Discover solutions for women’s hormonal health issues caused by testosterone deficiency and improve your quality of life.
Hello, I’m Dr. Alex Jimenez. With my extensive background as a Doctor of Chiropractic (DC), Advanced Practice Registered Nurse (APRN), and Board-Certified Family Nurse Practitioner (FNP-BC), along with certifications as a Functional Medicine Practitioner (CFMP, IFMCP), Advanced Tonal Neuropathy Practitioner (ATN), and in Chiropractic Craniocervical Spinal Therapy (CCST), my career has been dedicated to unraveling the complex web of human health. This educational post explores the often-overlooked and misdiagnosed issue of testosterone deficiency in women. We will delve into the critical roles testosterone plays in female physiology, from maintaining libido and bone density to supporting cognitive function and metabolic health. We will differentiate between primary and secondary hypogonadism, outlining their distinct causes and appropriate diagnostic and treatment pathways.
Furthermore, we will examine the intricate interplay between testosterone and other systems, such as the thyroid and the adrenal stress response, explaining concepts like pregnenolone steal and the impact of severe caloric deficits. This journey emphasizes an integrative approach, showing how chiropractic care, functional medicine, and medical oversight converge to provide comprehensive, patient-centered solutions. Here at Injury Medical Clinic PA, our team, under the medical direction of Dr. Maria Guadalupe Cardenas, MD, is committed to empowering women with the knowledge and tools they need to reclaim their vitality and challenge the outdated notion that declining health is an inevitable part of aging.
At Injury Medical Clinic PA, also known as Mission Plaza Injury Medical Clinic, we have cultivated a unique and powerful healthcare model right here in El Paso, Texas. Our philosophy is rooted in the understanding that the human body is an interconnected system, where dysfunction in one area can ripple outward and affect overall well-being. To address this complexity, we have built a multidisciplinary team that brings together diverse expertise under one roof, ensuring our patients receive truly holistic care.
As a Doctor of Chiropractic and Family Nurse Practitioner, I bridge the gap between structural health and systemic function. I focus on the body’s biomechanics, nervous system integrity, and musculoskeletal health through chiropractic adjustments, while also managing and diagnosing conditions from a primary care and functional medicine perspective.
This comprehensive approach is fortified by the invaluable expertise of our Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is Board Certified in Internal Medicine (NPI #1164426749, Texas MD License #J2933) and brings over four decades of experience to our practice. Her profound knowledge of internal medicine provides the essential medical oversight that anchors our integrative protocols. She works side by side with our team, reviewing complex cases, guiding medical treatment plans, and ensuring our patients receive the highest standard of care. This collaborative relationship between a Doctor of Chiropractic/Nurse Practitioner and an Internist is a cornerstone of modern integrative medicine, allowing us to safely and effectively blend therapies like chiropractic care, physical rehabilitation, functional medicine, and conventional medical treatments.
Together, our team is dedicated to uncovering the root causes of our patients’ health concerns—whether it’s a personal injury, a chronic pain condition, or a complex metabolic issue like hormonal imbalance. We believe in empowering our patients with knowledge and personalized treatment plans that go beyond mere symptom management. By integrating chiropractic care for neuromuscular optimization with Dr. Cardenas’s medical guidance and the deep diagnostic tools of functional medicine, we offer a pathway to true healing and sustained vitality.
Testosterone. This single word often conjures images of male athletes and bodybuilders, but this perception is dangerously incomplete. For far too long, the medical community and society at large have overlooked the vital role testosterone plays in women’s health. The consequences of this oversight are profound. I see it every day in my practice: women walking through my doors feeling utterly depleted, struggling with a constellation of symptoms that have been dismissed or, worse, misdiagnosed.
They are exhausted, despite getting enough sleep. They feel a pervasive sense of sadness or emotional flatness. Their desire for intimacy has vanished. They watch their muscle tone fade, replaced by stubborn fat, especially around their midsection. They feel like they are living in a fog, unable to think clearly or recall information as they once did.
What is the typical response they receive from their conventional doctor? All too often, it’s a prescription for an antidepressant and a pat on the back with the well-meaning but ultimately dismissive advice to “age gracefully.” Does this sound familiar? This scenario isn’t just an anecdote; it’s a widespread clinical reality. Women are being treated for depression when the root cause is a hormone deficiency. This is not just a failure of diagnosis; it’s a failure to listen to and understand the female body.
