Explore the link between women’s hormonal health and testosterone deficiency. Find ways to manage and improve your wellness.
Table of Contents
This educational post explores the often-misunderstood and under-diagnosed issue of testosterone deficiency in women. For too long, symptoms like fatigue, depression, weight gain, and low libido have been dismissed as inevitable consequences of aging. However, a growing body of evidence, which we will explore in detail, reveals that these are often hallmark signs of hormonal imbalance, specifically low testosterone. I am Dr. Alex Jimenez, and in this comprehensive guide, I will walk you through the critical role testosterone plays in female health, drawing from the latest findings of leading researchers and my clinical experience. We will dissect the physiological pathways of testosterone production, differentiate between primary and secondary hypogonadism, and uncover the root causes—from ovarian failure to the intricate interplay of stress, thyroid function, and metabolic health. This journey will empower you to understand your body, advocate for proper testing, and explore effective, evidence-based treatment strategies.
At Injury Medical Clinic PA in El Paso, Texas, we champion an integrative, multidisciplinary approach. This post will also show how we deliver comprehensive patient care through the unique collaboration between me, Dr. Alexander Jimenez (DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST), and our esteemed Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas, a Board-Certified Internist with over four decades of experience (NPI #1164426749, Texas MD License #J2933), provides essential medical oversight, ensuring our diagnostic and treatment protocols meet the highest standards of care. Together, we integrate functional medicine, integrative chiropractic care, medical diagnostics, and personalized rehabilitation to address the whole person, not just their symptoms. We will discuss how this collaborative model is uniquely positioned to manage complex conditions like hormone deficiencies, providing a seamless blend of medical precision and holistic healing. By the end of this post, you will have a deep understanding of female testosterone deficiency and a clear roadmap toward reclaiming your vitality.
As a clinician with dual credentials in chiropractic and advanced practice nursing, specializing in functional medicine, I have dedicated my career to uncovering the root causes of chronic symptoms that diminish quality of life. One of the most pervasive and damaging misconceptions I encounter daily in my practice revolves around testosterone and its role in women’s health. For far too long, the narrative has been that testosterone is exclusively a “male” hormone, and its presence in women is either insignificant or problematic. This could not be further from the truth.
It is a clinical reality that breaks my heart: countless women enter my office feeling utterly defeated. They describe a constellation of symptoms—crippling fatigue, a persistent low mood or depression, a complete loss of libido, unexplained weight gain despite their best efforts, and a noticeable decline in muscle mass and physical strength. They have often seen multiple doctors, only to be told this is just “part of getting older.” Many are handed a prescription for an antidepressant and advised to “age gracefully.” This advice is not only dismissive but also scientifically unsound. It is a profound disservice to women who are suffering not from a primary psychiatric disorder, but from a tangible, measurable, and, most importantly, treatable hormone deficiency.
The notion that women should accept a decline in vitality as an inevitable part of aging is a lie. My wife is 46 years old, and through a proactive, evidence-based approach to hormone optimization, she looks and functions with the energy and vitality of someone in her mid-twenties. I am not just her husband; I am her doctor, and I apply the same rigorous scientific principles to her care as I do for every patient who walks through my doors. The knowledge and tools to reverse this decline are not hidden; they are readily available in published research and clinical playbooks. My mission is to bring this information to light.
Women produce testosterone, and they always have. It is an essential biological component for optimal female health. The idea that hormones are “complicated” is often used as a shield to mask a lack of understanding or an unwillingness to investigate deeper. In reality, the physiology is elegant and comprehensible. By understanding how and why testosterone works in the female body, we can move from a place of passive acceptance to one of proactive empowerment. This post is your first step on that journey.
Testosterone in women is not a biological accident; it is a cornerstone of health and well-being. Its influence extends far beyond the bedroom, touching nearly every system in the body. To truly grasp why its deficiency can be so devastating, we must first appreciate its multifaceted functions. The production of this vital hormone is a beautifully orchestrated process involving multiple organs working in concert.
The female body manufactures testosterone through a distributed network of endocrine tissues. This decentralized production system highlights its systemic importance. Here is the breakdown:
This distributed production model means that a disruption in any one of these areas—be it ovarian health, adrenal function, or metabolic status—can impact a woman’s overall testosterone levels.
While testosterone is most famous for its role in sexual desire, its job description is far more extensive. As confirmed in a pivotal 2021 publication in The Lancet Diabetes & Endocrinology, testosterone deficiency in women is not merely correlated with poor health outcomes; it is independently associated with them. This is a crucial distinction. A correlation means two things happen together; an association implies a direct, causal link. Let’s explore these critical functions in detail.
