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Low Testosterone, an important but often overlooked issue with fertility and female hormones.

Updated: Mar 1

A factor that is often overlooked when assessing hormones for a female client with infertility is low testosterone. This is because testosterone is predominantly seen as a male hormone and as a female, it might not feel quite right when you are told you need to increase your testosterone levels.


This is why I thought it would be beneficial to write about the subject, because low testosterone can be common in females, especially over the age of 35, as it naturally starts to decline from this age. I am seeing this hormone picture pop up more and more frequently with clients when I do DUTCH tests (comprehensive dried urine tests) for them. It is important to be aware of what causes it and what we can do to bring our hormones back into balance.


Why is testosterone important for females?


Testosterone is naturally produced in the adrenal glands and ovaries and naturally starts to decline over the age of 35, as with the hormone progesterone. DHEA is a steroid hormone precursor that is produced in the adrenal cortex and is converted by enzymes into testosterone and estradiol (E2)


As well as aging, stress and adrenal (HPA axis) dysfunction can reduce levels of testosterone by lowering the production of DHEA from the adrenal glands, which results in less DHEA available to be converted into testosterone.


If you are over the age of 40 and are trying to conceive it is recommended to get tested for testosterone and DHEA-S (DHEA Sulfate is the test used) and if they are on the low end of normal, then you may need further support.



Testosterone and DHEA levels play an important role in the early stages of egg development and maturity, so a deficiency may affect egg quality.


In terms of fertility, testosterone is important for:

  • Regulating follicle development as testosterone supports the structure of the follicles that hold and release the egg during ovulation.

  • Stimulating the synthesis of Follicle-Stimulating Hormone (FSH) receptors in the ovaries which helps the follicles grow.

  • Increasing blood flow to the reproductive organs, which improves the production of cervical mucus.

  • Helps to increase libido around ovulation time to help things along.


What are the symptoms of low testosterone?


The symptoms of low testosterone can overlap with similar symptoms seen with adrenal fatigue (HPA axis dysfunction) and low thyroid function, so can often be overlooked. Here are some of the most common symptoms:

  • Low energy and fatigue

  • Muscle weakness

  • Feels the cold easy

  • Difficulty losing weight

  • Poor sleep

  • Depressed mood and anxiety

  • Brain fog, lack of concentration

  • Hair loss

  • Low libido

  • Infertility

  • ·Low bone density


Sex Hormone Binding Globulin (SHBG)


Another factor to take into consideration when analysing hormones is Sex Hormone Binding Globulin (SHBG) as it is usually tested alongside testosterone and DHEA-S. SHBG is a protein that is made mostly in the liver. ‘It binds (attaches) to sex hormones in your blood. SHBG helps to control the amount of sex hormones that are actively working in your body’ (1)


SHBG plays an important role in regulating testosterone levels by transporting it throughout the body. When SHBG is elevated, it decreases the levels of free testosterone available in the body. There are many factors that increase SHBG levels, such as exercise and weight loss, but the main one is stress. High cortisol levels from stress can lead to increased SHBG levels, which is one reason stress can really play havoc with our hormones and push them out of whack.


According to Dr. Jolene Brighten, `Chronic unrelented stress doesn’t give your adrenals a break. Your body keeps pumping out cortisol, plus other hormones to try to make even more cortisol. Eventually, the production of all hormones drops, including DHEA, impacting testosterone production. While this may feel like a betrayal by your body, it is actually how your body keeps you from overproducing the pro-aging hormone cortisol’ (2)


What can we do naturally to increase our testosterone and DHEA levels?


All is not lost when our testosterone and DHEA are low, as there are several diet and lifestyle actions we can take to work to increase levels naturally. These are:


Step 1 - Nourish with nutrients.


The most supportive nutrients for increasing the production of testosterone are zinc, magnesium, and healthy fats. Let us look at each one.


Zinc

Zinc is one of those nutrients that you can easily think you have covered because you are taking a prenatal multivitamin with zinc and eating plenty of meat. However, this may not be the case!


