Testosterone in Women: When Low Looks Like Depression

But testosterone is not just a “male hormone”. Women make it too. In the ovaries and adrenal glands. And also in peripheral tissues where other hormones get converted downstream.

And when it drops too low, the symptoms can look uncomfortably familiar.

Low mood. Low motivation. Fatigue that is not fixed by sleep. Brain fog. Losing that spark. Sometimes anxiety. Sometimes a flat, grey kind of sadness that doesn’t have a clear reason.

In other words. It can look like depression.

Not always. Not for everyone. And I’m not saying testosterone is the cause of every mood issue in women. But it’s one of the most overlooked pieces of the puzzle, especially in women who feel brushed off with “it’s stress” or “you’re just getting older” or “here’s an SSRI”.

So let’s talk about it. In plain language. With nuance. And with the kind of practical lens that functional medicine tends to bring.

The tricky part: low testosterone doesn’t announce itself

When women think “hormones”, they usually think estrogen, progesterone, thyroid. Maybe cortisol if they have been on wellness TikTok for a while.

Testosterone tends to be missing from the conversation.

Partly because the symptoms are not dramatic. They’re sneaky and slow. And because the cultural storyline is that testosterone equals aggression and libido and muscle, so if you’re not specifically thinking about sex drive or the gym, it doesn’t come up.

Also, a lot of women with low testosterone don’t feel “depressed” in the classic sense. They just don’t feel like themselves.

They’ll say things like:

• “I can’t get excited about anything.”
• “Everything feels like effort.”
• “I’m tired, but it’s not just sleepiness.”
• “I used to be driven. Now I’m just… not.”
• “I feel flat.”
• “My confidence is gone.”
• “I’m more sensitive. Everything hits harder.”

And then, because those symptoms overlap with a million other things, they get labeled as depression, burnout, perimenopause, mom life, stress, aging, you name it.

Sometimes it is those things. Sometimes it is also hormones. Sometimes it’s nutrient status, inflammation, gut issues, trauma, blood sugar, thyroid, iron. Usually it’s not one thing.

But testosterone deserves to be on the list.

What testosterone actually does in women (beyond libido)

Yes, testosterone can impact sexual desire. That’s the one everyone knows.

But it also plays a role in:

• Motivation and drive
• The “get up and go” feeling. Not in a hustle culture way. More like… life feels doable again.
• Mood resilience
• Not “happy all the time”, but less easily knocked down, less emotionally fragile.
• Cognitive function
• Focus, mental stamina, verbal fluency for some women, and that “my brain works” feeling.
• Muscle mass and strength
• Maintaining lean mass, which ties into metabolic health, blood sugar, and aging well.
• Bone density
• Estrogen matters here too, but testosterone contributes.
• Energy and vitality
• Again, not caffeine energy. More like baseline aliveness.

So if testosterone is low, it’s not weird that the symptoms can resemble depression. If your body loses some of the hormonal signals that support drive, strength, and mental steadiness, life can feel heavier.

Depression vs low testosterone: where they overlap

Here’s the overlap that trips people up.

Symptoms that can be shared by both

• Low mood
• Fatigue
• Low motivation
• Brain fog
• Sleep disruption (either too much or not enough)
• Loss of interest in things you used to enjoy
• Lower confidence
• Irritability

Clues that low testosterone might be in the mix

These are not definitive, but they’re patterns I see come up.

• A noticeable drop in libido that feels different than “I’m busy” or “I’m stressed”
• Loss of muscle tone or strength even with exercise
• More body fat gain especially if training and diet haven’t changed much
• Exercise feels harder to recover from
• Apathy more than sadness
• Like the emotional volume got turned down.
• Feeling older overnight
• Not wrinkles. More like your internal vitality dipped.

And one more. This is a big one.

You can be doing “all the right things” and still feel off.

You’re eating clean. You’re exercising. You’re meditating. You cut alcohol. You take magnesium. You got your thyroid checked and they said it was “normal”.

But you still feel like you’re dragging yourself through your life.

That’s the moment to widen the lens.

Why testosterone gets low in women in the first place

There are several common scenarios. Some are obvious. Some are not.

