Ice Baths & Women's Testosterone
- Thomas P Seager, PhD
- 6 days ago
- 12 min read
Updated: 2 days ago
How can cold plunge therapy can improve testosterone levels for women?
Summary
Many people are surprised to learn that testosterone, not estrogen, is the primary sex hormone in women's bodies — just as it is in men.
Low testosterone in women can result in several health issues including decreased energy, low libido, cognitive strain and overall decline in well-being.
My recent book, Uncommon Testosterone (Seager 2025), summarizes several articles that document the sex health and fertility benefits of cold plunge for women.
Case studies show that ice baths can not only stimulate the secondary sources of testosterone in women, but even in those women who are post-menopausal.
Cold plunge therapy activates and recruits brown fat tissue, correcting metabolic disorders associated with insulin resistance and modulating testosterone levels.
Testosterone plays a vital role in women's hormonal health
Contrary to common belief, testosterone reigns as the most abundant sex hormone in women's bodies, paralleling its dominant position in men. While labs often report estrogen and testosterone in different units, converting these units for comparison shows a higher total testosterone concentration. In fact, healthy women have 2x-3x more testosterone circulating in their bloodstream than total estrogens (i.e., estrone, estradiol, and estriol). A quarter of this testosterone is produced in the gonad (ovarian) tissue, with the rest coming from the adrenal glands (Burger 2002), fat cells, and the skin (Chen et al. 2002).
Testosterone levels will often fluctuate throughout a woman's life, and the association of maximum testosterone production with ovulation may explain why many women experience a 50% testosterone drop after menopause. Although a healthy woman will still only create one tenth of the testosterone of a healthy man, it is just as crucial to a woman's health to maintain proper testosterone balance. Sustaining stable hormone levels is fundamental for healthy development in women, not only through-out adolescence but well past child-bearing years.
Insufficient testosterone levels can result in various health issues
The "primary indication for the prescription of low testosterone for women is loss of sexual desire", causing those affected women significant distress (Davis et al. 2015). Along with this, multiple negative health consequences may accompany low testosterone levels in women, including "reduced overall well-being, depressive symptoms, energy depletion, muscle deterioration and weakness, diminished sexual interest, (decreased) receptiveness to sexual advances, (impaired) arousal and climax, pubic hair thinning, cognitive and memory impairments," along with elevated osteoporosis risk due to compromised bone density (Al-Azzawi and Palacious 2009).
However, a study by Rohr (2002) reveals another important point- testosterone imbalance has negative consequences for both lower and higher than average testosterone levels. Higher testosterone levels, or hyperandrogenic states, can also exist within women and create their own health complications as a result.
These hyperandrogenic states can result in:
hirsutism (excessive hair growth),
acne,
polycystic ovary syndrome (PCOS), a
and irregular menstruation cycles.
Not only this, but "Social research suggests high androgen levels cause aggressive behavior in men and women and as a consequence may cause depression." It is also found that "higher androgen values are more pronounced at young ages, including before and after delivery of a baby" and might be responsible for the decline in mood (referred to as the "baby blues"), especially during the postpartum period of child birth. So how can women counteract these hormone fluctuations to remain at the necessary equilibrium?
Cold therapy stimulates both primary and secondary sources of testosterone in women
When a woman plunges her whole body neck-deep into cold water, her adrenals, skin cells, and fat cells all go into overdrive in response. In fact, there have been studies showing that cold stimulates production of testosterone in women. For example, a few years ago a case study of 32 undergraduate women participated in a cold pressor test of pain tolerance. This cold pressor test is a psychological instrument for inducing a stress response in subjects. Although most people can't last for more than one minute, the test requires subjects to submerge the non-dominant hand in a bowl of ice water for five minutes or less.
When studying this relationship between testosterone and pain tolerance, the researchers chose the cold pressor test as a standardized instrument for creating pain. While they initially did not intend to study the relationship between cold exposure and testosterone, when measuring saliva testosterone prior to and after the test, they unintentionally created the first study of non-pharmaceutical testosterone therapy in women. What they then discovered was that cold stimulation increases testosterone in women, even without exercise (Archey et al. 2019).
The female participants who vocalized their discomfort showed greater testosterone increases than those who remained silent, though both groups demonstrated significant elevation in testosterone levels. Since this study focused exclusively on young, pre-menopausal women and involved only hand immersion rather than full-body cold exposure, the findings may not directly apply to older women experiencing whole-body cold water therapy.