Let’s be unequivocally clear: women produce testosterone. They always have, and they always will need it to function optimally. It is not a “male” hormone; it is a human hormone, essential for both sexes, albeit in different concentrations. Understanding where it comes from is the first step in appreciating its importance. The female body has a sophisticated system for producing this crucial hormone:
The widespread distribution of testosterone production underscores its systemic importance. This is not a hormone with a single, isolated function. It is a master regulator that influences a vast array of physiological processes, contributing significantly to a woman’s quality of life.
When a woman’s testosterone levels are optimal, the benefits are felt throughout her body and mind. It is the driving force behind many of the qualities we associate with youth and vitality. Let’s break down its key functions:
The scientific community is increasingly recognizing these connections. A landmark 2021 study published in The Lancet Diabetes & Endocrinology provided powerful confirmation of what integrative practitioners have observed for years. The researchers found that testosterone deficiency in women is independently associated with decreased bone mineral density, sexual dysfunction, and a significantly impaired quality of life (Davis et al., 2021). The key word here is associated, not just correlated. This implies a direct, causal link. If a woman has low testosterone, it is not a coincidence that she is also experiencing these debilitating symptoms; it is a direct physiological consequence.
When a woman presents with the classic symptoms of low testosterone and lab tests confirm it, the diagnosis is often hypogonadism. However, many doctors use this term without fully understanding its nuances. They often treat all cases as if they are the same, which is a critical mistake. I see this every single day—women put on a one-size-fits-all protocol that fails to address the underlying cause of their hormonal imbalance. To truly help a patient, we must first understand why her testosterone is low. There are two fundamentally different types of hypogonadism, and each requires a unique approach.
Primary hypogonadism is a problem with the ovaries themselves. Think of the ovaries as the “factory” responsible for producing estrogen, progesterone, and a significant portion of a woman’s testosterone. In primary hypogonadism, this factory is broken or has shut down. The communication system from the brain works perfectly fine, but the ovaries can’t respond to the signals.
To understand this, we need to look at the hypothalamic-pituitary-ovarian (HPO) axis. This intricate hormonal feedback loop governs reproductive function. Here’s how it works in a healthy system:
In primary hypogonadism, the brain detects that hormone levels are low. In response, the hypothalamus and pituitary go into overdrive, screaming for the ovaries to get to work. They pump out massive amounts of LH and FSH. When we run lab tests on a woman with primary hypogonadism, we see a very clear pattern: sky-high LH and FSH levels and rock-bottom testosterone and estrogen levels. The signal is deafening, but the receiver—the ovaries—is cooked.
There are several reasons why this can happen:
When the factory is permanently out of commission, there is only one logical solution: we must supply the body with the hormones it can no longer produce on its own. The treatment for primary hypogonadism is exogenous hormone replacement. This means providing testosterone from an outside source, typically in the form of creams, gels, pellets, or injections.
However, simply giving testosterone is not enough. We must take a comprehensive approach, which we call Hormone Replacement Therapy (HRT). This involves replacing not just testosterone, but also estrogen and progesterone in a balanced, physiologic manner that mimics the body’s natural state. At Injury Medical Clinic PA, we also integrate crucial cofactors—vitamins and minerals like Vitamin D, magnesium, and B vitamins that are essential for hormone synthesis and function. In some cases, we may also use specific peptides, which are small protein chains that can act as signaling molecules to help optimize the body’s response to the replaced hormones. This multi-pronged strategy ensures that we are not just masking a deficiency but truly restoring systemic balance.
Secondary hypogonadism is a completely different beast. In this case, the ovaries (the factory) are perfectly healthy and fully capable of producing hormones. The problem lies upstream, in the command-and-control centers of the brain: the hypothalamus or the pituitary gland. Management is essentially offline.
The communication chain breaks down at the very beginning. The hypothalamus fails to release GnRH in its normal, pulsatile manner, or the pituitary gland fails to respond to GnRH. This means the pituitary doesn’t release adequate amounts of LH and FSH. Without these crucial signals, the ovaries have no instructions. They are sitting there, ready and waiting, but the message to start production never arrives.
The lab results for secondary hypogonadism paint a starkly different picture from primary hypogonadism. We see low GnRH (though this is difficult to measure directly), which leads to low LH, low FSH, and consequently, testosterone levels in the cellar. The entire HPO axis is suppressed from the top down.
Herein lies the most critical issue with secondary hypogonadism: you absolutely must find out why the brain has gone quiet. Simply replacing testosterone without addressing the root cause is like patching a leaky roof without fixing the hole. You might feel a little better temporarily, but you are ignoring the underlying pathology, and you’ll likely still feel like crap in the long run because the primary problem is still raging.
