Do low androgen levels contribute to unfavorable body composition in women?

In women, androgens such as testosterone and dehydroepiandrosterone (DHEA) play essential roles in metabolic health and physical function. Research indicates that these hormones are not merely male-specific but are critical for maintaining the musculoskeletal system and regulating adipose tissue in women.

Clinical and effectiveness evidence

The association between androgens and body composition is well-documented across several populations:

• Lean Mass Maintenance: Serum testosterone and DHEA levels are positively associated with skeletal muscle mass and strength. In older women, free testosterone levels correlate directly with muscle mass, and local intramuscular conversion of DHEA into active androgens accounts for over 75% of the variation in muscle strength.
• Body Composition Shifts: In hypopituitary women, transdermal testosterone replacement has demonstrated improvements in overall body composition and bone metabolism. Furthermore, longitudinal data from the Baltimore Longitudinal Study of Aging shows that declines in bioavailable testosterone correlate with increased body fat percentage and reduced muscle force.
• Hormonal Deprivation: Women who undergo oophorectomy (removal of ovaries) or experience premature ovarian failure often exhibit worsened body composition compared to age-matched controls, likely due to the abrupt loss of androgenic and estrogenic precursors.

Mechanistic explanations

Androgens influence body composition through direct action on muscle and adipose tissue receptors:

• Anabolic Muscle Signaling: DHEA is converted into testosterone and dihydrotestosterone (DHT) within muscle tissue. These potent androgens regulate muscle protein synthesis and adaptation. When androgen levels are suppressed (e.g., by certain oral contraceptives), muscle adaptation can be impaired unless precursors like DHEA are restored.
• Adipocyte Differentiation: Androgens modulate regional fat distribution by inhibiting the differentiation of subcutaneous fat cells. Specifically, testosterone and DHT downregulate adipogenic markers like PPARγ in subcutaneous abdominal depots. This inhibition can limit the storage capacity of "safer" subcutaneous fat, potentially shunting lipid storage toward visceral (internal) depots.
• Local Metabolism: Adipose tissue contains enzymes such as AKR1C3 that convert inactive precursors into potent androgens locally. This localized concentration can drive site-specific changes in fat cell size and metabolic function independently of circulating hormone levels.

Practical considerations

While the role of androgens is significant, they do not act in isolation. The estrogen milieu heavily modulates these effects, and in many female populations, estradiol remains a primary driver of lean mass maintenance. Additionally, while low androgens are linked to muscle loss, excess androgens (as seen in PCOS) are associated with unfavorable visceral fat accumulation, suggesting a "U-shaped" relationship where both deficiency and excess can negatively impact body composition.

Bottom line

Androgens are essential for maintaining muscle mass and regulating fat distribution in women. Low androgen signaling is a plausible contributor to unfavorable body composition, specifically through reduced muscle protein synthesis and shifts in how the body stores fat.