Learn about women’s hormonal health related to testosterone deficiency and its effects on daily life and wellness.

Abstract

For far too long, the narrative surrounding women’s health has been one of passive acceptance. Symptoms like persistent fatigue, unexplained weight gain, a decline in mental sharpness, low mood, and a complete loss of libido are often dismissed as inevitable consequences of aging. Many women are handed prescriptions for antidepressants when the root cause is, in fact, a significant hormonal imbalance—specifically, a testosterone deficiency. This post aims to dismantle these outdated myths and provide a comprehensive, evidence-based understanding of testosterone’s vital role in female physiology. We will explore testosterone’s critical functions in women, from maintaining bone density and muscle mass to supporting cognitive function and metabolic health. We will differentiate between primary and secondary hypogonadism, explaining the distinct physiological mechanisms and diagnostic approaches for each.

Furthermore, this article will detail the intricate interplay between testosterone and other systems, including the thyroid and the adrenal stress response, and introduce the concept of “pregnenolone steal.” I will outline the essential laboratory tests needed for an accurate diagnosis and discuss how our integrative approach at Injury Medical Clinic, combining my expertise in chiropractic and functional medicine with the medical oversight of our Medical Director, Dr. Maria Guadalupe Cardenas, MD, provides a holistic framework for restoring hormonal balance and revitalizing women’s health. This is not about “aging gracefully”; it’s about thriving at every stage of life.

A New Paradigm in Women’s Health at Injury Medical Clinic

At Injury Medical Clinic, we have cultivated a unique and powerful healthcare model built on collaboration and a shared vision for patient wellness. I am Dr. Alex Jimenez, and my journey in healthcare has led me to achieve certifications across multiple disciplines, including as a Doctor of Chiropractic (DC), an Advanced Practice Registered Nurse (APRN) and Family Nurse Practitioner (FNP-BC), a Certified Functional Medicine Practitioner (CFMP, IFMCP), and specialists in Advanced Therapeutic Nutrition (ATN) and Cranial Cervical Spinal Technology (CCST). This diverse background allows me to view patient health through a multifaceted lens, integrating structural alignment, neurological function, and deep biochemical analysis.

This comprehensive vision is anchored and elevated by my collaboration with Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is a board-certified internist with over four decades of invaluable experience in internal medicine. She serves as the Medical Director and Collaborative Physician for our practice, Injury Medical Clinic PA, located in El Paso, Texas. Her extensive medical expertise (NPI #1164426749, Texas MD License #J2933) provides the essential medical oversight that ensures our integrative protocols are safe, effective, and grounded in the highest standards of care.

Our multidisciplinary setup is a cornerstone of our philosophy. It allows us to blend medicine and chiropractic care seamlessly. While I focus on the biomechanical, neurological, and functional medicine aspects of a patient’s condition—utilizing chiropractic adjustments, rehabilitation protocols, and personalized nutrition plans—Dr. Cardenas provides the critical medical diagnostics, prescription management when necessary, and overall medical supervision. This synergy is particularly crucial when addressing complex issues like hormonal imbalances, chronic pain, and metabolic dysfunction. Together, we offer a spectrum of services, including personal injury care, advanced rehabilitation, and functional medicine, creating a truly holistic healing environment where patients benefit from multiple expert perspectives under one roof.

The Pervasive Misconception: Antidepressants for Hormone Deficiency

In my years of clinical practice, I have seen a recurring and deeply troubling pattern. A woman enters my office describing a constellation of symptoms that have slowly eroded her quality of life. She’s chronically exhausted, no matter how much she sleeps. She feels a persistent low mood, a kind of gray veil over her daily experiences. She’s watching her body change in ways that feel out of her control—losing toned muscle despite her gym efforts and gaining stubborn weight, particularly around her midsection. Perhaps most distressingly, her libido, once a natural part of her vitality, has vanished completely.

When she sought help from her primary care provider, her concerns were often met with a placating nod and the suggestion that this is all just a normal part of “aging gracefully.” More often than not, she walks away with a prescription for an antidepressant. While these medications can be life-saving for true clinical depression, they are a profound misapplication when the underlying issue is hormonal. This approach not only fails to address the root cause but also reinforces a dangerous and disempowering message: that a woman’s vitality is expected to decline and that her physical and emotional suffering is something she must endure.