This is where the real detective work of functional medicine begins. We have to investigate the various physiological stressors that can cause the hypothalamus and pituitary to downregulate their function. The body is intelligent; it shuts down non-essential functions like reproduction and peak performance when it perceives a threat to survival. Here are the most common culprits I investigate in my patients.
The first place I always look is thyroid function. The thyroid gland is the master of the body’s metabolism, and its influence extends to every single cell, including those in the brain and reproductive organs. There is a deeply intricate relationship between thyroid hormones and sex hormones.
When the thyroid is underactive (hypothyroidism), the entire metabolic system slows down. This can directly suppress the hypothalamus and pituitary. However, a more insidious mechanism is at play. In response to hypothyroidism, the pituitary often ramps up its production of Thyroid-Stimulating Hormone (TSH) in an attempt to whip the sluggish thyroid into action.
Here’s the problem: high TSH levels have been shown to increase the liver’s production of a protein called Sex Hormone-Binding Globulin (SHBG). As its name suggests, SHBG’s job is to bind to sex hormones—including testosterone—and transport them through the bloodstream. When a hormone is bound to SHBG, it is like being in handcuffs. It is biologically inactive and cannot attach to its receptor on a cell to carry out its function.
This creates a deceptive clinical picture. A woman might have a normal total testosterone level on her lab report, which can lead an inexperienced clinician to dismiss her symptoms. But if we also measure her free testosterone and SHBG, we often find that the SHBG is sky-high, hoarding all the available testosterone. Her free testosterone—the only form that matters for her cells—can be virtually zero. She has all the symptoms of testosterone deficiency because, at a cellular level, she is deficient. You can’t just look at one number; you have to see the whole story.
Next, we must evaluate the patient’s stress levels and the health of her adrenal glands. The body’s stress response system, known as the Hypothalamic-Pituitary-Adrenal (HPA) axis, is designed for short-term, acute threats. However, in our modern world, many of us live in a state of chronic stress—work deadlines, financial worries, relationship issues, poor sleep, and environmental toxins all contribute to a constantly activated stress response.
When you are chronically stressed, your adrenal glands are working overtime to pump out the stress hormone, cortisol. To produce all of its steroid hormones (cortisol, DHEA, testosterone, estrogen, progesterone), the body starts with cholesterol and converts it into a master precursor hormone called pregnenolone. From this pregnenolone “pool,” the body can then direct production down different pathways to make whichever hormone is most needed at the moment.
Under normal conditions, there is a healthy balance. But when you are under chronic stress, survival becomes the body’s number one priority. The adrenal glands prioritize cortisol production above all else. This triggers a phenomenon known as “pregnenolone steal” or “cortisol shunt.” The body literally “steals” pregnenolone from the pathways that lead to the production of other hormones, like DHEA (a direct precursor to testosterone) and testosterone itself, and shunts it all toward making more cortisol.
The result? Chronically elevated cortisol levels and depleted levels of DHEA and testosterone. You feel wired and tired, anxious, and you have no libido or energy. This is a survival mechanism. The body is essentially saying, “We are under attack! This is no time to worry about building muscle or reproducing. All resources must go to immediate survival.”
It’s crucial to understand that you cannot supplement, peptide, or magic-tea your way out of a cortisol problem. Giving someone with pregnenolone steal more DHEA or testosterone without addressing the stress is futile. The body will keep shunting resources toward cortisol. The only real solution is to drop the HPA load. This involves a multifaceted approach, including stress management techniques (meditation, breathwork, yoga), improving sleep hygiene, balancing blood sugar, and addressing any hidden sources of inflammation or emotional trauma.
Here is a trend I am seeing with increasing and alarming frequency in my clinic, especially with the widespread use of GLP-1 agonists (like Ozempic and Wegovy) for weight loss: severe and prolonged caloric deficits.
These medications are incredibly effective at suppressing appetite, which can lead to rapid and significant weight loss. While this can be beneficial for some, if not managed properly, it can put the body into a perceived starvation state. The hypothalamus is exquisitely sensitive to energy availability. It has sensors that monitor fuel levels, body fat stores, and caloric intake.
When the hypothalamus detects a severe and sustained energy deficit, it activates another powerful survival protocol. It interprets the lack of energy as a famine or a life-threatening situation. Biology will never invest precious energy in processes like reproduction (which requires a huge caloric investment) or building metabolically expensive tissue like muscle when it believes survival is at stake. Ever.
In response, the hypothalamus shuts down the HPO axis. It dramatically reduces the pulsatile release of GnRH, which grinds the entire reproductive hormone production chain to a halt. LH and FSH levels plummet, and the ovaries go dormant. This is the body’s way of conserving energy until the “famine” is over. The result is secondary hypogonadism, along with amenorrhea (loss of menstrual periods), fatigue, and muscle loss.
