Primary Causes & Action Plans

Total Testosterone

Your baseline testosterone production; primary measure of hormonal status
Total testosterone in women is typically 15-70 ng/dL. Levels below 30 ng/dL often produce fatigue, muscle loss, and low libido. But standard lab reference ranges are too broad; 40-60 ng/dL is optimal for most women.
Target 40-60 ng/dL (optimal)
Suggested Action Plan

If low, work with a hormone-knowledgeable doctor on bioidentical testosterone replacement. Topical cream or pellets are most physiologic. Retest 6-8 weeks after starting treatment.

Free Testosterone

Biologically active testosterone; better predicts symptom improvement than total
Most testosterone is bound; only a small percentage is free. Free testosterone is what produces effects. A woman can have low total but normal free testosterone (or vice versa). Free testosterone predicts symptomatic improvement better than total.
Target > 1.0 pg/mL
Suggested Action Plan

If free testosterone is low, testosterone replacement increases the free fraction proportionally. Retest 6-8 weeks after starting treatment to confirm improvement.

DHEA-S (DHEA-Sulfate)

Precursor to testosterone and estrogen; supportive hormone status
DHEA-S is the precursor to both testosterone and estrogen. Low DHEA-S indicates compromised adrenal or ovarian function. Supporting DHEA-S supports both testosterone and estrogen production.
Target 150-350 mcg/dL (women)
Suggested Action Plan

Support DHEA-S recovery through stress management, sleep, and adaptogenic herbs. Some women benefit from low-dose DHEA supplementation (25-50 mg daily), though this should be monitored by a physician.

SHBG (Sex Hormone-Binding Globulin)

Binds and inactivates testosterone; high SHBG can produce functional testosterone deficiency
High SHBG binds testosterone and reduces its bioavailable form. A woman can have normal total testosterone but low free testosterone if SHBG is high. This produces testosterone deficiency symptoms despite "normal" total levels.
Target < 40 nmol/L
Suggested Action Plan

Lower SHBG by improving insulin sensitivity, reducing inflammation, and losing excess weight. These interventions lower SHBG and increase free testosterone without needing to increase total testosterone.

Cortisol (Morning)

Stress hormones suppress testosterone; high cortisol prevents testosterone optimization
Chronically elevated cortisol suppresses GnRH and LH, reducing testosterone production. Women under chronic stress cannot effectively build testosterone even with supplementation.
Target 10-20 mcg/dL (8 AM)
Suggested Action Plan

Stress management is non-negotiable for testosterone optimization. Practice daily meditation, yoga, or breathwork. Ensure 8+ hours of sleep. Cortisol optimization is prerequisite for successful testosterone therapy.

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Getting Started

1
Get Comprehensive Testosterone Testing

Test total testosterone, free testosterone, DHEA-S, SHBG, and morning cortisol. Your specific pattern determines treatment approach: true testosterone deficiency vs. high SHBG reducing free testosterone vs. cortisol suppression.

2
Find a Hormone-Knowledgeable Physician

Many gynecologists do not routinely prescribe testosterone in women. Seek a functional medicine doctor, integrative gynecologist, or age management specialist familiar with women's testosterone therapy.

3
Start Bioidentical Testosterone

Bioidentical testosterone cream (applied daily), patches, or pellets (inserted every 3-4 months) are physiologic options. Injections are typically avoided in women. Start low (0.5-1.0 mg daily) and titrate upward based on symptoms and labs.

4
Monitor for Side Effects

Some women develop mild clitoral enlargement or increased facial hair. These are dose-dependent and often resolve with dose reduction. Virilization (deep voice, male-pattern baldness) suggests excessive dosing and requires reduction.

5
Retest in 6-8 Weeks

Biomarkers and symptoms should improve within 6-8 weeks of starting therapy. Retest to confirm free testosterone is optimal and adjust dose accordingly. Once optimized, monitor annually.

Why I built this guide.

"Low testosterone in women is common and highly treatable. Most women feel dramatically better once optimized."

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