1. Perimenopause and menopause

As women move into perimenopause, ovarian hormone production becomes more variable. Most people focus on estrogen and progesterone fluctuations. But testosterone can decline too, and in some women the drop is meaningful.

And after menopause, ovarian contribution decreases further. The adrenals and peripheral conversion still matter, but the total pool can be lower.

2. Surgical menopause or ovary removal

If a woman has her ovaries removed, testosterone can drop sharply. Even if she is placed on estrogen, she may still feel “not right” if testosterone is not addressed.

3. Chronic stress and HPA axis dysfunction

The adrenal glands play a role in androgen production. Chronic stress, inflammation, under-eating, overtraining, trauma, poor sleep. All of that can shift adrenal output.

Some women end up in a state where cortisol rhythm is dysregulated, and androgens are low too.

This is where functional medicine tends to get very interested, because it’s rarely “just stress”. It’s stress layered on top of physiology.

4. Under-eating and over-exercising

If your body thinks resources are scarce, it will prioritize survival. Reproduction and vitality signals can downshift.

Low energy availability, especially in very active women or women with restrictive diets, can impact sex hormones across the board. Testosterone included.

5. Birth control history (for some women)

Oral contraceptives can increase SHBG, sex hormone binding globulin. When SHBG is high, more testosterone is bound and unavailable. Some women feel fine on the pill. Some don’t. Some stop the pill and still have lingering high SHBG for a while.

This is one of those areas where you don’t want simplistic answers. But it belongs in the conversation.

6. Certain medications

SSRIs, opioids, and other medications can influence libido and hormone dynamics. Again, not a moral judgment. Just physiology.

7. Thyroid issues, insulin resistance, inflammation, nutrient deficiencies

Hormones do not exist in isolation. The body is a web.

If thyroid function is sluggish, if insulin is high, if inflammation is chronic, if iron or zinc is low. Hormone production and conversion can suffer.

That’s why a functional approach looks at systems, not just one lab number.

The lab problem: “normal range” can be misleading

This is where women get stuck.

They get labs. The result shows testosterone “in range”. They’re told it’s fine.

But a few things matter here:

1. The reference range is not the same as optimal
2. “Normal” often includes a huge chunk of the population, including people with metabolic dysfunction, chronic illness, and hormonal suppression. It’s a statistical range, not a thriving range.
3. Total testosterone is not the whole story
4. Free testosterone, SHBG, albumin. These influence what’s actually available to tissues.
5. Timing and context matter
6. Cycle day matters for some hormones. Menopause status matters. Symptoms matter.
7. Testing method matters
8. Some assays are not great at the low end of female testosterone. A sensitive method is often more accurate, especially when levels are low.

This is also why many women feel gaslit by labs. They feel awful. The labs say “normal”. And then the conversation stops.

It shouldn’t stop there. It should expand.

What to test if you suspect low testosterone (and what to look at alongside it)

I’m not your doctor here, and this is not medical advice. But if you want a more complete picture to discuss with your clinician, these are commonly considered:

• Total testosterone
• Free testosterone
• SHBG
• DHEA-S (an adrenal androgen precursor)
• Estradiol
• Progesterone (if cycling, timing matters)
• Thyroid panel (TSH, Free T4, Free T3, and often antibodies)
• Iron status (ferritin especially, plus iron/TIBC)
• Vitamin D
• B12, folate if relevant
• Fasting insulin, glucose, A1c (metabolic context)
• Inflammation markers if clinically indicated

In functional and integrative practice, we often zoom out further depending on the story. Gut health, nutrient absorption, cortisol rhythm, sleep quality, toxin burden. Not because it’s trendy, but because it explains why the hormones are low in the first place.

If you want that kind of systems based workup, that’s the vibe of Dr. Lisa Silvani’s practice at lisasilvani.com. Especially for women who are tired of chasing symptoms one at a time.

Before jumping to hormones, ask this: is it really depression?

This is delicate.

Some women truly have clinical depression and need mental health support, therapy, medication, community care, all of it. Hormones are not a substitute for that.

