Testosterone Deficiency Management for Women’s Hormonal Health

Understanding women’s hormonal health is crucial. Discover how testosterone deficiency affects overall well-being.

Female Testosterone Deficiency

Hello, I’m Dr. Alex Jimenez. With a career spanning decades and a passion for uncovering the root causes of health issues, I’ve dedicated my practice to a comprehensive, integrative approach to wellness. Holding credentials as a Doctor of Chiropractic (DC), Advanced Practice Registered Nurse (APRN), Family Nurse Practitioner-Board Certified (FNP-BC), Certified Functional Medicine Practitioner (CFMP), Institute for Functional Medicine Certified Practitioner (IFMCP), Autism Treatment Network (ATN) practitioner, and Certified in Chiropractic Spinal Trauma (CCST), I have seen firsthand how a fragmented approach to healthcare often fails patients, especially when it comes to the intricate world of hormonal health.
At our practice, Injury Medical Clinic PA in El Paso, Texas, we pride ourselves on a multidisciplinary model of care. This collaborative environment is the cornerstone of our philosophy. I work hand in hand with our Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is a highly respected, board-certified Internist with over 40 years of invaluable experience. Her medical oversight, combined with my expertise in chiropractic, functional medicine, rehabilitation, and personal injury care, allows us to create a truly integrated system. This synergy ensures that our patients receive a depth and breadth of care that addresses their health from every possible angle, bridging the gap between conventional medical protocols and holistic, patient-centered therapies.
This educational post is born from a desire to demystify one of the most misunderstood and undertreated aspects of women’s health: testosterone deficiency. It’s a topic I am deeply passionate about because I witness the profound, and often devastating, impact it has on my patients’ lives daily. They come to me feeling dismissed, unheard, and resigned to a life of fatigue, depression, and physical decline, having been told their symptoms are just an inevitable part of aging. I am here to tell you that this is not the truth. This narrative needs to be rewritten, and my goal is to empower you with the knowledge to do so.
Drawing on the latest evidence-based research from leading institutions and my own extensive clinical observations, this article will guide you through a comprehensive journey. We will dismantle common myths, explore the deep physiological roles of testosterone in the female body, and provide a clear roadmap for diagnosis and treatment. We will explore how our integrative model—combining Dr. Cardenas’s medical direction with chiropractic adjustments, functional medicine testing, nutritional strategies, and targeted lifestyle interventions—offers a powerful, effective solution. This is not just about replacing a hormone; it is about restoring vitality, function, and quality of life.

Abstract: Reclaiming Vitality – A Deep Dive into Female Testosterone Deficiency

This comprehensive educational post, authored from the first-person perspective of Dr. Alex Jimenez, DC, APRN, FNP-BC, offers an in-depth exploration of testosterone deficiency in women, challenging the pervasive and harmful myth that symptoms like fatigue, depression, low libido, and weight gain are merely normal consequences of aging. This article serves as an empowering guide, grounded in the latest scientific research and extensive clinical experience, to help women understand, diagnose, and effectively manage this often-overlooked condition.
The discussion begins by establishing testosterone’s critical physiological roles in the female body, extending far beyond libido to include bone mineral density, lean muscle mass maintenance, cognitive function, mood stability, and metabolic health. It dismantles the misconception that testosterone is solely a “male” hormone, detailing its production pathways in the ovaries, adrenal glands, and peripheral tissues.
A core focus is clearly differentiating between the two primary types of hormone deficiency: Primary Hypogonadism (ovarian failure) and Secondary Hypogonadism (hypothalamic-pituitary dysfunction). The post provides a detailed breakdown of the underlying causes, diagnostic markers (LH, FSH, Testosterone levels), and distinct treatment approaches for each. For primary hypogonadism, the necessity of exogenous hormone replacement is explained, while for secondary hypogonadism, the emphasis is placed on identifying and treating the upstream root cause.
The article then elaborates on the crucial interconnectedness of the endocrine system, detailing how conditions like thyroid dysfunction (elevated TSH and SHBG), chronic stress (HPA axis dysregulation and pregnenolone steal), and severe caloric restriction (hypothalamic shutdown) can directly lead to or exacerbate testosterone deficiency. It provides a clear, actionable list of essential laboratory tests required for a comprehensive diagnosis, including total and free testosterone, LH, FSH, SHBG, prolactin, and a full thyroid panel.
Finally, the post highlights the unique benefits of an integrative, multidisciplinary approach to treatment. It explains how the collaborative care model at Injury Medical Clinic, which unites the medical oversight of Dr. Maria Cardenas, MD (Internal Medicine), with the functional and structural expertise of Dr. Alex Jimenez, DC, APRN, FNP, provides a holistic framework. This integration of chiropractic care, functional medicine, nutritional therapy, and stress management is presented as essential for restoring hormonal balance, optimizing nervous system function, and addressing the whole person, not just their symptoms. The ultimate message is one of hope and empowerment, asserting that with proper understanding and a comprehensive approach, women can reclaim their vitality and thrive at any age.