Zinc is involved as a co-factor in over 300 enzyme functions in the body. It is also one of the trace minerals that is depleted by stress. As well as everything else going on in our lives, infertility is stress, chronic stress, so if our zinc stores get depleted, that is over 300 metabolic functions in the body that will be affected!


Zinc helps to regulate hormones and increase testosterone levels. It blocks the enzyme that converts testosterone to estrogen, so more testosterone is available. Zinc-rich foods are oysters, beef, lamb, pumpkin seeds, lentils, mushrooms, spinach, and avocado.


Supplementing with extra zinc may be beneficial if you are not getting enough dietary zinc, have an underactive thyroid or you are under a lot of stress.


Dietary fats

Testosterone, like all reproductive hormones, is made from dietary cholesterol. If you are not eating enough fat, or you do not absorb fat that well because of digestive issues, then the body may not have adequate cholesterol to make hormones. Aim to have a serving of healthy fats with each meal. This may include meat fat, butter, cheese, fermented dairy, sour cream, coconut oil, meat stock, avocado, salmon, nuts, seeds, and olive oil.


Aim to have oily fish such as tuna, salmon, sardines, and mackerel 2–3 times a week for an excellent source of Omega-3 essential fatty acids. Also, flaxseed oil, hemp seed oil, walnuts, and chia seeds. You might consider supplementing with Omega-3 if you do not feel you are getting enough in your diet. I recommend the Nordic Naturals Complete Omega or Cod Liver Oil, which is available from most health shops. Cod liver oil has the extra benefit of naturally occurring Vitamin D and A, which help to support hormone regulation and immune balance.


Magnesium

Low magnesium levels are connected to low testosterone levels and supplementation with magnesium levels has been shown to bring levels back to within normal ranges. Magnesium is another mineral that is depleted by stress and is a cofactor in over 300 metabolic functions of the body. Magnesium-rich foods include almonds, cashews, seeds, bananas, avocados, brown rice, and leafy green vegetables.


It is challenging to get enough magnesium from food so taking an additional magnesium supplement can help lower the stress hormone cortisol, which will have a knock-on effect of increasing DHEA and testosterone levels as we know they are depleted by stress and high cortisol levels. Magnesium also inhibits testosterone from binding to sex hormone binding globulin (SHBG) which increases free testosterone levels in the blood.


Ashwagandha

The Ayurvedic herb Ashwagandha, also known as Indian Ginseng or Winter Cherry, is my go-to for supporting the adrenal glands. As an adaptogen, ashwagandha helps us adapt to the stress we are experiencing by lowering cortisol levels and reducing symptoms of anxiety and sleep disturbances.


Ashwagandha has been proven in studies to lower levels of cortisol. `High concentrations of full-spectrum ashwagandha root extract reduce levels of serum cortisol, which elevates in stressful conditions (3) Ashwagandha is widely available as a tea, capsule, or powder, which can be added to smoothies.


Step 2 - Actively work to manage stress levels.


As mentioned previously, chronic stress and adrenal dysfunction can affect DHEA and testosterone production, mainly because of the overproduction of cortisol.


The Hypothalamic-pituitary-adrenal (HPA) axis consists of the hypothalamus, pituitary gland, and adrenal glands. It regulates the body’s adaptive response to stress. Adrenal fatigue, or HPA axis dysfunction, which is otherwise known, is when our adrenal glands function below normal levels, usually because of prolonged, chronic stress. The adrenal glands are situated on top of the kidneys and regulate our stress response by producing stress hormones such as cortisol and adrenaline in response to stress. Long-term stress can lead to the depletion of the adrenal glands and can cause imbalances in the production of cortisol.


Active stress reduction activities are therefore crucial when trying to reduce cortisol levels. Taking supplements will not do much if you are not taking the time to look after yourself.