But some women are told they’re depressed when what they’re actually experiencing is:

• hypothyroidism (or subclinical thyroid dysfunction)
• iron deficiency
• perimenopause hormone shifts
• sleep apnea
• blood sugar swings
• chronic inflammation
• burnout with depleted physiology
• and yes, sometimes low testosterone

A good clinician will take your mood seriously and also look for root causes.

Because if the root cause is hormonal, you can do years of therapy and still feel like you’re pushing a boulder uphill. Therapy helps. It’s just not the full answer when biology is dragging you down every morning.

What low testosterone “depression” often feels like, in real life terms

Here are a few common patterns. You might recognize one. Or two. Or none.

The high performer who suddenly can’t

She used to be sharp. Motivated. Productive. Then slowly she starts procrastinating everything, even things she cares about. She feels guilty. She tries harder. She gets more tired.

Her labs might show “normal” thyroid. Normal CBC. No one checks free testosterone or SHBG. She gets told to take a vacation.

A vacation helps for 3 days. Then she comes home and feels the same.

The mom who feels numb, not sad

She is not crying all the time. She is functioning. But she feels disconnected. Like she is watching her life through glass.

People assume postpartum depression or anxiety, which can be real. But sometimes the underlying physiology is also shifting, especially if sleep is wrecked, nutrition is depleted, and stress is constant.

The fit woman whose body stops responding

She trains. She lifts. She eats protein. Yet she loses strength, gains fat, and feels emotionally fragile.

Sometimes it’s overtraining, underfueling, and stress. Sometimes it’s perimenopause. Sometimes testosterone is part of the picture. And the answer is not “work out harder”.

So what do you do about it?

There are layers here. And I’ll say it again. This is not a “go get testosterone” post. It’s a “consider testosterone as a missing clue” post.

Step 1: don’t self diagnose, but do take yourself seriously

If you feel like you’re disappearing inside your own life, that matters.

Write down symptoms. Track sleep. Track cycle changes. Track libido, energy, mood, workout recovery. Not obsessively. Just enough to see patterns.

Bring that to a clinician who listens.

Step 2: address the foundations that support androgen production

This sounds boring, but boring works.

• Eat enough protein and overall calories
• Chronic under-eating is a hormone killer.
• Strength train, but don’t punish yourself
• Lifting supports testosterone signaling, muscle, and metabolic health. Overtraining does the opposite.
• Sleep
• Deep sleep is hormone repair time. If sleep is broken, fixing hormones is harder.
• Manage stress in a physiological way
• Not “just relax”. I mean actual nervous system regulation. Breath work, walking, therapy, boundaries, sunlight, social support. Pick what you can actually do.
• Correct nutrient deficiencies
• Iron, zinc, vitamin D, magnesium, B vitamins. You don’t guess here. You test when appropriate.

Step 3: look at the whole hormone ecosystem

Testosterone does not float alone. Estrogen, progesterone, thyroid, cortisol, insulin. If one is off, it affects the others.

A classic example:

High SHBG can make free testosterone low, even if total looks okay. Why is SHBG high? Sometimes estrogen exposure. Sometimes thyroid. Sometimes genetics. Sometimes the pill history. Sometimes liver metabolism.

The question is not just “is testosterone low?” but “why is it low, and what else is happening?”

Step 4: consider targeted therapies, carefully, with the right supervision

For some women, after a thorough evaluation, testosterone therapy may be considered. That might include:

• low dose transdermal testosterone (common in some menopause care models)
• addressing adrenal androgen support if DHEA-S is low (in select cases, under supervision)
• treating underlying thyroid dysfunction
• improving insulin sensitivity
• adjusting medications that may be contributing, when appropriate

And there are also risks and side effects to consider. Acne, hair growth, scalp hair thinning in genetically susceptible women, voice changes if dosing is too high, lipid changes, and more.

The goal is never “more testosterone”. The goal is the right amount for you, in context, monitored properly.

This is where you want an experienced clinician who understands female physiology and doesn’t treat you like a small man. Honestly, a lot of the horror stories come from dosing that is not truly tailored, or from poor monitoring, or from clinics that hand out hormones like candy.

Why functional medicine can be a good fit for this conversation

Traditional care can be great in acute medicine. In emergencies. In clear diagnoses.

