Endometriosis and Testosterone: What’s the Link?

Endometriosis and testosterone might sound like an odd couple at first. Endometriosis is usually discussed as an estrogen-driven condition, while testosterone is often pushed into the “male hormone” corner of the room like an awkward guest at a dinner party. But biology rarely respects neat little labels. People of all sexes produce testosterone, and emerging research suggests that androgen hormones may play a more interesting role in endometriosis than many of us were taught.

The short answer? Testosterone is not a magic cure for endometriosis, but it may be connected to the condition in several ways: lifetime risk, pain sensitivity, inflammation, menstrual suppression, sexual health, and the way symptoms show up in transmasculine and nonbinary people using testosterone therapy. The long answer is more nuancedand frankly, more usefulso let’s unpack it without turning this into a dusty endocrinology textbook.

What Is Endometriosis?

Endometriosis is a chronic inflammatory condition in which tissue similar to the lining of the uterus grows outside the uterus. These lesions may appear on the ovaries, fallopian tubes, pelvic lining, bowel, bladder, and other areas. Even though this tissue is outside the uterus, it can still respond to hormonal changes. That means it may thicken, inflame, bleed, or irritate nearby nerves and organs.

Common symptoms include painful periods, chronic pelvic pain, pain during or after sex, painful bowel movements, painful urination around menstruation, bloating, fatigue, heavy bleeding, and infertility. Some people have severe disease with few symptoms; others have intense pain with minimal visible disease. Endometriosis likes to keep everyone guessing, which is one reason diagnosis can take years.

Most mainstream treatment discussions focus on estrogen because estrogen can encourage endometriosis lesions to stay active. That is why many treatment plans involve hormonal birth control, progestins, GnRH agonists or antagonists, or surgery. But estrogen is not the only hormone in the story. Testosterone may be one of the quieter characters that deserves a few more lines.

Testosterone Is Not Just a “Male Hormone”

Testosterone is an androgen, a class of hormones involved in sexual development, libido, bone health, muscle maintenance, mood, energy, and reproductive function. Everyone produces testosterone, though typical levels vary by sex, age, ovarian or testicular function, medications, and other health factors.

In people with ovaries, testosterone is produced mainly by the ovaries and adrenal glands. It may influence sexual desire, energy, metabolism, follicle development, and the balance between different reproductive hormones. Testosterone can also be converted into estradiol, a form of estrogen, through an enzyme called aromatase. This conversion matters because endometriosis is sensitive to estrogenic activity.

So when we ask, “What’s the link between endometriosis and testosterone?” we are not asking whether testosterone simply cancels out estrogen like a superhero with a cape. The relationship is more like a complicated group chat: testosterone, estrogen, progesterone, inflammation, immune activity, nerves, and genetics are all messaging at once.

The Low-Testosterone Theory of Endometriosis

One of the most interesting research areas is the possibility that lower testosterone exposureespecially before birthmay be associated with a higher risk of developing endometriosis later in life. Some studies have explored markers of prenatal androgen exposure, such as anogenital distance, and found associations between lower prenatal testosterone signals and endometriosis risk.

This does not mean that someone “caused” their endometriosis by having low testosterone. Nobody needs that kind of guilt served with breakfast. It means researchers are studying whether early hormone environments may influence reproductive tract development, immune function, pain pathways, and later vulnerability to endometriosis.

There is also research suggesting that people with endometriosis, including those with ovarian endometriomas, may have lower circulating testosterone levels than people without the condition. Other genetic and observational studies have looked at whether lower genetically predicted testosterone is linked with higher endometriosis risk. These findings are intriguing, but they do not yet translate into a simple diagnostic test or a standard testosterone-based treatment.

Why Would Testosterone Matter in Endometriosis?

Testosterone may matter for several reasons. First, androgens can interact with inflammatory pathways. Endometriosis is not just “bad cramps”; it is associated with immune changes, inflammatory chemicals, scar tissue, nerve irritation, and pain sensitization. If androgen activity influences inflammation or pain processing, testosterone could affect how symptoms develop or feel.

Second, testosterone may influence the reproductive hormone balance. Endometriosis is often described as estrogen-dependent, and many lesions can create or respond to local estrogen. If testosterone levels are low, or if testosterone is converted into estrogen in certain tissues, that balance could matter.

Third, testosterone may influence sexual function. Endometriosis can cause pain with sex, pelvic floor tension, fatigue, and low desire. Hormonal treatments for endometriosis may also affect libido, vaginal lubrication, mood, and comfort. Testosterone is not the whole answer to sexual health, but it can be part of the conversation, especially when desire and arousal change during treatment.

Can Testosterone Treat Endometriosis?

At this time, testosterone is not a standard first-line treatment for endometriosis in cisgender women. Most medical treatment still focuses on reducing estrogen stimulation, suppressing ovulation, limiting menstruation, calming inflammation, and managing pain. Options may include continuous combined hormonal contraceptives, progestin-only pills, hormonal IUDs, depot medroxyprogesterone acetate, GnRH medications, pain relievers, pelvic floor physical therapy, and surgery when appropriate.

