Understanding androgen deficiency: what it is, related symptoms, and more

Medically reviewed by Rosanna Sutherby, PharmD on September 21, 2020. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


If you’ve been learning about hormones in your body and how they affect different aspects of health, you may have heard the phrase “androgen deficiency.”

In both men and women, an androgen deficiency can lead to symptoms that impact your quality of life (potentially resulting in a lack of energy or reduced sex drive, for instance). But what is an androgen deficiency, exactly? Here, you’ll find the answer to that question—plus learn what androgens are in the first place, symptoms associated with a deficiency, possible causes of low levels, and more—so keep reading.

What is an androgen?

Androgens are chemically-related sex hormones. They’re most often made in the male testes, female ovaries, and adrenal glands.

In the body, androgens control male sex traits and help with the development and growth of the reproductive system—such as the penis, testes, prostate, and sperm. They also help trigger puberty and influence vocals, facial hair, muscle mass, and sex drive.

In females, they can affect sex drive and may contribute to maintaining normal ovarian function, bone metabolism, cognition, and sexual function.

Testosterone is the principal circulating androgen in both men and women. You may commonly hear the two spoken of interchangeably, but the difference is that androgens are the group of hormones, and testosterone is the specific hormone within the group. Other androgens include dehydroepiandrosterone sulfate (DHEAS), dehydroepiandrosterone (DHEA), androstenedione, and dihydrotestosterone (DHT).

Symptoms of androgen deficiency in men

Male hypogonadism, also called testosterone deficiency syndrome (TDS), results when the testes do not produce enough androgen. Low testosterone symptoms in men can vary. Decreased libido is one of the most common symptoms, though males may also experience fatigue, erectile dysfunction, and body composition changes. However, diagnosing an androgen deficiency can be challenging and often requires a testosterone level test.

Generally, here are the symptoms to look for:

  • Reduced sense of well-being
  • Reduced energy levels (lethargy and easy fatigue)
  • Lack of stamina or endurance
  • Reduced libido
  • Mood changes and irritability
  • Loss of physical, social, and sexual drive
  • Hot flashes and sweating
  • Reduction in muscle mass and bone density

Reasons for androgen deficiency in men

It’s common for testosterone to decline with age in men. This gradual decline typically starts in men in their late 40s to early 50s, during which time men may develop depression, erectile dysfunction, mood swings, loss of muscle mass, or other symptoms. However, symptoms don’t always occur with age-related decline in testosterone.

Klinefelter syndrome, the most common sex-chromosome disorder, is a frequent cause of both androgen deficiency and infertility. It affects approximately 1 in 600 men, yet it remains largely undiagnosed.

Opioid-induced androgen deficiency is another possible cause of testosterone deficiency in men. Opioid-induced androgen deficiency is a form of “hypogonadotropic hypogonadism” and occurs in men who are chronically consuming opioids (due to addiction or to control chronic pain). This can also occur in women, though it’s not as widely recognized or well-defined.

Symptoms of androgen deficiency in women

Both premenopausal and postmenopausal women can suffer from androgen deficiency. Symptoms of an androgen deficiency in women may include:

  • Lack of energy or fatigue
  • Disturbed sleep and insomnia
  • Low motivation levels
  • Low self-esteem
  • Lack of sexual desire (libido)
  • Reduction of pubic hair
  • Reduction of bone density
  • Headaches

Reasons for androgen deficiency in women

Addison’s disease, also called adrenal insufficiency, is one reason why women may have an androgen deficiency. It’s an uncommon disorder where your adrenal glands (above the kidneys) produce too little cortisol and, sometimes, too little aldosterone.

Hypopituitarism, a deficiency of hormones in the pituitary gland, and bilateral oophorectomy, the removal of a woman's ovaries through surgery (known as an oophorectomy), can also cause severe androgen deficiency. Natural menopause can also lead to androgen deficiency.

Diagnosing androgen deficiency

If a healthcare provider suspects an androgen deficiency, they may conduct an evaluation around the patient’s medical history and conduct a physical examination along with laboratory testing.

According to the Medical Journal of Australia, patient history for an androgen deficiency in men may include:

  • Fertility history
  • Testicular abnormalities
  • Toxin exposure, medication, and occupation
  • Recent changes in sexual function
  • Patterns of body hair growth

A healthcare provider may also evaluate levels of testosterone and sex hormone-binding globulin (SHBG) to confirm an androgen deficiency in a woman.

Blood tests may be taken to determine the level of testosterone in the blood (serum testosterone). Your healthcare provider may also conduct tests to see if your low testosterone level is due to other medical conditions. These may include tests that check iron levels, genetic tests, MR scans of the brain, and a semen analysis.

Treatment options for androgen deficiency

If a blood test suggests an androgen deficiency, your healthcare provider might refer you to an endocrinologist who specializes in hormone issues and can give you an accurate diagnosis. Testosterone replacement—or hormone replacement therapy—is one option to relieve symptoms of a hormone deficiency.

Treatment may be done in the form of:

  • Tablets: tablets are usually taken once a day and are a common form of hormone therapy
  • Skin patches: skin patches are stuck to the skin and replaced every day (they can also help to relieve some side effects of hormone therapy, like indigestion)
  • Gels: gels are rubbed onto the skin and offer a convenient form of taking testosterone replacement therapy
  • Implants: implants are inserted under the skin after it has been numbed and release the hormone gradually over time
  • Injections: injections, such as gonadotropin injections, can be administered several times a week to stimulate testosterone production (and sperm production in males)

Testing testosterone levels at home

If you're interested in learning more about your androgen levels, our at-home Testosterone Test can be a good place to start. This test lets you check your levels of free testosterone from the convenience of home, and only requires a saliva sample (which you ship to a lab for analysis using the prepaid shipping label included with the kit). Free testosterone is the form of testosterone that’s biologically active because it isn’t bound to proteins.

Alternatively, consider the Men’s Health Test, which measures testosterone as well as DHEAS—another androgen which helps build and maintain muscle mass (among other functions). Taking either of these two tests may help alert you to a potential androgen deficiency, so you can then consult with your healthcare provider to learn what steps to take next.


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References

1. Androgen - An Overview. Science Direct. URL. Accessed September 21, 2020.

2. Androgen deficiency and replacement therapy in men. The Medical Journal of Australia. URL. Accessed September 21, 2020.

3. Høst C, Skakkebæk A, Groth KA, Bojesen A. The role of hypogonadism in Klinefelter syndrome. Asian J Androl. 2014;16(2):185-191. doi:10.4103/1008-682X.122201

4. Smith HS, Elliott JA. Opioid-induced androgen deficiency (OPIAD). Pain Physician. 2012 Jul;15(3 Suppl):ES145-56. PMID: 22786453.

5. Jakiel G, Baran A. Hipoandrogenizm u kobiet [Androgen deficiency in women]. Endokrynol Pol. 2005 Nov-Dec;56(6):1016-20. Polish. PMID: 16821229.

6. Addison's disease. Mayo Clinic. URL. Accessed September 21, 2020.

7. Karen K. Miller, Androgen Deficiency in Women, The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 6, 1 June 2001, Pages 2395–2401, https://doi.org/10.1210/jcem.86.6.7610

8. 11: Androgen deficiency and replacement therapy in men. The Medical Journal of Australia. URL. Accessed September 21, 2020.

9. Kallmann Syndrome. National Organization for Rare Disorders. URL. Accessed September 21, 2020.

10. Testosterone insufficiency in women: fact or fiction? Boston University School of Medicine. URL. Accessed September 21, 2020.

11. Hormone Replacement Therapy. The National Health Service. URL. Accessed September 21, 2020.

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