But these “I feel off and nobody can tell me why” cases are where women tend to drift toward integrative and functional medicine.

Because functional medicine asks:

• What changed?
• When did it start?
• What systems are involved?
• What are the upstream contributors?
• What is keeping the body stuck?

That’s the exact model Dr. Lisa Silvani uses in her work, and it’s why her site has so much emphasis on systems like gut health, hormones, detox pathways, immune function, and energy metabolism.

If you’re reading this and thinking, “this is me, and I’m tired of being dismissed”, you can explore her resources at https://www.lisasilvani.com and consider booking a free consultation to talk through what’s going on. Not every case needs hormones. But every case deserves a real workup.

A quick word on antidepressants (because this topic can get heated)

If you’re on an antidepressant and it helps you, that’s a win.

If you’re on one and you feel numb and your libido is gone and you’re still exhausted, that’s data too. It doesn’t mean you did something wrong. It means the plan might need adjusting, and the root cause might not be purely neurotransmitters.

Also, it’s not either or.

A woman can have depression and low testosterone. A woman can have trauma and perimenopause and thyroid issues. Humans are layered.

The best care plan is usually the one that stops pretending it has to be simple.

Red flags that deserve immediate professional help

Just to be responsible here.

If you have thoughts of self harm, suicide, or you feel unsafe, please seek immediate help. Contact emergency services, go to the ER, or reach out to a crisis hotline in your country. Hormone conversations can happen later. Safety first.

Also, sudden severe mood changes, new panic attacks, psychosis, or postpartum symptoms should be evaluated promptly.

The takeaway (the part I hope sticks)

Low testosterone in women can look like depression because testosterone supports things like drive, resilience, muscle, and cognitive energy. When it drops, the world can feel heavier.

Not every woman with depression has low testosterone. Not every woman with low testosterone feels depressed.

But if you’re dealing with persistent low mood, low motivation, fatigue, brain fog, and a loss of vitality, especially around perimenopause, postpartum, chronic stress, or after years of intense training or under-eating, it’s worth expanding the conversation beyond “it’s all in your head”.

You’re not lazy. You’re not broken. And you’re not imagining it.

Sometimes, it’s hormones. Sometimes, it’s the whole system.

If you want help sorting out which it might be for you, you can learn more about Dr. Lisa Silvani’s functional and integrative approach, and book a free consultation, at https://www.lisasilvani.com.

FAQs (Frequently Asked Questions)

Is testosterone only important for men, or do women produce it too?

Testosterone is not just a “male hormone”; women also produce it in their ovaries, adrenal glands, and peripheral tissues where other hormones convert downstream. It plays essential roles beyond what is commonly recognized.

What are common symptoms of low testosterone in women?

Low testosterone in women can cause symptoms like low mood, low motivation, fatigue unrelieved by sleep, brain fog, loss of spark or drive, anxiety, and sometimes a flat or grey sadness resembling depression.

How does low testosterone differ from classic depression in women?

While some symptoms overlap with depression—such as low mood and fatigue—low testosterone often presents as feeling “not like yourself,” with apathy rather than sadness, loss of confidence, increased sensitivity, and a noticeable drop in libido that doesn’t align with stress or lifestyle factors.

Besides libido, what roles does testosterone play in women’s health?

Testosterone supports motivation and drive, mood resilience, cognitive function (like focus and mental stamina), muscle mass and strength maintenance, bone density, and overall energy and vitality—not just sexual desire.

Why might a woman’s testosterone levels drop?

Common causes include perimenopause and menopause leading to decreased ovarian hormone production (including testosterone), surgical menopause or ovary removal causing sharp drops in testosterone levels, as well as other factors like stress, aging, nutrient deficiencies, inflammation, and thyroid issues.

When should women consider testing their testosterone levels?

Women who experience persistent symptoms such as unexplained low motivation, fatigue not fixed by sleep, loss of muscle tone despite exercise, increased body fat without lifestyle changes, difficulty recovering from workouts, apathy rather than sadness, or feeling older internally despite healthy habits might benefit from evaluating their testosterone levels as part of a broader hormonal and health assessment.

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