Understanding this wide-ranging impact is the first step. When a woman presents with depression, fatigue, and weight gain, a perceptive clinician should see these not as isolated issues, but as potential signals of a systemic hormonal imbalance rooted in testosterone deficiency.
At Injury Medical Clinic PA, we have built a practice model founded on collaboration and a shared vision of patient-centered care. We recognize that the human body is a complex, interconnected system and that true healing requires a multidisciplinary approach that transcends the traditional silos of medicine. This philosophy is embodied in the professional partnership between me, Dr. Alex Jimenez, and our Medical Director, Dr. Maria Guadalupe Cardenas, MD.
My background provides a unique clinical lens. As a Doctor of Chiropractic (DC), my training is rooted in the body’s biomechanical and neurological integrity. As an Advanced Practice Registered Nurse (APRN) and Board-Certified Family Nurse Practitioner (FNP-BC), I have the diagnostic and prescriptive authority to manage a wide range of medical conditions. My certifications as a Certified Functional Medicine Practitioner (CFMP) and an Institute for Functional Medicine Certified Practitioner (IFMCP) also drive my commitment to identifying and treating the root causes of disease.
This multifaceted expertise is powerfully complemented by Dr. Maria Guadalupe Cardenas’s profound experience. As a Board-Certified Internist with over 40 years of practice, Dr. Cardenas brings an exhaustive knowledge of pathophysiology, pharmacology, and the complexities of internal medicine. Her role as our Medical Director and Collaborative Physician is not a mere formality; it is the cornerstone of our integrative model. This structure, where an MD provides medical direction and oversight for a clinic led by a chiropractor and nurse practitioner, is common in cutting-edge integrative and injury care settings. It ensures our patients receive the best of all worlds: holistic, root-cause-oriented care grounded in the rigorous standards and diagnostic precision of conventional medicine.
When a patient comes to us with symptoms suggestive of testosterone deficiency, our collaborative process begins immediately.
This seamless integration of medical oversight, functional medicine investigation, and chiropractic care allows us to provide a level of comprehensive treatment that isn’t possible in a conventional, single-specialty setting. We don’t just replace a hormone; we rebuild the foundations of health so the body can regulate itself more effectively.
When a woman’s testosterone is low, the diagnosis is broadly termed hypogonadism. However, labeling the condition is not enough. It is like saying a car won’t start without asking if the problem is a dead battery or an empty gas tank. To treat effectively, we must understand why the testosterone is low. In my clinical practice, I see a concerning trend where the term “hypogonadism” is used generically, leading to one-size-fits-all treatment that often fails. There are two distinct types of hypogonadism, each with a different cause and a different management strategy.
Primary hypogonadism is a problem with the “factory” itself—the ovaries. In this scenario, the ovaries have lost their ability to produce hormones, including testosterone and estrogen, despite receiving the correct signals from the brain. Think of it as a factory with broken machinery. The management team (the brain) is shouting instructions, but no one on the factory floor can hear or respond.
The Hormonal Signature:
The brain, specifically the pituitary gland, senses the low levels of ovarian hormones in the blood. To stimulate the failing ovaries, it ramps up production of signaling hormones. The key hormonal markers for primary hypogonadism are:
Common Causes of Primary Hypogonadism:
The Treatment Solution for Primary Hypogonadism:
When the factory is permanently broken, there is no way to fix the machinery. The signal from the brain is fine, but the receiver is cooked. The only logical and effective solution is to provide the hormones that the body can no longer make. This is exogenous hormone replacement.
The treatment plan for primary hypogonadism is direct and clear:
Hormone Replacement Therapy (HRT): This involves replacing both estrogen and progesterone (if the woman has a uterus) to manage menopausal symptoms and protect long-term health. Crucially, it must also include testosterone replacement. Omitting testosterone ignores a huge piece of the puzzle.
Supportive Cofactors and Peptides: We also support this therapy with nutritional cofactors necessary for hormone metabolism and may use specific peptides (small protein signaling molecules) that can help improve cellular sensitivity to the hormones being administered.
For primary hypogonadism, attempting to “boost” the ovaries is futile. The focus must be on safe and effective replacement to restore physiological balance.
Secondary hypogonadism is a completely different beast. Here, the ovaries (the factory) are perfectly healthy and capable of producing hormones. The problem lies upstream, in the brain’s command-and-control centers: the hypothalamus and the pituitary gland. “Management” is essentially offline.