Testosterone in Women: The Overlooked Key to Vitality

Testosterone. The word itself often conjures images of masculinity, athletic prowess, and aggression. For decades, it has been almost exclusively discussed in the context of men’s health. But what if I told you that one of the most common reasons a woman in her 40s or 50s is handed a prescription for an antidepressant is not due to a primary psychiatric disorder, but because of a profound and undiagnosed testosterone deficiency? This is not speculation; it is a clinical reality I confront every single day in my practice.
Women arrive at my clinic describing a familiar and heartbreaking constellation of symptoms. They feel a bone-deep exhaustion that no amount of sleep can fix. They report a complete loss of libido, which strains their relationships and chips away at their sense of self. They are struggling with unexplained weight gain, particularly around the midsection, despite their best efforts with diet and exercise. They feel a mental fog that clouds their thinking and a pervasive sense of low mood or even depression. They are watching their muscle tone disappear, replaced by a softness they don’t recognize.
And what is the typical response they receive from the conventional medical system? Too often, their concerns are dismissed. They are told to “age gracefully.” They are told this is just a normal part of perimenopause or menopause. And, most alarmingly, they are frequently prescribed an antidepressant to manage their low mood. This treatment completely misses the underlying hormonal root cause and can sometimes even worsen their low libido. Does this scenario sound familiar? If it does, you are not alone, and you must understand that you are not simply “getting older”—you are likely suffering from a treatable medical condition.

The Fundamental Role of Testosterone in Female Physiology

To begin this journey, we must first dismantle the myth that testosterone is exclusively a male hormone. It is not. Women produce testosterone, and they always have. It is an essential component of female physiology, and without optimal levels, the body cannot function as designed. Let’s break down where it comes from.
The female body has a sophisticated system for producing this vital hormone:

• The Ovaries: These are the primary producers, responsible for manufacturing approximately 50 percent of a woman’s total testosterone output during her reproductive years. This production is intricately linked to the menstrual cycle and overall ovarian health.
• The Adrenal Glands: Sitting atop the kidneys, these small but mighty endocrine glands produce about 25 percent of the body’s testosterone. This production is part of the adrenal cascade, which also produces stress hormones like cortisol.
• Peripheral Conversion: The remaining 25 percent is synthesized in various tissues throughout the body, including fat (adipose tissue) and muscle. This process involves converting precursor hormones, such as androstenedione, into active testosterone. This pathway is particularly important because it shows how body composition—the ratio of fat to muscle—can directly influence hormone levels.

Once produced, testosterone doesn’t just float around aimlessly. It travels through the bloodstream and binds to androgen receptors in cells throughout the body, triggering a cascade of critical biological functions. The notion that its only job is to govern sex drive is a gross oversimplification. In women, optimal testosterone levels are the driving force behind:

• Libido and Sexual Function: This is its most well-known role. Testosterone is the primary driver of sexual desire, arousal, and orgasm in women. Low levels are a direct cause of hypoactive sexual desire disorder (HSDD).
• Bone Mineral Density: Testosterone plays a crucial role in stimulating osteoblasts, the cells responsible for building new bone tissue. Testosterone deficiency is a significant and independent risk factor for osteopenia and osteoporosis, increasing the likelihood of fractures as women age.
• Lean Muscle Mass and Strength: It is a powerful anabolic hormone, meaning it promotes protein synthesis and muscle growth. This is why women with low testosterone struggle to maintain or build muscle, even with consistent strength training. This muscle loss (sarcopenia) lowers metabolic rate and increases frailty.
• Cognitive Sharpness and Clarity: The brain is rich in androgen receptors, particularly in areas associated with memory, focus, and spatial awareness. Optimal testosterone levels contribute to mental acuity and protect against cognitive decline. The “brain fog” so many women describe is often a direct symptom of hormonal imbalance.
• Mood Stability and Well-being: Testosterone profoundly affects neurotransmitter systems in the brain, including dopamine and serotonin. It promotes confidence, motivation, and emotional resilience. Deficiency is strongly linked to symptoms of depression, anxiety, and irritability.
• Red Blood Cell Production (Erythropoiesis): Testosterone stimulates the kidneys to produce erythropoietin (EPO), a hormone that signals the bone marrow to create new red blood cells. This is essential for oxygen-carrying capacity and energy levels. Chronic fatigue in testosterone-deficient women can be partly attributed to suboptimal red blood cell counts.
• Metabolic Rate and Body Composition: By promoting lean muscle mass, which is metabolically active tissue, testosterone helps to maintain a healthy resting metabolic rate. Deficiency contributes to a metabolic slowdown, making it easier to gain fat and harder to lose it.