The only way to fix this is to fix the energy issue. This doesn’t necessarily mean abandoning weight loss goals, but it does mean pursuing them intelligently. It requires adequate protein intake to preserve muscle mass, avoiding excessively low-calorie levels for extended periods, and possibly incorporating strategies like “diet breaks” or “refeed days” to signal to the hypothalamus that energy is still available. You have to work with your biology, not against it.
You cannot guess when it comes to hormones. To navigate this complex landscape, you need data. You need labs. Arming yourself with the right information is the first step toward reclaiming your health. When a woman comes to me with symptoms of hormonal imbalance, I insist on a comprehensive panel that goes far beyond a simple total testosterone level. Here is the bare minimum set of labs you need to get a clear picture of what’s happening:
This lab panel provides the foundational data needed to identify the root cause of your low testosterone and to formulate a targeted, effective treatment plan. I’ll share a downloadable guide with these lab recommendations in my stories and on our website so you can take it to your doctor and advocate for your own health.
You might be wondering how chiropractic care fits into the treatment of a hormonal issue like testosterone deficiency. This is a perfect example of where our integrative model at Injury Medical Clinic PA truly shines. The body is not a collection of separate parts; it’s a unified whole. Structural health, nervous system function, and hormonal balance are inextricably linked.
The HPO and HPA axes—the very systems that control your sex hormones and stress response—are governed by the brain. The brain, in turn, relies on a constant stream of accurate information from the body to make its decisions. A huge portion of this information comes from proprioceptors—specialized nerve endings in the joints and muscles, especially those in the spine.
When there are spinal misalignments, or what chiropractors call subluxations, particularly in the upper cervical (neck) and pelvic regions, it can create “noise” in the nervous system. This aberrant signaling can interfere with the brain’s ability to accurately perceive what’s happening in the body and regulate its functions properly. The upper cervical spine is particularly critical, as it houses the brainstem, a vital relay station for communication between the brain and the rest of the body.
Through precise, gentle chiropractic adjustments, my goal is to restore proper motion and alignment to the spine. This isn’t just about “cracking backs”; it’s about optimizing nervous system function. By reducing structural stress and improving the quality of the signals going to the brain, we can help to normalize the function of the hypothalamus and pituitary. Think of it as improving the connection quality on a phone call between the brain and the endocrine glands.
Furthermore, chronic pain and structural imbalances are significant physical stressors that can keep the HPA axis in a state of overdrive. This contributes directly to the “pregnenolone steal” phenomenon we discussed earlier, depleting testosterone. Chiropractic care has been shown to strongly affect the autonomic nervous system, which has two branches: the “fight-or-flight” sympathetic branch and the “rest-and-digest” parasympathetic branch.
Many people with chronic stress and pain are stuck in a state of sympathetic dominance. Chiropractic adjustments, especially to the upper cervical and sacral areas, can help to shift the body out of this stressed state and into a more parasympathetic-dominant mode. This helps to lower the HPA load, reduce cortisol output, and free up pregnenolone to be converted into essential hormones like DHEA and testosterone.
By combining chiropractic care to optimize the nervous system with the functional medicine approach to identify and address the root biochemical imbalances, and under the watchful medical oversight of Dr. Cardenas, we create a powerful synergy. We address the problem from multiple angles—structural, neurological, biochemical, and medical—to help the body restore its natural, healthy hormonal balance.
I want to leave you with a message of profound hope. The pervasive narrative that women are destined to feel tired, depressed, and passionless as they get older is a lie. It is a lie born of ignorance and a failure to apply the vast body of scientific knowledge that we already possess. Symptoms like fatigue, weight gain, depression, and lost libido are not normal signs of aging. They are signs of a physiological imbalance that can, and should, be addressed.
I see the proof every day, not just in my clinic but in my own home. My wife is forty-six years old. By conventional standards, she should be “slowing down.” But she looks and functions like she’s twenty-five. She is vibrant, strong, sharp, and full of life. Why? Because I am her doctor, and we apply the very principles I have outlined here. We monitor her hormones, optimize her nutrition, manage her stress, and ensure her body is in balance.
You do not have to accept a diminished quality of life. The information is out there. The research has been done. Everything you need is in the playbook. I am committed to making this knowledge accessible to everyone, which is why I share it freely through posts like this, on my social media, and on our clinic’s website. You have the power to take control of your health journey. The first step is knowledge. The second is action.