There is one historical clue, though: danazol. Danazol is a synthetic androgen that was once commonly used to treat endometriosis by creating a low-estrogen, high-androgen environment. It can reduce pain for some people, but it often causes side effects such as acne, oily skin, weight changes, unwanted hair growth, voice changes, and unfavorable cholesterol changes. Because of those effects, danazol is used less often today than newer hormonal options.

In other words, androgenic therapy can influence endometriosis symptoms, but that does not mean taking testosterone casually is safe, appropriate, or effective. Hormones are powerful tools, not wellness gummies with better branding.

Endometriosis and Testosterone Therapy in Transmasculine People

The link between endometriosis and testosterone becomes especially important for trans men, transmasculine people, and some nonbinary people who use testosterone as gender-affirming hormone therapy. Testosterone often suppresses ovulation and menstruation, and many people stop having periods within months. Since periods often trigger endometriosis pain, it would be reasonable to think testosterone would always improve endometriosis.

Sometimes it does. Some people experience less bleeding, fewer menstrual flares, and improved quality of life after starting testosterone. But the story is not universal. Studies and clinical reports show that pelvic pain can persist in some people on testosterone. Some continue to have bleeding. Some have pain that begins or changes after testosterone therapy starts. Some are later found to have endometriosis during surgery, including hysterectomy.

Why might that happen? Several possibilities exist. Testosterone may not fully suppress ovarian activity in every person. Endometrial or endometriosis-like tissue may remain active. Testosterone can be converted into estradiol through aromatization in body tissues. Pelvic pain may also come from overlapping causes, including pelvic floor muscle tension, vaginal or vulvar tissue changes, bladder pain, bowel conditions, adhesions, ovarian cysts, or nerve sensitization.

The key point: testosterone therapy does not rule out endometriosis. If a person on testosterone has pelvic pain, bleeding, pain with sex, bowel symptoms, or urinary pain, they deserve a careful evaluationnot a dismissive “but you’re on testosterone, so it can’t be endo.” That sentence belongs in the trash next to expired yogurt.

Does Low Testosterone Cause Endometriosis?

Current evidence does not prove that low testosterone alone causes endometriosis. Endometriosis is multifactorial, meaning many forces may contribute: genetics, immune function, inflammation, estrogen activity, progesterone resistance, menstrual flow patterns, environmental exposures, pain pathways, and possibly prenatal hormone exposure.

Low testosterone may be one piece of the puzzle, not the whole jigsaw box. It may help explain why some people are more vulnerable to endometriosis, why pain sensitivity varies, or why certain symptoms cluster together. But a person can have normal testosterone and still have endometriosis. Another person can have low testosterone and never develop it.

Should You Test Testosterone Levels If You Have Endometriosis?

Hormone testing may be useful in selected cases, especially when someone has symptoms such as low libido, fatigue, irregular cycles, hair changes, acne, signs of polycystic ovary syndrome, early menopause symptoms, or concerns related to gender-affirming hormone therapy. A clinician may check total testosterone, free testosterone, sex hormone-binding globulin, estradiol, progesterone, thyroid markers, prolactin, or other labs depending on the situation.

However, testosterone testing is not a diagnostic test for endometriosis. Normal lab results do not exclude the disease, and abnormal results do not confirm it. Endometriosis is usually diagnosed based on symptoms, exam findings, imaging when helpful, response to treatment, and sometimes laparoscopy with tissue confirmation.

Symptoms That Deserve Attention

Whether or not testosterone is part of your health picture, certain symptoms should not be ignored. Severe pelvic pain that disrupts school, work, relationships, or sleep deserves medical care. So does pain that does not improve with over-the-counter medication, pain with bowel movements or urination, heavy bleeding, bleeding after starting testosterone therapy, infertility, or pain during sex.

For people using testosterone, it is especially helpful to track whether pain is cyclical, whether it appears near injection days or dose changes, whether bleeding continues, and whether symptoms involve the bladder, bowel, pelvic floor, or vaginal tissue. A symptom diary may sound boring, but it can turn a vague appointment into a productive one. Your future self may send you a thank-you card.

Treatment Options: What Actually Helps?

Endometriosis treatment should be individualized. A person trying to conceive may need a very different plan from someone trying to stop periods, preserve fertility for later, manage gender dysphoria, or avoid estrogen-containing medication.

Common options include nonsteroidal anti-inflammatory drugs for pain, hormonal suppression to reduce bleeding and lesion activity, pelvic floor physical therapy, lifestyle strategies to support sleep and inflammation control, mental health support for chronic pain stress, and surgery to remove endometriosis lesions when symptoms are severe or persistent. Excision surgery, when performed by a skilled surgeon, may help some patients, especially those with deep infiltrating disease, endometriomas, bowel involvement, or symptoms that do not respond to medication.

