Why Are Testosterone Levels High – But Libido and Energy Still Low?

By Dr. Jennifer Berman

Many women are surprised to learn their testosterone levels are elevated – especially when they feel anything but high-functioning. Low libido, chronic fatigue, brain fog, and lack of motivation are common complaints. So why isn’t testosterone – the so-called ‘hormone of vitality and desire’ – delivering its promised benefits?

The answer is complex. Testosterone doesn’t act in a vacuum. And in women, particularly, hormone balance is a symphony – not a solo performance. Elevated testosterone may not indicate optimal function, but rather a compensatory or dysfunctional state. Let’s unpack the science behind why high testosterone doesn’t always translate into high energy, libido, or well-being.

1. Bioavailability vs. Total Levels

Just because a lab test shows high total testosterone doesn’t mean your tissues are receiving or responding to it.

Much of the body’s testosterone is bound to sex hormone-binding globulin (SHBG), which renders it inactive. Women with low SHBG-often due to insulin resistance or high insulin levels-may have higher levels of free testosterone, but still experience symptoms of deficiency due to receptor desensitization or impaired intracellular signaling.

Furthermore, high cortisol (stress hormone) and systemic inflammation can down-regulate androgen receptors, blunting testosterone’s effects at the cellular level.

2. Metabolic Dysfunction and PCOS

Women with polycystic ovary syndrome (PCOS) often have elevated testosterone, but instead of vitality, they experience fatigue, irregular cycles, and low libido.

This paradox is due to underlying insulin resistance, chronic low-grade inflammation, and hormonal chaos that impairs the body’s ability to utilize testosterone constructively.

Androgens in this context often become ‘rogue’-causing acne, hair thinning, and hirsutism – without delivering the positive effects on muscle tone, mood, or sex drive.

3. Hormonal Crosstalk and Imbalance

Testosterone’s effects are modulated by the balance of estrogen, progesterone, thyroid hormones, insulin, and cortisol. A disruption in any of these systems can mute testosterone’s beneficial impact.

For instance, low progesterone (common in estrogen-dominant states) can increase anxiety and disrupt sleep, both of which counteract testosterone’s energizing and libido-enhancing qualities.

Thyroid dysfunction-especially hypothyroidism-can cause fatigue, weight gain, and low libido, regardless of androgen status.

4. Emotional and Neurochemical Factors

Testosterone supports dopamine and serotonin, neurotransmitters linked to motivation and pleasure. But chronic stress, trauma, anxiety, or mood disorders can override hormonal cues.

Women process sexual desire differently than men: relational, contextual, and emotional factors are often more influential than raw hormone levels.

If a woman is in an unsupportive relationship, battling body image issues, or living in a high-stress environment, her libido may remain suppressed even with ‘optimal’ hormones.

5. Misinterpretation of Lab Results

Lab values must always be interpreted in clinical context. A ‘high’ testosterone on paper may be a red flag of dysfunction-like an adrenal or ovarian response to stress-not a marker of health or optimization.

Additionally, many labs use male-based reference ranges or outdated metrics for assessing women’s hormone health. Functional and integrative approaches prioritize symptom correlation and hormonal rhythm, not just static numbers.

Conclusion: A Systems-Based Approach to Libido and Energy

If your testosterone is high but you still feel low, it’s not about needing more hormone-it’s about restoring hormonal harmony, metabolic function, and emotional alignment.

Effective treatment starts with understanding your unique biochemistry, lifestyle, and needs.

Precision hormone optimization, combined with nervous system support, nutrition, and targeted supplementation, can restore true vitality.

You don’t need to accept low energy and low libido as your baseline. You need a provider who understands that hormone health is about balance-not just numbers.

Next Steps

Interested in uncovering the root cause of your symptoms? Dr. Jennifer Berman offers personalized hormone optimization and integrative wellness solutions tailored to each woman’s biology and goals.

Schedule your Hormone Clarity Consult today and begin the process of reclaiming your energy, focus, and desire-with science, not guesswork.