The hypothalamus fails to release Gonadotropin-Releasing Hormone (GnRH) in its normal, pulsatile fashion. Without this top-level command, the pituitary gland does not receive the signal to release its own hormones, LH and FSH. Consequently, the ovaries never get the message to produce estrogen and testosterone. It’s like a fully functional factory sitting idle because the head office never sent the day’s production orders.
The Hormonal Signature:
The lab results for secondary hypogonadism paint a very different picture from primary:
The Critical Question: Why is the Brain Offline?
Herein lies the most important part of diagnosing secondary hypogonadism. Simply replacing testosterone without asking why the hypothalamus-pituitary axis has shut down is a clinical error. It’s like jump-starting the car every morning without ever checking why the alternator isn’t charging the battery. You are treating the symptom (low testosterone) but ignoring the root cause, which means you will never achieve true health and will likely continue to feel unwell.
As a functional medicine practitioner, this is where my investigation begins. We must peel back the layers to find the source of the upstream dysfunction. Here are the most common culprits I see in my clinical practice at Injury Medical Clinic.
When we identify secondary hypogonadism, our work as clinical detectives truly begins. The low hormone levels are merely the downstream effect of an upstream problem. At Injury Medical Clinic, our integrative team focuses on a systematic investigation to pinpoint and address these root causes. Treating the source is the only path to sustainable recovery. Here are the key areas we investigate.
The first place I always look when I see a profile of secondary hypogonadism is thyroid function. The thyroid gland governs the body’s metabolic rate and energy production, and its influence on the reproductive axis is profound. The relationship is complex and bidirectional.
A common scenario is subclinical hypothyroidism, where the TSH (Thyroid-Stimulating Hormone) is elevated, but T4 and T3 levels may still be within the “normal” lab range. An elevated TSH signals that the brain is working harder to stimulate a sluggish thyroid. This elevated TSH has a direct and detrimental effect on testosterone availability.
The SHBG Connection:
Elevated TSH signals the liver to increase its production of Sex Hormone-Binding Globulin (SHBG). SHBG is a protein that circulates in the bloodstream and acts like a “hormone sponge.” Its primary job is to bind to sex hormones, including testosterone and estrogen, rendering them biologically inactive.
Think of it this way:
When high TSH drives up SHBG levels, a large portion of the total testosterone gets “hoarded” by SHBG. A woman can have a perfectly normal total testosterone level on her lab report, leading an unsuspecting clinician to dismiss her symptoms. However, if her SHBG is sky-high, her free testosterone could be virtually zero. She is hormonally deficient at the cellular level, despite having normal total levels in her blood. Standard, superficial hormone panels miss this critical nuance.
Our Approach:
This is why a comprehensive thyroid panel is non-negotiable in our workup. We never look at TSH. Our panel includes:
If we identify thyroid dysfunction, our treatment is multifactorial. We use targeted nutrients like iodine, selenium, zinc, and tyrosine to support thyroid hormone production. We may recommend specific dietary changes to reduce inflammation. Under Dr. Cardenas’s medical guidance, we may initiate prescription thyroid medication (like T4, T3, or desiccated thyroid) if necessary. By optimizing thyroid function, we can lower SHBG, which “un-cages” the free testosterone, often restoring hormonal balance without needing to add exogenous testosterone.
The second major area of investigation is the Hypothalamic-Pituitary-Adrenal (HPA) axis, our central stress response system. In our modern world, many people live in a state of chronic stress, whether from work pressure, relationship issues, financial worries, or even hidden physiological stressors like chronic infections or inflammation.
When the body perceives chronic stress, the HPA axis goes into overdrive, leading to sustained high levels of the stress hormone cortisol. This has a direct and damaging effect on sex hormone production through a phenomenon known as the “pregnenolone steal” or, more accurately, the “cortisol shunt.”
Understanding the Steroid Hormone Cascade:
To understand this, we need to look at the basic flowchart of steroid hormone synthesis. All steroid hormones—cortisol, DHEA, testosterone, estrogen, and progesterone—are made from cholesterol. The pathway looks something like this:
Cholesterol → Pregnenolone → (Multiple pathways)
Pregnenolone is the “mother hormone.” It sits at a critical crossroads. From pregnenolone, the body can go down one of two major pathways:
Under normal conditions, the body allocates pregnenolone resources down both pathways in a balanced manner.
How the “Steal” Happens:
During chronic stress, survival becomes the body’s number one priority. The adrenal glands pump out large amounts of cortisol to manage the perceived threat. To do this, the enzymatic machinery in the adrenal glands is upregulated to preferentially shunt the available pregnenolone down the pathway toward cortisol production.
This means that the resources (pregnenolone) that would normally be used to produce DHEA—the direct precursor to testosterone—are “stolen” or diverted to make cortisol instead. The body will always prioritize immediate survival (cortisol production) over long-term functions like reproduction and vitality (sex hormone production).