Here are a few suggestions to bring into your daily routine:


Meditation - commit to 10 minutes a day of meditation. If you struggle to do this yourself, there are some fantastic apps available including Headspace and Smiling Minds. A daily meditation practice really helps to calm the mind. At first, you might feel (like I did!) that it was a waste of time and you have too many thoughts running around in your head. But after a week or so of regular practice, it becomes easier to drop into your calm inner space. A 2013 study discovered that `mindfulness meditation lowers cortisol levels in the blood, suggesting that it can lower stress and may decrease the risk of diseases that arise from stress’ (4)


Take time out to breathe- when you are feeling stressed or overwhelmed, taking a minute or two to practice deep breathing can instantly help you feel calm and relaxed. `Deep breathing causes the vagus nerve to signal your nervous system to lower your heart rate, blood pressure, and cortisol’ (5) Close your eyes and take a slow deep breath into the count of 4, hold your breath to the count of 4 and exhale to the count of 4. Try to do this about 4 – 7 times before you open your eyes.


Gratitude journal - keep a journal by your bed and try to think of 3 things you are grateful for each night. This can have a positive effect on your mindset, so worth taking the time.


Yoga - subscribe to Yoga with Adriene on YouTube and aim to complete a 20-minute practice at home on most days of the week. You can pick from over 10 years of her free videos to suit what you need, for example, stress, relaxing yoga, energising yoga, etc. There are other great yoga channels out there, but this is my top pick.


Sleep – I know this is difficult if you have very young children, but try where possible to get plenty of sleep. It can be tempting to stay up late to take time out for yourself (I am guilty of this!) but aim to get to bed before 10.30 pm at least 3 days a week.


For further information on supporting your adrenal glands, check out my blog post on Stress and Infertility.


Step 3 – Schedule time to exercise.


Try to do some resistance training with some weights at least 3 times a week, even with light dumbbells, as this can help to increase testosterone levels naturally. This can also include exercises that use your own body weight, such as squats, lunges, planks, etc


Short bursts of high-interval training like sprints, star jumps, etc. can also increase testosterone levels, but I would advise not to do anything over-strenuous as this will stress your adrenal glands further.


Summary


So, in summary, DHEA and testosterone levels are an important but often overlooked part of the infertility puzzle. If any of the symptoms listed in this article resonate with you, then I would recommend asking to get your DHEA, testosterone, and sex hormone binding globulin (SHBG) levels checked either through a blood test with your fertility test or with a DUTCH test.


My 3-step strategy of nourishing with nutrients, actively working to manage stress, and resistance training can help to lower the stress hormone cortisol, which has a positive effect on increasing DHEA and testosterone levels and your energy and vitality.


If you do research on low testosterone in females online, you may notice that many doctors are recommending DHEA supplements to boost what is naturally declining with age, especially in America. Unfortunately, we cannot access DHEA supplements in Australia and New Zealand without a prescription, so this is something you will need to discuss with your doctor if your results show you may benefit from this. If you are under the age of 35, then you should find my 3-step strategy enough to boost your testosterone levels naturally. If you are over the age of 35, then DHEA may be worth exploring with your fertility doctor, as this could be one of the missing pieces of the puzzle with egg quality and fertility rates.


References


Medline Plus SHBG Blood test – sourced from Medlineplus.gov (14/12/22)


Brighten Dr. J, Low testosterone in Women and how to increase T naturally, sourced 18/12/22 www.drbrighten.com


Chandrasekhar K et al. A Prospective, Randomized Double-Blind, Placebo-Controlled Study of Safety and Efficacy of a High-Concentration Full-Spectrum Extract of Ashwagandha Root in Reducing Stress and Anxiety in Adults Indian J Psychol Med, 2012 July- Sept 34 (3) 255- 262


Tyrakithanakan et L, Effects of Mindfulness meditation on serum cortisol of medical studies. J Med Assoc, Thai, 2013 Jan 96, Suppl 1:590 – 5


Knerek S, Undestanding Cortisol the Stress Hormone, Nov 27, 2018, Michigan State university Extension.


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