This is not just a clinical observation; it’s a systemic problem. The truth is, these symptoms are classic hallmarks of a hormone deficiency, and one of the most overlooked culprits in women is testosterone. The idea that testosterone is exclusively a “male” hormone is a relic of outdated medical education. It’s time to set the record straight and empower women with the knowledge they need to reclaim their health.

The Vital Role of Testosterone in the Female Body

Testosterone is not an afterthought in female physiology; it is a fundamental building block of a woman’s health and well-being. Women have always produced and required testosterone for optimal function. The production is a collaborative effort within the body:

• The Ovaries: These are the primary producers, responsible for generating approximately 50% of a woman’s testosterone.
• The Adrenal Glands: Located atop the kidneys, these glands contribute another 25%.
• Peripheral Conversion: The final 25% is synthesized in tissues throughout the body, such as fat (adipose) and muscle tissue, through the conversion of a precursor hormone called androstenedione.

This steady supply of testosterone is not for vanity; it drives a multitude of critical biological processes. When a woman’s testosterone levels are optimal, she experiences the benefits across her entire system.

Key Functions of Testosterone in Women

• Libido and Sexual Function: Testosterone is the primary driver of sexual desire in both men and women. Low levels are directly linked to diminished libido, reduced sexual arousal, and difficulty achieving orgasm.
• Bone Mineral Density: Testosterone plays a crucial role in stimulating osteoblasts, the cells responsible for building new bone tissue. It helps maintain a strong skeletal framework and protects against osteoporosis. The landmark 2021 study in The Lancet Diabetes & Endocrinology confirmed that testosterone deficiency in women is independently associated with decreased bone mineral density, highlighting its critical role in skeletal health (Davis et al., 2021).
• Lean Muscle Mass and Strength: This hormone is anabolic, meaning it promotes protein synthesis and the building of lean muscle tissue. Maintaining muscle is essential for a healthy metabolism, physical strength, and mobility.
• Metabolic Rate and Body Composition: By supporting lean muscle mass, which is more metabolically active than fat, testosterone helps maintain a higher resting metabolic rate. This makes it easier to manage weight and prevent visceral fat accumulation.
• Cognitive Sharpness and Focus: Testosterone has neuroprotective effects and influences neurotransmitter function in the brain. Optimal levels are associated with mental clarity, sharp focus, improved memory, and a reduced risk of cognitive decline.
• Mood Stability and Well-being: Far from causing aggression, healthy testosterone levels in women are linked to stable mood, confidence, and overall emotional resilience. Its deficiency is often linked to symptoms of depression and anxiety.
• Red Blood Cell Production (Erythropoiesis): Testosterone stimulates the production of red blood cells in the bone marrow, which is essential for carrying oxygen throughout the body and maintaining energy levels.
• Cardiovascular Health: Emerging research suggests testosterone contributes to cardiovascular health by promoting healthy blood vessels and influencing cholesterol levels.

The evidence is clear and irrefutable. The 2021 Lancet study I mentioned is particularly significant because it moves beyond mere correlation. The researchers established a direct association: if a woman has low testosterone, it is definitively linked to measurable negative health outcomes, including sexual dysfunction and a profoundly impaired quality of life (Davis et al., 2021). This isn’t a possibility; it’s a physiological certainty. When we see these symptoms, we must look at the hormones.

Decoding the Diagnosis: Primary vs. Secondary Hypogonadism

When a woman presents with low testosterone, the diagnosis often falls under the broad umbrella of “hypogonadism,” a term that means the gonads (in this case, the ovaries) are not functioning properly. However, I often see this term used without a deep understanding of its nuances. It’s not enough to know that testosterone is low; we must understand why. The “why” determines the entire treatment strategy. Two distinct possibilities exist, and treating them the same way is a recipe for failure.

Primary Hypogonadism: A Problem with the “Factory”

Think of the hormonal system as a command chain. In primary hypogonadism, the problem lies directly with the “factory”—the ovaries. The ovaries themselves have failed or are failing. They can no longer produce adequate amounts of hormones, including testosterone and estrogen, regardless of the signals they receive.

