treatment for abnormal testosterone levels need periodic monitoring which includes:

  • Assessing improvement in clinical symptoms like fatigue, low libido, menstrual irregularity, etc.
  • Examining hair growth patterns, acne changes
  • Repeating testosterone and related hormone blood tests
  • Checking for side effects of medications like spironolactone, metformin, etc.
  • Pelvic ultrasound if on testosterone replacement to evaluate ovarian changes
  • Bone mineral density tests for women on long-term testosterone therapy
  • Blood count, liver function, lipid profile, and metabolic testing as needed

Dose adjustments, medication changes, or additions are made based on progress and test results.

Lifestyle Measures to Optimize Testosterone

Alongside medical treatment, the following lifestyle habits can help regulate testosterone:

  • Maintain healthy body weight – Being significantly overweight or underweight alters hormone balance.
  • Limit alcohol intake – Chronic alcohol excess drives testosterone and estrogen deficiency.
  • Perform resistance training – Strength training triggers modest beneficial elevations in testosterone.
  • Reduce stress – Excess stress hormones impair testosterone metabolism.
  • Get good sleep – Lack of sleep disrupts testosterone release.
  • Quit smoking – Cigarette compounds hamper testosterone synthesis.
  • Boost intake of healthy fats – Polyunsaturated and monounsaturated fats help testosterone production.
  • Consume high Boron foods – Boron mineral aids testosterone and estrogen metabolism. Good sources are nuts, prunes, avocado, etc.

A balanced nutritious diet and active lifestyle provide the foundation for maintaining optimal testosterone status long-term.

Role of Age in Evaluating Testosterone Levels

The approach to interpreting testosterone levels must consider a woman’s age:

Young Females

  • Testosterone levels before puberty below age 8 should be very low.
  • High levels at a young age warrant investigation for precocious puberty or tumors.
  • Tests must specify reference ranges appropriate for prepubertal children.

Reproductive Age

  • Testing in women is indicated only if symptoms of hormone imbalance like irregular periods, infertility, acne, excess hair growth, etc are present.
  • Symptomatic women need evaluation for PCOS, adrenal disorders, rare testosterone-secreting tumors, etc.


  • Testosterone starts to decline several years before menopause as ovaries age.
  • Low-normal levels consistent with perimenopausal status may not need treatment.
  • Postmenopausal hormone therapy helps control associated symptoms.

Older Women

  • Postmenopausal women have the lowest testosterone levels.
  • However, replacement is still controversial for age-related deficiency without specific symptoms.
  • Benefits vs risks have to be carefully weighed.

Doctors consider the changing testosterone requirements throughout a woman’s lifespan when advising testing and interpreting results.

Takeaway Points

Key points to remember about testosterone’s role in female health:

  • Testosterone is essential for female reproductive development and has wider health implications. Both total and free levels must be tested.
  • Normal testosterone range in women varies across life stages. Symptoms along with levels determine abnormal high or low status.
  • High testosterone causes irregular periods, excess hair growth, infertility, etc. Causes include PCOS, adrenal tumors, medications, etc.
  • Low testosterone can impair sex drive, mood, and bone strength. Primary ovarian failure after menopause is the most common cause.
  • Testing for testosterone imbalance must be guided by clinical symptoms. Testing healthy asymptomatic women is rarely needed.
  • Lifestyle modification and medical treatment help restore levels to normal and relieve associated symptoms.
  • Regular monitoring of testosterone levels is important during treatment along with assessing for possible side effects.
  • Maintaining optimal testosterone balance throughout the lifespan is key for women’s health and well-being. Consulting a doctor facilitates proper diagnosis and management when abnormalities occur.

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