The clinical result is a hormonal profile of:
Why You Can’t Supplement Your Way Out of a Cortisol Problem:
I see many patients who have been told to take DHEA or pregnenolone supplements to fix this. This is a misguided and often ineffective approach. If the underlying driver—chronic stress—isn’t addressed, the body will take the supplemental pregnenolone you provide and keep shunting it toward cortisol production. You are pouring more raw materials into a system that is programmed to divert them.
Our Approach:
The only real solution is to drop the HPA load. This requires a deep, functional medicine approach:
By restoring balance to the HPA axis, we allow the body to naturally redirect pregnenolone back towards the DHEA and testosterone pathway, restoring hormone levels from the inside out.
I am seeing this with increasing frequency in my clinic, particularly with the widespread use of GLP-1 agonist medications (like semaglutide and tirzepatide) for weight loss, as well as the prevalence of extreme dieting and exercise regimens. The underlying issue is one of energy availability.
The hypothalamus, the master gland of the endocrine system, is exquisitely sensitive to the body’s energy status. Its primary directive is to ensure survival. From a biological and evolutionary perspective, functions like reproduction (which includes maintaining a healthy libido and menstrual cycle) and performance (building muscle) are energy-expensive luxuries. The body will not invest in these “luxuries” if it perceives starvation or an energy crisis.
How It Happens:
When a woman is in a severe caloric deficit—either through extreme dieting, the appetite-crushing effects of GLP-1 drugs, or a combination of both—or when she is engaged in excessive exercise without adequate caloric intake (a condition known as Relative Energy Deficiency in Sport, or RED-S), the hypothalamus receives danger signals.
These signals indicate that there is not enough energy to sustain basic life functions and support reproduction. In response, the hypothalamus executes a protective shutdown protocol. It dramatically reduces or completely stops pulsatile GnRH release.
This shutdown has a cascading effect:
This is a classic presentation of hypothalamic amenorrhea in its extreme form. Still, even less severe energy deficits can significantly downregulate the entire HPG axis, leading to secondary hypogonadism. The body is intelligently putting a hold on reproduction and anabolism until the energy crisis is resolved.
Our Approach:
The solution here is not hormones; it is energy. You have to fix the energy issue first.
Fixing secondary hypogonadism requires a thorough, patient, and methodical approach. It is about restoring the body’s fundamental systems—metabolism, stress response, and energy balance. Only then can the endocrine system come back online and function as it was designed.
You cannot manage what you do not measure. Guesswork has no place in hormone optimization. To accurately diagnose the type of hypogonadism and identify its underlying cause, a specific and comprehensive set of laboratory tests is essential. Many patients come to me frustrated because their previous doctors only ran a “total testosterone” test, saw that it was “normal,” and dismissed their concerns. This is inadequate.
At Injury Medical Clinic, our approach, overseen by Dr. Cardenas, is to gather all the necessary data points to see the full picture of your hormonal symphony. Here is the bare minimum panel I recommend for any woman experiencing symptoms of hormonal imbalance. I will keep a list of these in my social media stories for your reference.
This core set of tests evaluates the entire Hypothalamic-Pituitary-Gonadal (HPG) axis from top to bottom.
As discussed, thyroid function is inextricably linked to sex hormone balance. A simple TSH test is not enough.
To complete the functional picture, we often include these markers to assess for other potential root causes.
By assembling this complete dataset, we move beyond guessing and into precision, evidence-based medicine. Interpreted in the context of your unique symptoms and history, the results of these tests give us a clear roadmap. They tell us not only what is wrong but why, allowing us to design a targeted, effective, and personalized treatment plan that addresses the root cause of your suffering.
The message I want to leave you with is one of hope and empowerment. The symptoms you are experiencing—the fatigue, the depression, the weight gain, the lost libido—are not a personal failing or an inevitable sentence of aging. They are real, measurable physiological signals that something is out of balance in your body. That is a lie you no longer have to accept.
My wife, at 46, is a living testament to what is possible when you reject the dismissive narrative and embrace a proactive, scientific approach to health. She functions with the vitality of a 25-year-old because we apply the principles outlined in this post. The research is detailed, and the clinical playbook is written. Everything you need is available.
Your journey starts with knowledge. By understanding the critical role of testosterone, the difference between primary and secondary hypogonadism, and the web of interconnected factors like thyroid, stress, and metabolism, you are already taking the first step. The next step is action.