Dr. Alexander Jimenez is a Doctor of Chiropractic, Advanced Practice Registered Nurse, and Board-Certified Family Nurse Practitioner with certifications in Functional Medicine, Advanced Tonal Neuropathy, and Craniocervical Spinal Therapy. He is the founder of Injury Medical Clinic PA in El Paso, Texas, where he works in collaboration with Medical Director Dr. Maria Guadalupe Cardenas, MD (Internal Medicine).
Clinical Observations by Dr. Alexander Jimenez, DC, APRN, FNP-BC:
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Professional Scope of Practice *
The information herein on "Women's Hormonal Health & Treatment for Testosterone Deficiency" is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.
Blog Information & Scope Discussions
Welcome to El Paso's Premier Fitness, Injury Care Clinic & Wellness Blog, where Dr. Alex Jimenez, DC, FNP-C, a Multi-State board-certified Family Practice Nurse Practitioner (FNP-BC) and Chiropractor (DC), presents insights on how our multidisciplinary team is dedicated to holistic healing and personalized care. Our practice aligns with evidence-based treatment protocols inspired by integrative medicine principles, similar to those found on this site and our family practice-based chiromed.com site, focusing on restoring health naturally for patients of all ages.
Our areas of multidisciplinary practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols.
Our information scope is multidisciplinary, focusing on musculoskeletal and physical medicine, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somato-visceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and functional medicine articles, topics, and discussions.
We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for musculoskeletal injuries or disorders.
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We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, please feel free to ask Dr. Alex Jimenez, DC, APRN, FNP-BC, or contact us at 915-850-0900.
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Blessings
Dr. Alex Jimenez DC, MSACP, APRN, FNP-BC*, CCST, IFMCP, CFMP, ATN
email: coach@elpasofunctionalmedicine.com
Multidisciplinary Licensing & Board Certifications:
Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License #: TX5807, Verified: TX5807
New Mexico DC License #: NM-DC2182, Verified: NM-DC2182
Multi-State Advanced Practice Registered Nurse (APRN*) in Texas & Multi-States
Multistate Compact APRN License by Endorsement (42 States)
Texas APRN License #: 1191402, Verified: 1191402 *
Florida APRN License #: 11043890, Verified: APRN11043890 *
Verify Link: Nursys License Verifier
* Prescriptive Authority Authorized
ANCC FNP-BC: Board Certified Nurse Practitioner*
Compact Status: Multi-State License: Authorized to Practice in 40 States*
Graduate with Honors: ICHS: MSN-FNP (Family Nurse Practitioner Program)
Degree Granted. Master's in Family Practice MSN Diploma (Cum Laude)
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
(Licensed Nurse Practitioner & Chiropractor - Multistate)*
Clinical Director
Digital Business Card
Dr. Maria Cardenas, MD
(Board Certified: Internal Medicine)
(Licensed Medical Doctor)
Medical Director, Clinical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
Licenses and Board Certifications:
MD: Medical Doctor
DC: Doctor of Chiropractic
APRNP: Advanced Practice Registered Nurse
FNP-BC: Family Practice Specialization (Multi-State Board Certified)
RN: Registered Nurse (Multi-State Compact License)
CFMP: Certified Functional Medicine Provider
MSN-FNP: Master of Science in Family Practice Medicine
MSACP: Master of Science in Advanced Clinical Practice
IFMCP: Institute of Functional Medicine
CCST: Certified Chiropractic Spinal Trauma
ATN: Advanced Translational Neutrogenomics
Memberships & Associations:
TCA: Texas Chiropractic Association: Member ID: 104311
AANP: American Association of Nurse Practitioners: Member ID: 2198960
ANA: American Nurse Association: Member ID: 06458222 (District TX01)
TNA: Texas Nurse Association: Member ID: 06458222
NPI: 1205907805
| Primary Taxonomy | Selected Taxonomy | State | License Number |
|---|---|---|---|
| No | 111N00000X - Chiropractor | NM | DC2182 |
| Yes | 111N00000X - Chiropractor | TX | DC5807 |
| Yes | 363LF0000X - Nurse Practitioner - Family | TX | 1191402 |
| Yes | 363LF0000X - Nurse Practitioner - Family | FL | 11043890 |
| Yes | 363LF0000X - Nurse Practitioner - Family | CO | C-APN.0105610-C-NP |
| Yes | 363LF0000X - Nurse Practitioner - Family | NY | N25929 |
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
(Licensed Nurse Practitioner & Chiropractor - Multistate)*
Clinical Director
Digital Business Card
Dr. Maria Cardenas, MD
(Board Certified: Internal Medicine)*
(Licensed Medical Doctor)*
Medical Director, Clinical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
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