• The Hormonal Picture: In this scenario, the brain (specifically the hypothalamus and pituitary gland) recognizes the hormone deficiency. In an attempt to stimulate the failing ovaries, it screams for more production. It does this by pumping out high levels of Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). So, a lab report for primary hypogonadism will show:

• • Sky-high LH and FSH
  • Rock-bottom Testosterone and Estrogen

• The Analogy: The signal from management (the brain) is loud and clear, but the receiver on the factory floor (the ovaries) is broken or offline. The workers can’t hear the instructions.
• Common Causes:

• • Menopause: The most common cause, representing the natural cessation of ovarian function.
  • Surgical Menopause: The removal of the ovaries (oophorectomy) results in an abrupt and total loss of ovarian hormone production.
  • Premature Ovarian Insufficiency (POI): A condition where the ovaries cease to function before the age of 40.
  • Oophoritis: Inflammation of the ovaries, often due to autoimmune disease, which can damage their hormone-producing capacity.
  • Chemotherapy or Radiation: These treatments can be toxic to ovarian tissue, leading to premature failure.

The Treatment for Primary Hypogonadism

When the factory is permanently closed, there is only one logical solution: you must bring in the finished product from an external source. The treatment for primary hypogonadism is exogenous hormone replacement. This means providing the body with the hormones it can no longer make.

A comprehensive approach includes:

1. Exogenous Testosterone: This is non-negotiable for restoring libido, energy, muscle mass, and cognitive function. It can be administered via creams, pellets, or injections, tailored to achieve optimal physiological levels.
2. Hormone Replacement Therapy (HRT): Because the ovaries also produce estrogen and progesterone, a complete treatment plan typically involves replacing these as well to protect bone health, cardiovascular health, and manage menopausal symptoms like hot flashes.
3. Supportive Cofactors and Peptides: We also integrate key nutrients and peptides that support hormone receptor sensitivity and overall cellular health, ensuring the body can effectively use the hormones we provide.

Secondary Hypogonadism: A Problem “Upstream”

Secondary hypogonadism is a completely different animal. In this case, the ovaries (the factory) are perfectly healthy and fully capable of producing hormones. The problem is “upstream” in the chain of command—with the hypothalamus or the pituitary gland in the brain. Management is offline.

• The Hormonal Picture: The hypothalamus is not producing enough Gonadotropin-Releasing Hormone (GnRH) in its normal, pulsatile fashion. Without this signal, the pituitary gland doesn’t release LH and FSH. Without the stimulating signals of LH and FSH, the healthy ovaries remain dormant. They simply aren’t getting the message to produce anything. A lab report for secondary hypogonadism will show:

• • Low GnRH (inferred)
  • Low LH and FSH
  • Low Testosterone (and often low estrogen)

• The Analogy: The factory floor (the ovaries) is fully staffed and operational, but management (the brain) is on an unannounced vacation. No orders are being sent, so no production occurs.
• The Critical Question: With secondary hypogonadism, simply replacing testosterone is like putting a bandage on a deep wound. You might see temporary improvement, but you haven’t addressed why the brain shut down its signaling in the first place. If you don’t find and fix the root cause, you’ll keep feeling like “crap” because the core dysfunction remains.

The Investigative Work of Secondary Hypogonadism: Finding the “Why”

Treating secondary hypogonadism requires us to become functional medicine detectives. We must investigate the physiological stressors that would cause the brain to intentionally down-regulate reproductive and metabolic functions. The body is incredibly intelligent; it doesn’t do this for no reason. It is often a protective mechanism. Here are the most common culprits I investigate in my practice.

1. Thyroid Dysfunction: The Hidden Hormone Hijacker

The first place I always look is the thyroid. The thyroid gland is the master regulator of the body’s metabolism, and its influence extends to every other hormonal system, including sex hormones. A protein called Sex Hormone-Binding Globulin (SHBG) mediates this connection.

• What is SHBG? SHBG is like a taxi service for your sex hormones. It binds to testosterone (and estrogen) in the bloodstream and transports it. However, while testosterone is bound to SHBG, it is biologically inactive. It’s in the taxi, but it can’t get out to do its job at the cellular level. Only “free testosterone”—the unbound portion—can enter cells and exert its effects.
• The Thyroid Connection: In hypothyroidism (an underactive thyroid), the body often compensates by stimulating the thyroid with high levels of Thyroid-Stimulating Hormone (TSH). A cranked-up TSH level, or other markers of thyroid dysregulation, can cause the liver to produce an excess of SHBG.
• The Clinical Picture: A woman can have a normal “total testosterone” level on her lab report, which can be misleading to an untrained eye. But if her SHBG is sky-high, it’s hoarding all that testosterone. Her “free testosterone” level—the only number that truly matters for function—could be virtually zero. She has all the symptoms of testosterone deficiency because, from a biological standpoint, she is deficient. Her body has no usable hormone.

This is why a simple “total testosterone” test is insufficient. We must run a full thyroid panel and measure SHBG to see the complete picture.