For transmasculine and nonbinary patients on testosterone, care may include adjusting testosterone delivery, adding menstrual suppression, evaluating pelvic floor dysfunction, treating vaginal or vulvar atrophy, considering imaging, or discussing hysterectomy and/or excision surgery when appropriate. The best care is both medically competent and gender-affirming.

Fertility, Libido, and Quality of Life

Endometriosis can affect fertility by causing inflammation, scarring, ovarian endometriomas, altered egg quality, or changes in implantation. Testosterone-related questions may become more complex for people preserving fertility before or during gender-affirming care. Anyone who wants biological children, now or later, should ask about fertility preservation, egg freezing, embryo freezing, and how surgery or hormones may affect future options.

Libido is another area where testosterone enters the chat. Some people with endometriosis report low desire because sex hurts, they are exhausted, they feel disconnected from their body, or medications change hormone levels. For others, testosterone therapy may increase desire but also create genital dryness or pelvic discomfort. The lesson is simple: sexual health is not just a hormone number. Pain, safety, relationship dynamics, body image, pelvic floor function, and lubrication all matter.

Common Myths About Endometriosis and Testosterone

Myth 1: Testosterone cures endometriosis.

Testosterone may reduce periods and help some symptoms in some people, but it does not reliably eliminate endometriosis lesions or guarantee pain relief.

Myth 2: People on testosterone cannot have endometriosis.

They can. Endometriosis has been found in transmasculine people using testosterone, including people whose periods stopped.

Myth 3: Low testosterone means you definitely have endometriosis.

No. Low testosterone may be associated with endometriosis risk in some research, but it is not a stand-alone diagnosis.

Myth 4: Endometriosis is only about estrogen.

Estrogen is important, but endometriosis also involves immune activity, inflammation, nerves, genetics, progesterone resistance, and possibly androgen signaling.

Real-Life Style Experiences: What the Link Can Feel Like

Experiences with endometriosis and testosterone vary widely, but a few patterns come up again and again in clinics, support groups, and patient conversations. Imagine someone who spent years being told their periods were “just bad luck.” Every month brought cramps that felt less like cramps and more like a tiny construction crew jackhammering the pelvis. They finally learned about endometriosis after developing bowel pain and fatigue. When hormone testing later showed low-normal testosterone, they wondered whether that number explained everything. The answer was not simple, but the conversation helped them understand that their pain was biological, complex, and realnot a personality flaw.

Another common experience involves sexual health. A person may start hormonal treatment for endometriosis and feel grateful because the monthly pain finally calms down. Then their libido drops, vaginal dryness appears, or sex becomes uncomfortable in a new way. They may wonder whether testosterone is involved. Sometimes the issue is lower androgen activity. Sometimes it is pelvic floor guarding from years of pain. Sometimes it is medication-related dryness. Often, it is a combination. The most helpful care does not say, “Here is one hormone, problem solved.” It looks at the whole picture: pain control, lubrication, pelvic floor therapy, relationship communication, medication side effects, and emotional recovery.

For a transmasculine person, the story may be different. Starting testosterone may bring relief from bleeding and dysphoria, which can feel life-changing. Then, months later, pelvic cramping returns. The person may feel confused or even betrayed by their body. They may worry that seeking gynecologic care will be uncomfortable, invalidating, or full of wrong names and awkward assumptions. In that situation, the medical message should be clear: pelvic pain on testosterone is real, and it deserves respectful care. Testosterone can suppress menstruation, but it does not make someone immune to endometriosis, ovarian cysts, pelvic floor dysfunction, or other causes of pain.

There are also people who feel better on testosterone or androgen-influencing treatments. Their bleeding stops, flares become less dramatic, and life feels less ruled by a calendar. That improvement is valid too. Endometriosis is not a one-lane road; it is a traffic circle with confusing signs. The goal is not to force everyone into the same treatment plan. The goal is to find the safest, most effective approach for each person’s body, goals, identity, fertility plans, and tolerance for side effects.

The biggest shared experience is often relief after being believed. Whether the conversation is about low testosterone, estrogen suppression, trans health, surgery, libido, or chronic pain, people with endometriosis need clinicians who listen carefully. A good appointment should leave a person feeling less like a mystery file and more like a partner in the plan.

Conclusion: So, What Is the Link?

The link between endometriosis and testosterone is real enough to deserve attention, but not simple enough for clickbait medicine. Research suggests that lower testosterone exposure or activity may be associated with endometriosis risk, pain, and related reproductive changes. Testosterone therapy may reduce menstruation and improve symptoms for some transmasculine and nonbinary people, yet endometriosis and pelvic pain can persist. Androgen-based treatment has a history in endometriosis care, but side effects and individual goals matter.

If you suspect endometriosis, have pelvic pain while using testosterone, or notice changes in bleeding, libido, or pain patterns, the smartest next step is not guessing your way through hormones. It is finding a clinician who understands endometriosis, hormone therapy, and your personal goals. The body may be complicated, but your pain deserves a serious answer.

Editorial note: This article is for educational purposes only and should not replace medical advice, diagnosis, or treatment from a qualified healthcare professional.