What happens to testosterone levels in men and women as they age?

Many of the symptoms of low testosterone levels in men and women are non-specific, and are often readily attributed to aging or disease, without looking for the real cause.

In both men and women, blood levels of the major male sex hormones (androgens) decline by about 1% every year from our mid-thirties.

By the age of 70, at least one in every 10 men experiences the ‘androgen deficiency of the aging male’ (ADAM). This is where low testosterone levels can reduce quality of life and cause symptoms such as lower libido, erectile dysfunction, fatigue, disturbed sleep and lower concentration.

Women in their 40s have on average half the testosterone level they had in their 20s. This decline can make a major difference to libido, mood and general wellbeing. Low testosterone levels also contribute to skin wrinkling, pelvic-floor problems and ‘middle-aged spread’.

How does reduced testosterone affect men and women?

Testosterone levels in men and women don’t just affect quality of life. They also play an important role in maintaining strong bones, cognitive functioning, and metabolic and cardiovascular health.

Testosterone deficiency symptoms appears moreso in those who have diabetes, smoke, are overweight or obese, drink excessive amounts of alcohol, or suffer from chronic stress (which disrupts nearly all hormonal pathways to some extent). You can prevent this by making sensible dietary and lifestyle choices.

Women can modify androgen levels with oral hormone replacement therapy (HRT). This decreases the amount of testosterone available to keep us at peak function. Women on HRT with sexual dysfunction or unexplained fatigue should consider transdermal estrogen patches.

How to test testosterone levels

Men who think they may be low in testosterone can take a number of screening questionnaires to identify if they’re at risk.

They can then follow up any abnormal score with blood tests. The best time to have these tests is as early in the morning as possible because this is when testosterone levels tend to peak, and this peak tends to flatten out with aging. Salivary testosterone can also provide a reasonable approximation of free testosterone levels.

Adult men with abnormally low levels of total testosterone (less than 8nmol per liter) or with low free testosterone levels (of less than 10nmol per liter) and symptoms that suggest low levels, are generally said to suffer from ADAM.

There is no good reason for men to check testosterone levels or take supplements in the absence of symptoms. Moreover, using testosterone in the absence of deficiency is problematic, as prolonged use can negatively affect health and mood (such as ’roid rage’ – the aggression that often accompanies on-going use of steroids).

For women, there are no standardized screening questionnaires for low testosterone levels.

However, women with adequate estrogen levels who have significantly diminished sexual motivation and/or desire, persistent unexplainable fatigue, or a decreased sense of wellbeing, should consider testing their testosterone levels. They can also consider trialling androgen supplements once they exclude other possible causes of their symptoms.

Treatment thresholds for women are also unclear. Many clinicians advocate just treating women based on symptoms, as most tests are only standardized for male levels of testosterone, and quite inaccurate at the 10–20 times lower levels of testosterone healthy women have.

How to combat declining testosterone levels in men and women

Supplements can address low testosterone levels in men and women and result in improved quality of life and sexual, mental and physical functioning. This is hardly surprising, as all androgens are performance-enhancing drugs.

Testosterone treatment now comes in many forms including:

  • capsules (Andriol)
  • patches (Androderm)
  • gel (Testogel)
  • short-term injections administered every 1-3 weeks (Sustanon)
  • long-term ‘depot injections’ every 4-6 months (Renadron)
  • testosterone pellet implants that contain only testosterone extracted from plant materials.

The best formulation for men depends on how much they need to restore testosterone levels and reduce their symptoms.

For women who need very little testosterone to restore healthy levels, doctors recommend transdermal patches and topical gels. Post-menopausal women should take testosterone in combination with HRT. This is due to a lack of adequate safety and efficacy data on taking testosterone alone.

Pro-hormones such as androstenedione, androstenediol and DHEA, which the body partly metabolises into testosterone, can also be very effective in increasing testosterone levels in women.

Some herbal formulations work to inhibit liver enzymes, thus increasing the bodies’ natural testosterone levels. These include Tribulus Terrestris, Eurycoma Longifolia and Vitex. However, none of these are effective methods of treating androgen deficiency, and have their own risks.

Men and women may be able to slow declining testosterone levels by exercising regularly, enjoying good quality sleep, managing stress levels, and stopping smoking.

Last reviewed 24/Feb/2017

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