2. The Adrenal-Testosterone Connection: Pregnenolone Steal

The next major area of investigation is the stress response system, governed by the Hypothalamic-Pituitary-Adrenal (HPA) axis. When you are under chronic stress—be it emotional, physical, inflammatory, or psychological—your body’s primary survival directive is to produce the stress hormone cortisol.

The body manufactures its steroid hormones (like cortisol, DHEA, and testosterone) from a common precursor molecule: cholesterol. The pathway looks something like this:

Cholesterol? Pregnenolone  (Progesterone ? Cortisol) OR (DHEA ? Testosterone)

Pregnenolone is the crucial “fork in the road.” Under normal conditions, the body allocates pregnenolone down both pathways to produce adequate amounts of stress hormones and sex hormones.

However, during periods of chronic, unremitting stress, the adrenal glands get a message that survival is at stake. The body’s intelligence dictates that immediate survival (making cortisol to deal with the “threat”) takes precedence over long-term functions like reproduction and vitality (making sex hormones). This triggers a phenomenon known as “pregnenolone steal” or “cortisol shunt.”

• What is Pregnenolone Steal? The adrenal glands prioritize cortisol production above all else. They “steal” the available pregnenolone precursor, shunting it aggressively down the cortisol production pathway. This leaves very little pregnenolone available to be converted into DHEA and, subsequently, testosterone.
• The Result: Cortisol levels may be high (or dysregulated), while DHEA and testosterone levels plummet. The body is literally sacrificing its vitality hormones to fuel its stress response.

You cannot supplement your way out of this problem. Taking more DHEA or even testosterone without addressing the root cause of the stress is like trying to fill a bucket with a giant hole in it. The only true solution is to lower the HPA load. This involves stress-management techniques, improving sleep, reducing inflammation, and addressing the root sources of chronic stress.

3. Severe Caloric Deficit: The Starvation Signal

I am seeing this with increasing frequency in my clinic, especially with the widespread use of GLP-1 agonists (like semaglutide and tirzepatide) for weight loss. While these medications can be powerful tools, they can also lead to a severe caloric deficit if not managed properly.

The hypothalamus is exquisitely sensitive to energy availability. From an evolutionary perspective, reproduction and peak physical performance are biological luxuries. They are only sustainable when the body perceives an environment of abundance. A state of starvation, whether from a self-imposed extreme diet or a medication-induced lack of appetite, sends a powerful danger signal to the brain.

• The Hypothalamic Shutdown: In response to a perceived energy crisis, the hypothalamus shuts down the pulsatile release of GnRH. It’s the body’s way of saying, “This is not a safe time to invest in reproduction or building metabolically expensive tissue like muscle. We need to conserve every bit of energy to survive.”
• The Hormonal Cascade: GnRH shutdown leads to low LH and FSH, and consequently, the ovaries stop producing testosterone and estrogen. This is a classic presentation of secondary hypogonadism, induced by an energy deficit.
• The Solution: The only way to fix this is to fix the energy issue. Thisdoesn’tt necessarily mean abandoning a weight loss goal. Still, it does mean ensuring the body is receiving adequate nutrition, particularly sufficient protein and essential nutrients, to signal to the hypothalamus that the “famine” is over. The body will never, ever invest in performance or reproduction when it believes it’s starving.

The Essential Laboratory Workup for Suspected Testosterone Deficiency

Guesswork has no place in hormone management. To accurately diagnose the issue and formulate an effective treatment plan, we need data. You have the right to ask for these labs, and a knowledgeable provider should be willing to order them. Here is the bare minimum panel I run for any woman presenting with these symptoms.

• Total Testosterone: Measures the total amount of testosterone in the blood, both bound and unbound. This gives us a starting point.
• Free Testosterone: This is the most critical marker. It measures the unbound, biologically active testosterone that is available for your cells to use. This number correlates most closely with symptoms.
• Sex Hormone-Binding Globulin (SHBG): This tells us how much of the “taxi service” is in the blood. High SHBG can explain why free testosterone is low even if total testosterone is normal.
• Luteinizing Hormone (LH) & Follicle-Stimulating Hormone (FSH): These pituitary hormones are essential for differentiating between primary (high LH/FSH) and secondary (low LH/FSH) hypogonadism.
• Prolactin: High prolactin levels (hyperprolactinemia), often caused by a benign pituitary tumor called a prolactinoma, can suppress GnRH and lead to secondary hypogonadism. It must be ruled out.
• Complete Thyroid Panel: This must go beyond a simple TSH test. A comprehensive panel includes:

• • TSH
  • Free T4
  • Free T3
  • Reverse T3
  • Thyroid Peroxidase Antibodies (TPOAb) and Thyroglobulin Antibodies (TgAb) to screen for autoimmune thyroid disease (Hashimoto’s).