The scientific community is increasingly recognizing the gravity of this issue. This isn’t just anecdotal evidence from clinicians like me. A landmark 2021 study published in one of the world’s most prestigious medical journals, The Lancet Diabetes & Endocrinology, provided powerful confirmation of what we’ve observed for years. The researchers conducted a systematic review and meta-analysis. They concluded that testosterone deficiency in women is independently associated with decreased bone mineral density, sexual dysfunction, and an overall impaired quality of life (Islam et al., 2021).
Pay close attention to the language here: associated, not just correlated. In scientific terms, this implies a strong, direct link. This isn’t a random coincidence; it’s a cause-and-effect relationship. If you have low testosterone, it is not a benign finding. It is a pathological state that is actively undermining your physical and mental health. When a woman presents with these symptoms, the question isn’t if she has a hormone problem, but what kind of hormone problem it is. And that’s where the diagnostic journey must begin.

Unraveling Hypogonadism: Primary vs. Secondary Deficiency

When we identify low testosterone in a woman, it falls under the medical diagnosis of hypogonadism, which means diminished functional activity of the gonads (the ovaries in women). However, many physicians use this term as a catch-all without truly understanding the critical distinction between its two main forms. I see this every day in my practice when I review patient histories—women being treated with a one-size-fits-all approach that is doomed to fail because their doctor never identified the source of the problem. Getting this diagnosis right is everything, because the treatment pathways are completely different.
There are only two possibilities for why testosterone is low: Primary Hypogonadism or Secondary Hypogonadism. Let’s break these down so you can understand the difference.

Primary Hypogonadism: When the Factory Is Broken

Primary hypogonadism is a problem with the ovaries themselves. Think of the endocrine system as a corporate hierarchy. The brain (specifically the hypothalamus and pituitary gland) is the management, sending out instructions. The ovaries are the factory floor, responsible for producing the final product (estrogen, progesterone, and testosterone). In primary hypogonadism, the factory itself is broken, offline, or has shut down.
The brain, doing its job, recognizes that blood hormone levels are dangerously low. In response, it screams for more production. It sends a flood of stimulating signals down to the ovaries. These signals are two key hormones: Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). The pituitary gland pumps out LH and FSH in ever-increasing amounts, desperately trying to get the ovaries to respond.
But in primary hypogonadism, the ovaries can’t hear the signal or can’t respond. The receiver is cooked. The result is a very specific and unmistakable laboratory pattern:

• Sky-High LH and FSH: The brain is shouting, so the levels of these stimulating hormones are dramatically elevated.
• Rock-Bottom Testosterone (and Estrogen): Despite the intense stimulation, the broken factory cannot produce the hormones, so bloodstream levels are very low.

This is a state of ovarian failure. The signal from management is perfectly fine, but the machinery on the factory floor is non-functional.

Causes of Primary Hypogonadism

There are several reasons why a woman might develop primary hypogonadism:

• Natural Menopause: This is the most common cause. As a woman approaches her late 40s and 50s, the ovaries naturally run out of viable eggs and stop producing hormones. This is a normal, albeit often challenging, biological transition.
• Surgical Menopause (Oophorectomy): If a woman has her ovaries surgically removed, for reasons such as cancer, severe endometriosis, or cysts, she is immediately plunged into primary hypogonadism, regardless of her age. Hormone production ceases overnight.
• Premature Ovarian Insufficiency (POI): This is a condition where the ovaries stop functioning properly before the age of 40. It can be caused by genetic factors (like Turner syndrome or Fragile X syndrome), autoimmune diseases where the body’s immune system mistakenly attacks the ovaries (oophoritis), or damage from chemotherapy or radiation therapy.
• Infections or Pelvic Inflammatory Disease: Severe infections can sometimes cause irreparable damage to the ovarian tissue, leading to a loss of function.