You do not have to navigate this journey alone. The science is on your side, and dedicated clinicians are here to help. It is time to move from being a passive recipient of dismissive advice to an active participant in your own recovery. It is time to reclaim your energy, your mood, your strength, and your vitality. It is time to feel like yourself again.
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Professional Scope of Practice *
The information herein on "Women's Hormonal Health: Testosterone Deficiency Explained" is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.
Blog Information & Scope Discussions
Welcome to El Paso's Premier Wellness and Injury Care Clinic & Wellness Blog, where Dr. Alex Jimenez, DC, FNP-C, a Multi-State board-certified Family Practice Nurse Practitioner (FNP-BC) and Chiropractor (DC), presents insights on how our multidisciplinary team is dedicated to holistic healing and personalized care. Our practice aligns with evidence-based treatment protocols inspired by integrative medicine principles, similar to those found on this site and our family practice-based chiromed.com site, focusing on restoring health naturally for patients of all ages.
Our areas of multidisciplinary practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols.
Our information scope is multidisciplinary, focusing on musculoskeletal and physical medicine, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somato-visceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and functional medicine articles, topics, and discussions.
We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for musculoskeletal injuries or disorders.
Our videos, posts, topics, and insights address clinical matters and issues that are directly or indirectly related to our clinical scope of practice.
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We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, please feel free to ask Dr. Alex Jimenez, DC, APRN, FNP-BC, or contact us at 915-850-0900.
We are here to help you and your family.
Blessings
Dr. Alex Jimenez DC, MSACP, APRN, FNP-BC*, CCST, IFMCP, CFMP, ATN
email: coach@elpasofunctionalmedicine.com
Multidisciplinary Licensing & Board Certifications:
Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License #: TX5807, Verified: TX5807
New Mexico DC License #: NM-DC2182, Verified: NM-DC2182
Multi-State Advanced Practice Registered Nurse (APRN*) in Texas & Multi-States
Multi-state Compact APRN License by Endorsement (42 States)
Texas APRN License #: 1191402, Verified: 1191402 *
Florida APRN License #: 11043890, Verified: APRN11043890 *
Colorado License #: C-APN.0105610-C-NP, Verified: C-APN.0105610-C-NP
New York License #: N25929, Verified N25929
License Verification Link: Nursys License Verifier
* Prescriptive Authority Authorized
ANCC FNP-BC: Board Certified Nurse Practitioner*
Compact Status: Multi-State License: Authorized to Practice in 40 States*
Graduate with Honors: ICHS: MSN-FNP (Family Nurse Practitioner Program)
Degree Granted. Master's in Family Practice MSN Diploma (Cum Laude)
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
(Licensed Nurse Practitioner & Chiropractor - Multistate)*
Clinical Director
Digital Business Card
Dr. Maria Cardenas, MD
(Board Certified: Internal Medicine)
(Licensed Medical Doctor)
Medical Director, Clinical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
Licenses and Board Certifications:
MD: Medical Doctor
DC: Doctor of Chiropractic
APRNP: Advanced Practice Registered Nurse
FNP-BC: Family Practice Specialization (Multi-State Board Certified)
RN: Registered Nurse (Multi-State Compact License)
CFMP: Certified Functional Medicine Provider
MSN-FNP: Master of Science in Family Practice Medicine
MSACP: Master of Science in Advanced Clinical Practice
IFMCP: Institute of Functional Medicine
CCST: Certified Chiropractic Spinal Trauma
ATN: Advanced Translational Neutrogenomics
Memberships & Associations:
TCA: Texas Chiropractic Association: Member ID: 104311
AANP: American Association of Nurse Practitioners: Member ID: 2198960
ANA: American Nurse Association: Member ID: 06458222 (District TX01)
TNA: Texas Nurse Association: Member ID: 06458222
NPI: 1205907805
| Primary Taxonomy | Selected Taxonomy | State | License Number |
|---|---|---|---|
| No | 111N00000X - Chiropractor | NM | DC2182 |
| Yes | 111N00000X - Chiropractor | TX | DC5807 |
| Yes | 363LF0000X - Nurse Practitioner - Family | TX | 1191402 |
| Yes | 363LF0000X - Nurse Practitioner - Family | FL | 11043890 |
| Yes | 363LF0000X - Nurse Practitioner - Family | CO | C-APN.0105610-C-NP |
| Yes | 363LF0000X - Nurse Practitioner - Family | NY | N25929 |
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
(Licensed Nurse Practitioner & Chiropractor - Multistate)*
Clinical Director
Digital Business Card
Dr. Maria Cardenas, MD
(Board Certified: Internal Medicine)*
(Licensed Medical Doctor)*
Medical Director, Clinical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
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