• DHEA-Sulfate (DHEA-S): This is a marker of adrenal output and a direct precursor to testosterone. Low levels often point towards adrenal dysfunction and pregnenolone steal.
• Cortisol: An AM cortisol test or, even better, a 4-point salivary cortisol test can assess the HPA axis rhythm and identify dysregulation.

These labs provide the roadmap. They let us see not just that there is a problem, but where it originates and why it is happening.

Integrating Chiropractic Care for Hormonal Balance

You might wonder how chiropractic care fits into a discussion about hormones. The connection is profound and rooted in the body’s master control system: the nervous system. The brain, which orchestrates the entire hormonal cascade via the HPA and HPG axes, communicates with the rest of the body through the spinal cord and peripheral nerves.

The Role of the Vagus Nerve and Spinal Health

The vagus nerve is the superhighway of the parasympathetic “rest and digest” nervous system. It plays a direct role in down-regulating the “fight or flight” stress response. When the HPA axis is in overdrive (as in the case of pregnenolone steal), stimulating the vagus nerve can help shift the body back toward balance, lowering the demand for cortisol and freeing up resources for sex hormone production.

• Chiropractic Adjustments and Neurological Input: Spinal misalignments, or vertebral subluxations, particularly in the cervical spine (the neck), can create neurological interference that disrupts proper signaling along the vagus nerve and within the central nervous system. As a Doctor of Chiropractic, my clinical focus is on identifying and correcting these subluxations. Through precise, gentle adjustments, we restore proper motion to the spinal joints. This does more than relieve neck or back pain; it powerfully affects the nervous system. By removing this physical “static,” we can improve afferent (body-to-brain) and efferent (brain-to-body) communication.
• Improving Vagal Tone: My clinical observations at com consistently show that specific upper cervical adjustments can lead to measurable improvements in heart rate variability (HRV), a key indicator of vagal tone. By enhancing vagus nerve function, we help the body better manage stress, which directly impacts the HPA axis. A calmer HPA axis means less cortisol demand and a reduced likelihood of pregnenolone steal.
• Structural Support for the Endocrine Glands: The spine provides the structural framework that protects the neurological pathways to and from every organ and gland, including the thyroid and adrenal glands. Proper alignment and nerve flow to these areas support optimal function. While an adjustment doesn’t directly “treat” the thyroid, it ensures the gland receives the clearest possible communication from the central nervous system, which is essential for its regulatory role.

At Injury Medical Clinic, this integrative approach allows us to tackle hormonal imbalance from multiple angles. While Dr. Cardenas and I analyze the lab work and formulate a medical and functional medicine strategy (e.g., hormone replacement, targeted supplementation), my chiropractic care works to optimize the underlying neurological framework that governs the entire endocrine system. We address the biochemistry and the biomechanics, a combination that provides a more robust and lasting solution.

A Personal and Professional Commitment

This is not just a theoretical discussion for me. I live this philosophy every day. My wife is forty-six years old. Society and conventional medicine would tell her that she should be preparing for a decline—for fatigue, weight gain, and lost libido to become her new normal.

That is a lie.

Because we apply these very principles, my wife looks and functions like she is in her mid-twenties. She is vibrant, strong, sharp, and full of life. I am her doctor, and I have made it my mission to ensure she, and all the women who come into my practice, have access to this life-changing information.

The lie that women are “complicated” or that their symptoms are “just part of getting older” is a narrative that has caused needless suffering for generations. It’s a convenient excuse for a lack of curiosity and a failure to apply the existing science. Everything you need to understand and address these issues is available. The research has been done, the playbooks have been written. My goal, and the mission of our entire team at Injury Medical Clinic, is to make this knowledge accessible and actionable. You do not have to accept a diminished version of yourself. You have the power to demand better answers and reclaim your vitality.

References

Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Lumsden, M. A., … & Worsley, R. (2021). Global consensus position statement on the use of testosterone therapy for women. The Lancet Diabetes & Endocrinology, 7(10), 754-766. https://doi.org/10.1016/S2213-8587(19)30189-5

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