The Only Solution for Primary Hypogonadism

When the factory is permanently broken, there is only one logical and effective solution: you must provide the body with the hormones it can no longer make. This is called exogenous hormone replacement. You bypass the broken factory entirely and supply the finished product directly.
The treatment for primary hypogonadism is not a magic tea or a simple supplement. It requires a comprehensive and medically supervised Hormone Replacement Therapy (HRT) regimen. This typically includes:

1. Exogenous Testosterone: This is the key component we’re focusing on. It can be administered via creams, gels, pellets, or injections to restore blood levels to a healthy, youthful range. This directly addresses the symptoms of low libido, fatigue, muscle loss, and mood changes.
2. Estrogen and Progesterone: For women who are in menopause and still have a uterus, it is crucial to replace estrogen (to manage symptoms like hot flashes, vaginal dryness, and protect bones) and progesterone (to protect the uterine lining from the effects of unopposed estrogen).
3. Supportive Cofactors and Peptides: A sophisticated approach also involves ensuring the body has all the necessary building blocks and signaling molecules to use these hormones effectively. This can include optimizing levels of Vitamin D, magnesium, and zinc, and sometimes utilizing specific peptides. Peptides are short chains of amino acids that act as signaling molecules in the body. For instance, peptides that support mitochondrial function and reduce inflammation can amplify the benefits of HRT by improving cellular health and energy production.

In our clinic, this is where the integrative model shines. While Dr. Cardenas oversees the medical necessity and prescription of HRT, my team and I focus on the foundational support. We use functional medicine testing to identify and correct nutritional deficiencies, and our chiropractic care ensures the nervous system—the master communication network that coordinates all endocrine function—is free of interference. This combination provides a robust framework for successful hormone replacement.

Secondary Hypogonadism: A Problem with Management

Now, let’s turn to secondary hypogonadism. This is a completely different scenario, and confusing it with primary hypogonadism is a critical clinical error.
In secondary hypogonadism, the ovaries—the factory—are perfectly fine. They are healthy, capable, and ready to produce hormones. The problem lies upstream, with the management team: the hypothalamus and the pituitary gland in the brain. For some reason, management has gone offline. They are not sending the necessary signals (GnRH, LH, and FSH) down to the ovaries.
The hypothalamus is supposed to release Gonadotropin-Releasing Hormone (GnRH) in a pulsatile fashion. This GnRH then signals the pituitary to release LH and FSH. But in secondary hypogonadism, this entire chain of command is suppressed.
This leads to a laboratory pattern that is the mirror opposite of primary hypogonadism:

• Low GnRH (though this is difficult to measure directly in blood tests)
• Low LH and FSH: Because GnRH is not stimulating the pituitary, it doesn’t release the stimulating hormones. The signals to the ovaries are weak or absent.
• Low Testosterone (and Estrogen): The healthy, functional ovaries are just sitting there, waiting for instructions that never arrive. Without the LH signal, they do not produce testosterone.

The ovaries are not the problem; they are simply not getting the signal to do their job.

The Crucial Question: Why Is Management Offline?

Here is the most important part: with secondary hypogonadism, simply giving exogenous testosterone is like putting a bucket under a leak in the ceiling without ever going to fix the broken pipe in the roof. You are treating the downstream symptom, not the upstream cause. You might feel a little better temporarily, but you will never truly resolve the issue, and you will likely continue to feel “like crap” because the root problem is still raging.
Therefore, the entire goal of diagnosing secondary hypogonadism is to answer one question: WHY? Why has the hypothalamic-pituitary axis gone silent? Investigating the “why” is the cornerstone of a functional medicine approach. Here are the most common culprits I investigate in my patients.

The “Why” of Secondary Hypogonadism: A Functional Medicine Investigation

When a patient’s lab results point to secondary hypogonadism—low testosterone accompanied by low LH and FSH—my role as a functional medicine practitioner kicks into high gear. This is where we move beyond simply naming the condition and start acting like a detective, hunting for the underlying dysfunction that has silenced the brain’s hormonal command center. Simply prescribing testosterone at this stage is a clinical failure. We must peel back the layers and address the root cause.
Here are the three most common and impactful areas I investigate first, each of which can single-handedly suppress the hypothalamic-pituitary-ovarian (HPO) axis.

1. Thyroid Function: The Master Metabolic Regulator

The very first place I look is the thyroid. The thyroid gland is the master regulator of the body’s metabolism. Every single cell in your body has thyroid hormone receptors, and its function is intimately and inextricably linked with reproductive hormone health. Ignoring the thyroid when evaluating sex hormones is like trying to fix a car’s engine without checking if there’s gas in the tank.
The standard medical approach often involves checking only a Thyroid-Stimulating Hormone (TSH) level. If it falls within the wide “normal” lab range, the patient is told their thyroid is fine. This is a woefully inadequate assessment. In functional medicine, we know that a “normal” TSH can hide significant underlying thyroid dysfunction.
Here’s how a sluggish thyroid (hypothyroidism) directly tanks your testosterone levels:

• Increased Sex Hormone-Binding Globulin (SHBG): When the body is in a hypothyroid state, the brain releases more TSH to try to stimulate the thyroid gland. Even a “high-normal ” TSH is a sign that the brain is working harder than it should. This elevated TSH has a downstream effect: it signals the liver to produce more Sex Hormone-Binding Globulin (SHBG).
• SHBG: The Testosterone Hoarder: Think of SHBG as a “hormone tax” that binds very tightly to testosterone in the bloodstream. When testosterone is bound to SHBG, it is biologically useless. It cannot detach to enter a cell and bind to its receptor. It’s like having a key to your house, but it’s permanently glued inside a locked box.
• The Free Testosterone Dilemma: This creates a deceptive clinical picture. A woman can have a normal total testosterone level on her lab report, leading her doctor to believe everything is fine. However, if her SHBG is sky-high, her free testosterone—the amount that is actually unbound and available to do its job—can be virtually zero. She will have all the debilitating symptoms of low testosterone, but her standard lab test will be “normal.”

This is why a comprehensive thyroid panel is non-negotiable. At a bare minimum, in addition to TSH, we must test:

• Free T4 and Free T3: These are the actual thyroid hormones. T4 is the storage form, and T3 is the active form. Low T3 is a major red flag.
• Reverse T3 (rT3): Under stress, the body can convert T4 into an inactive “antagonist” form called reverse T3, which blocks the action of active T3.
• Thyroid Antibodies (TPO and TG): These test for Hashimoto’s thyroiditis, an autoimmune condition that is the number one cause of hypothyroidism in the United States.

If we find thyroid dysfunction, our treatment focuses on supporting the thyroid with nutrients like iodine, selenium, and zinc, managing the autoimmune component if present, and, when medically necessary and in collaboration with Dr. Cardenas, prescribing the appropriate thyroid hormone medication (often including T3, not just T4). By optimizing thyroid function and lowering SHBG, we can “liberate” the testosterone already present, often restoring free testosterone levels without needing to add any exogenous testosterone.

2. The HPA Axis: Chronic Stress and Pregnenolone Steal

The second major area of investigation is the Hypothalamic-Pituitary-Adrenal (HPA) axis, our central stress response system. In our modern world, most people are living in a state of chronic, unrelenting stress. This isn’t just psychological stress from work or relationships; it’s also physiological stress from poor sleep, hidden infections, inflammatory foods, environmental toxins, and blood sugar dysregulation.
When the body perceives chronic stress, it prioritizes survival above all else. Reproduction, repair, and optimal performance become secondary luxuries. The adrenal glands are commanded to pump out the survival hormone: cortisol.
This is where a phenomenon known as the “pregnenolone steal” or “cortisol shunt” occurs. To understand this, we need to look at the adrenal hormone production cascade. It all starts with cholesterol, which is converted into a master hormone called pregnenolone. From pregnenolone, the body has two main pathways it can follow:

1. The Cortisol Pathway: Pregnenolone -> Progesterone -> Cortisol
2. The Sex Hormone Pathway: Pregnenolone -> DHEA -> Androstenedione -> Testosterone (and Estrogen)

Under normal circumstances, the body maintains a healthy balance, producing both cortisol and sex hormones. But when you are chronically stressed, the HPA axis goes into overdrive. The demand for cortisol becomes relentless. To meet this demand, the body “steals” the raw material—pregnenolone—and shunts it preferentially down the cortisol production pathway.
This leaves very little pregnenolone available to be converted into DHEA (dehydroepiandrosterone), which is the direct precursor to testosterone produced in the adrenal glands. The result? Cortisol levels are high, and DHEA and testosterone levels plummet. The adrenals are so busy making the survival hormone that they have no resources left to make the “thrive” hormones.

The Futility of Chasing Symptoms

This is a critical concept to grasp. You cannot supplement, peptide, or magic tea your way out of a cortisol problem. If your body is screaming for survival, giving it a little extra DHEA or testosterone is like trying to redecorate a house that’s on fire. It’s completely missing the point. Your body will keep prioritizing cortisol production.
The only effective solution is to drop the HPA load. This is a cornerstone of our integrative approach. We work with patients to identify and mitigate their primary stressors:

• Chiropractic Care: Spinal misalignments, or subluxations, are a major source of physical stress on the nervous system. They create a state of background “noise” or interference that keeps the HPA axis in low-grade, chronic activation. By delivering precise chiropractic adjustments, we restore proper motion and alignment to the spine, which calms the nervous system, reduces nociceptive input to the brain, and directly helps to down-regulate a chronically activated HPA axis. This is a powerful, non-invasive way to lower the body’s overall stress burden.
• Dietary and Lifestyle Modification: We guide patients to adopt an anti-inflammatory diet, stabilize their blood sugar, and improve their sleep hygiene.
• Stress Management Techniques: We teach and encourage practices like meditation, deep breathing exercises, mindfulness, and gentle movement like yoga or tai chi.
• Adaptogenic Herbs and Nutrients: We may use targeted supplements like Ashwagandha, Rhodiola, and phosphatidylserine to help modulate the cortisol response and support adrenal resilience, but only after the foundational lifestyle changes are in place.

