Why does this matter?

In women, testosterone is produced by the ovaries as well as by the adrenal glands. The concentration of testosterone in females begins increasing as early as the age of six to support the development of muscle mass while peak levels are typically observed in the 30s to 40s.

Some but not all studies suggest that decreased levels of testosterone in women could be related to some types of cancer, including breast cancer. It’s still not clear whether there would be any direct effect since there are other factors that can affect cancer risk.

The following are some women’s health factors that could be influenced by testosterone.

Sexual health

In studies of women ranging in age from 19-65, endogenous testosterone levels were associated with sexual desire and arousal. Testosterone is also associated with vaginal health testosterone levels were inversely associated with vaginal atrophy in postmenopausal women, and testosterone can help enhance vaginal blood flow as well as lubrication.

Randomized control trials have demonstrated that administration of testosterone both with and without estrogen administration was effective for treating menopausal women with hypoactive sexual desire.

Bone, muscle, and cardiovascular health

Women during their later reproductive years who have lower concentrations of testosterone showed a decline in bone mineral density of more than 1% annually. For postmenopausal women, testosterone is positively associated with the density of the lumbar spine and hip. In both populations, this relationship is independent of estradiol.

Like bone density, high concentrations of testosterone in women 67-94 years of age are associated with greater lean body mass and women given a combination of estrogen and testosterone had increased lean mass and decreased fat mass compared to estrogen alone.

Though this evidence suggests that there may be a key role of testosterone in helping prevent the onset of osteoporosis in advanced age, clinical trials using testosterone therapy in women have been small and the risk of fracture remains uncertain.

In general, testosterone in women is positively correlated to a decreased risk of coronary and cardiovascular artery disease. In addition, contrary to widespread belief, randomized controlled trials have also shown that testosterone will not adversely affect known cardiovascular risk factors. However, this should be interpreted with some caution. Though low concentrations of testosterone are associated with a higher chance of cardiovascular disease, other factors like sex hormone-binding globulin (SHBG) and estrogen could also have an effect.

In addition, since there is a relationship between greater muscle mass and bone density with testosterone in women, it may also be plausible that those can have greater levels of physical activity with fewer physical barriers to strength and injury, and that in turn would also reduce cardiovascular disease (CVD) risk. Finally, there is a U-shaped relationship with testosterone; excessively high testosterone levels may also pose an increased risk of CVD in women.

Cognition

High-quality evidence of the effect of testosterone on cognition is lacking, with studies reporting single-dose treatments or short duration. Though some studies do indeed point to a positive effect of testosterone on cognition, there are methodological issues.

However, methodologically stronger studies suggest that there is a positive association between verbal learning and memory and concentration of testosterone in postmenopausal women. This testosterone was administered to the patients and these effects seem to be independent of testosterone converting to estradiol (aromatization). Further investigation is needed to determine if treatment of testosterone in this population is warranted, but this does suggest a role of testosterone in women’s cognition.