By addressing the root causes of stress and calming the HPA axis, we allow the body to rebalance its hormone production naturally. The “pregnenolone steal” resolves, and the adrenal glands can once again allocate resources to making DHEA and testosterone.

3. Energy Balance: The Starvation Signal

The third major culprit I’m seeing with increasing frequency lately is severe caloric deficit and chronic under-eating. This is particularly prevalent in the era of extreme dieting and the widespread use of GLP-1 agonist medications (like Ozempic or Wegovy) for weight loss.
The hypothalamus is exquisitely sensitive to energy availability. It has sophisticated mechanisms to monitor your energy intake and your energy stores (body fat). Its primary directive, passed down through millennia of evolution, is to ensure survival. Biology will never invest precious energy in processes like reproduction (which includes making sex hormones) or high-level performance when it perceives a state of starvation.
When a woman engages in chronic, severe caloric restriction, her body receives a powerful danger signal. “Famine is here. Resources are scarce. Shut down all non-essential functions.”
In response to this perceived energy crisis, the hypothalamus shuts down GnRH pulsatility. It stops sending the signal to the pituitary. The entire HPO axis goes dark. LH and FSH levels drop, ovarian function is suppressed, and testosterone production grinds to a halt. This condition is known as functional hypothalamic amenorrhea when it becomes severe enough to stop menstrual cycles, but the hormonal suppression begins long before that point.
This is a protective mechanism. It would be evolutionarily foolish for the body to support a potential pregnancy when thereisn’tt enough food to sustain the mother. This is not a disease; it is an appropriate and intelligent adaptation to a perceived environmental threat.
The rise of GLP-1 agonists has created a new wave of this problem. These drugs are incredibly effective at suppressing appetite and inducing weight loss. However, if not managed properly with adequate protein and nutrient intake, they can easily lead to a state of severe caloric and nutritional deficit. Patients lose weight rapidly, but they also often lose muscle mass, and their hormonal systems crash. They feel weak, exhausted, and their libido disappears—classic symptoms of secondary hypogonadism induced by a perceived starvation state.

The Solution: Fixing the Energy Issue

The solution here is conceptually simple but can be behaviorally challenging for patients conditioned to believe that “less is more.” You have to fix the energy issue. This means:

• Eating Enough Food: We work with patients to calculate their true energy needs and ensure they are consuming enough calories to support their basal metabolic rate and activity levels.
• Prioritizing Protein: Adequate protein intake is crucial to preserve lean muscle mass during weight loss and to provide the amino acid building blocks for hormones and neurotransmitters.
• Nutrient Density: The focus must shift from calorie counting to nutrient density, ensuring the body is receiving all the vitamins, minerals, and healthy fats it needs to function.

You cannot trick biology. If the body believes it is starving, it will not produce testosterone. Restoring energy balance is the non-negotiable first step to restarting the HPO axis and resolving this type of secondary hypogonadism.

The Diagnostic Toolkit: Essential Labs for Clarity

To navigate this complex landscape and arrive at an accurate diagnosis, we must rely on objective data. Guesswork has no place in hormone management. Empowering yourself means knowing which tests to ask for and how to interpret them. When a patient comes to me with symptoms of testosterone deficiency, I insist on a comprehensive panel that goes far beyond the standard screening.
Here is the bare minimum list of labs you need to get a clear picture of what is happening in your body. I will have a more detailed list available in my clinic’s resources, but this is the essential starting point.

• Total Testosterone: This measures the total amount of testosterone circulating in your blood, including both the bound and unbound forms. It provides a general overview but can be misleading on its own.
• Free Testosterone: This is one of the most critical markers. It measures the tiny fraction (usually 1-2%) of testosterone that is not bound to SHBG or albumin and is therefore biologically active and available to your cells. This is the testosterone that “counts.” You can have normal total T but rock-bottom free T and be highly symptomatic.
• LH (Luteinizing Hormone) and FSH (Follicle-Stimulating Hormone): These two pituitary hormones are the key to differentiating between primary and secondary hypogonadism.
  • High LH/FSH + Low Testosterone = Primary Hypogonadism (ovarian failure)
  • Low LH/FSH + Low Testosterone = Secondary Hypogonadism (brain/pituitary issue)
• SHBG (Sex Hormone-Binding Globulin): As discussed, this is crucial for interpreting your free testosterone levels. High SHBG can be caused by hypothyroidism, high estrogen levels (including from oral contraceptives), or a low-calorie diet. It effectively “steals” your free testosterone.
• Prolactin: This is another pituitary hormone. Elevated prolactin levels (hyperprolactinemia) can be caused by stress, certain medications, or a benign pituitary tumor (prolactinoma). High prolactin directly suppresses GnRH, leading to secondary hypogonadism. It must always be checked.
• A Complete Thyroid Panel: As emphasized, this is non-negotiable. It must include TSH, Free T4, Free T3, Reverse T3, and Thyroid Peroxidase (TPO) and Thyroglobulin (TG) antibodies. Anything less is an incomplete picture.

Armed with these results, we can move from speculation to a precise diagnosis and formulate a targeted, effective treatment plan.

My Wife’s Story: A Testament to the Research

I want to share something personal because I believe it illustrates the power of this knowledge. My wife is forty-six years old. According to the conventional narrative, she should be “slowing down.” She should be accepting fatigue, weight gain, and a loss of libido as her new normal.
But that is a lie.
My wife looks and functions like she’s twenty-five. She is vibrant, energetic, strong, and sharp. Why? Because I am her doctor. We apply the very principles I am sharing with you today. We monitor her hormones regularly. We ensure her thyroid is optimal. We manage her stress through lifestyle and targeted support. We prioritize her nutrition, sleep, and physical activity. We do not accept “normal aging” as an excuse for a diminished quality of life.
Everything you need to reclaim your own vitality is available. It’s not a secret guarded by an elite few. It is all there in the scientific literature, in the research, in the playbooks of functional and integrative medicine. My mission is to make this information accessible to you, to give you the tools to have an intelligent conversation with your healthcare provider, and to advocate for the care you deserve.
You are not destined for a life of managed decline. Fatigue, depression, weight gain, and lost libido are not mandatory rites of passage into middle age. They are signals from your body that something is out of balance. By listening to those signals and applying a systematic, evidence-based approach, you can restore that balance and rewrite your story.

The Integrative Chiropractic Approach: A Synergistic Framework for Hormonal Health

Now, you might be asking, “This is all fascinating information about hormones, but where does chiropractic care fit in?” This is a crucial question, and the answer lies at the very heart of our integrative model at Injury Medical Clinic. Restoring hormonal balance isn’t just about prescribing hormones or supplements; it is about restoring the body’s innate ability to regulate itself. This is where the unique contribution of chiropractic care, combined with functional medicine and medical oversight, becomes indispensable.
Our entire endocrine (hormonal) system is directly controlled by the nervous system. The brain—specifically the hypothalamus and pituitary—is the command-and-control center. It sends signals down the spinal cord and out through peripheral nerves to every organ and gland in the body, including the ovaries and adrenal glands. It also receives a constant stream of information back from the body, which it uses to make decisions and maintain homeostasis, or balance.

Subluxation: The Stress of Structural Interference

In chiropractic, we focus on a condition known as vertebral subluxation. A subluxation is a complex of functional, structural, and pathological articular changes that compromise neural integrity and may influence organ system function and general health. In simpler terms, it occurs when a spinal vertebra loses its normal position or motion, placing stress and irritation on the delicate nerves and spinal cord it is designed to protect.
This structural interference creates deep physiological stress. It bombards the central nervous system with aberrant signals known as nociceptive input. Even without pain, this constant, low-grade “static” on the line forces the nervous system into a state of heightened alert, perpetuating a “fight-or-flight” response. This directly and chronically activates the HPA axis—the very same stress axis we identified as a primary cause of secondary hypogonadism through the “pregnenolone steal” mechanism.
Therefore, an uncorrected subluxation complex acts as a persistent, underlying stressor that can keep cortisol production high and actively suppress the production of your vital sex hormones, including testosterone. You can eat a perfect diet, take all the right supplements, and meditate for an hour a day. Still, if your nervous system is being constantly irritated by structural misalignments, you will be fighting an uphill battle to calm your HPA axis.

Chiropractic Adjustments: Restoring Nervous System Harmony

This is where the power of the chiropractic adjustment comes in. A specific, gentle, and precise chiropractic adjustment is designed to restore proper motion and alignment to the affected spinal segments. The effect is not just mechanical; it is profoundly neurological.
Research has shown that chiropractic adjustments can:

• Decrease Nociceptive Input: By restoring normal joint mechanics, adjustments reduce the aberrant signals being sent to the brain, effectively “quieting the noise” (Pickar, 2002).
• Modulate the Autonomic Nervous System: Studies have shown that adjustments can shift the balance of the autonomic nervous system away from sympathetic (“fight-or-flight”) dominance and toward a more parasympathetic (“rest-and-digest”) state. This is crucial for healing, recovery, and hormone regulation.
• Influence HPA Axis Function: By reducing the overall stress load on the nervous system, chiropractic care can help down-regulate a chronically activated HPA axis, thereby mitigating pregnenolone steal and allowing the body to redirect resources back toward the production of DHEA and testosterone (Kovanur Sampath et al., 2022).
• Improve Somatosensory Processing: Adjustments have been shown to alter how the brain processes information from the body, leading to better coordination, balance, and overall sensorimotor integration. This improved brain-body communication is fundamental to optimal self-regulation.

In the context of treating female testosterone deficiency, chiropractic care is not a “treatment” for the hormone problem itself. Instead, it is a foundational therapy that removes a major source of interference and creates the optimal neurological environment for the body to heal and regulate its own endocrine system. It helps to fix the upstream problem of HPA axis dysregulation, making all other interventions—whether it’s HRT, nutritional changes, or stress management techniques—more effective.

The Multidisciplinary Synergy in Action

Let’s walk through how our team at Injury Medical Clinic would manage a hypothetical patient—a 48-year-old woman presenting with fatigue, brain fog, weight gain, and low libido.

• Comprehensive Intake and Examination: She would first have a detailed consultation with me. We would discuss her complete health history, symptoms, and lifestyle. I would perform a thorough physical, neurological, and chiropractic structural examination to identify any areas of subluxation and nervous system interference.
• Advanced Laboratory Testing: Based on her symptoms, I would order the comprehensive hormone and thyroid panel we discussed earlier. This provides the crucial biochemical data to understand the nature of her hormonal imbalance.
• Medical Collaboration with Dr. Cardenas: Dr. Cardenas and I would review the lab results and my examination findings. Her expertise as an internist is vital here. If the labs show clear primary hypogonadism (ovarian failure), Dr. Cardenas would lead the medical management, prescribing the appropriate bioidentical Hormone Replacement Therapy (HRT), including testosterone, estrogen, and progesterone. Her medical oversight ensures this is done safely and effectively, in accordance with the highest standards of care.
• Functional Medicine Root Cause Analysis: If the labs instead point to secondary hypogonadism, my functional medicine investigation begins. We would analyze the results to pinpoint the upstream driver—is it a thyroid issue? HPA axis dysregulation? An energy deficit?
• Integrated Treatment Plan: A multifaceted plan would then be created:
  • Chiropractic Care: I would begin a course of specific chiropractic adjustments to correct her spinal subluxations, reduce stress on her nervous system, and help down-regulate her HPA axis.
  • Nutritional and Lifestyle Coaching: Our team would provide her with a personalized nutritional plan to support thyroid function, stabilize blood sugar, and reduce inflammation. We would also coach her on sleep hygiene and stress management techniques.
  • Targeted Supplementation: Based on her functional testing, we might recommend specific nutrients (like Vitamin D, B vitamins, or magnesium) or adaptogenic herbs to support her adrenal and thyroid health.
  • Rehabilitation and Exercise: Our rehabilitation specialists would design an exercise program focused on building lean muscle mass through resistance training, which further helps to improve insulin sensitivity and boost metabolic rate.

This is not a fragmented approach where the patient sees a chiropractor for her back, a medical doctor for her hormones, and a nutritionist for her diet. It is a cohesive, coordinated strategy in which every member of the team communicates and works toward the same goal: restoring function and vitality to the whole person. Dr. Cardenas provides the essential medical framework and prescriptive authority, while my team and I build the foundational health from the ground up, addressing structure, function, and biochemistry simultaneously.
This is the future of healthcare. It is patient-centered, evidence-based, and truly integrative. It recognizes that health is not merely the absence of disease but the vibrant expression of life, and that achieving it requires a comprehensive approach that honors the intricate connections between all of the body’s systems.

References

• Islam, R. M., Bell, R. J., Green, S., Page, M. J., & Davis, S. R. (2021). Endogenous testosterone concentrations and risk of incident cardiovascular events in women: a systematic review and meta-analysis. The Lancet Diabetes & Endocrinology, 9(6), 347–360. https://doi.org/10.1016/S2213-8587(21)00067-1
• Kovanur Sampath, K., Mani, R., Cotter, J. D., & Tumilty, S. (2022). Changes in biochemical markers of pain/inflammation, muscle damage, and stress-related hormones following spinal manipulative therapy: a systematic review and meta-analysis. Musculoskeletal Science and Practice, 61, 102598. https://doi.org/10.1016/j.msksp.2022.102598
• Pickar, J. G. (2002). Neurophysiological effects of spinal manipulation. The Spine Journal, 2(5), 357–371. https://doi.org/10.1016/s1529-9430(02)00400-x

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