The researchers included male subjects as a comparative measure for pain tolerance assessment. While they couldn't attribute sex-based differences in pain endurance to testosterone levels, they did establish that even limited cold stimulation can trigger testosterone production in younger women. In fact, women's testosterone levels increased nearly twice as much as men's in response to the cold stimulus.
Although the researchers didn't explicitly discuss the therapeutic potential for naturally enhancing testosterone production in menopausal women, their findings clearly suggest a logical next research direction: measuring testosterone levels before and after implementing whole-body cold immersion protocols for women in ice baths.
Case studies of cold plunge boosting women's testosterone
In one case study with Pamela Butler, a 60-year old female yoga instructor, cold plunging boosted her total testosterone levels to over 160 ng/dl. Pamela's testosterone levels were not only unheard of for a woman 60 years of age, but her case study is especially unique because she no longer has any ovaries.
Pamela underwent a total hysterectomy and oophorectomy (removal of ovaries) at the age of 42, triggering surgical menopause. She suffered from osteoarthritis and Hashimoto's thyroiditis, along with a medical history of low testosterone levels. Since the surgery, Pamela had been on low-dose hormone replacement therapy (HRT), but she reported of a medication sensitivity and prefers non-pharmaceutical interventions. When she first tested her testosterone levels on October 5, 2023, it revealed her levels to be at 14 ng/dL. It was in December 2023 that she began daily cold plunge therapy at 46°F (8°C).
Following 40 consecutive days of cold plunge therapy, Pamela experienced notable improvements in her mental health, mood, anxiety, and osteoarthritis symptoms, enabling her to stop steroid injections for back pain.
Subsequent testing on May 28, 2024, revealed a dramatic increase in Pamela's testosterone to 168 ng/dL. This lead her endocrinologist to recommend discontinuing testosterone supplementation. Her estradiol levels also rose from 20 pg/mL to 32 pg/mL. Rather than experiencing negative or masculinizing effects, Pamela reported enhanced mental clarity, focus, and reduced depression and anxiety.
Another case study on Elise DeSoutter, a 32-year old nulliparous (has never given birth) had similar findings. Along with infertility, Eloise has a biological sister with polycystic ovary syndrome (PCOS). She decided to begin a personal cold water immersion regimen to evaluate potential effects on her fertility health markers. Over the course of four months, Eloise immersed herself in water ranging from 2-8°C, starting with daily sessions before transitioning to 2-3 weekly immersions.
Measurements taken on the third day of Eloise's menstrual cycle, both before and after the intervention, showed significant hormonal and body composition changes. Her total testosterone nearly doubled, rising from 0.6 to 1.1 nmol/L.
Estrogen levels showed an even more dramatic change, tripling from their initial value. DEXA scanning revealed Eloise gained 2% in total muscle mass while losing 2% of her total fat mass, with no change in bone density. Throughout the study period, Eloise maintained her usual lifestyle without additional modifications during this time. She also reported subjective improvements in her mood, confidence, libido, and energy levels.
Ice baths can also improve sexual function and fertility
Most people don't realize that the leading cause of infertility in women of child-bearing age is polycystic ovarian syndrome (PCOS). This is a disorder that causes cysts (fluid-filled sacs) to develop on the ovaries, interfering with ovarian function & causing them to overproduce testosterone. You may also be surprised to learn that PCOS is associated with obesity, high body mass index, and actually originates in insulin resistance, a result of metabolic dysfunction.
In addition, as mentioned by Ben Bikman in Why We Get Sick (Bikman 2020), insulin resistance accompanies 8 out of the 10 leading causes of death in the United States, including cancer, Alzheimer's, cardiovascular disease, Type 2 diabetes, and obesity.
In Cold Plunge Sex Health, I explain how infertility is derived from this metabolic dysfunction, coinciding with insulin resistance. Because sexual function & reproduction is metabolically demanding, it makes sense that metabolic disorders disrupt sexual & reproduction functions. These irregularities in fecundity are are typically attributed to both overfeeding and starvation. While cold plunge therapy may not provide benefits when facing starvation or insufficient nutrients, ice baths can prove beneficial when addressing issues such as overfeeding — e.g. insulin resistance resulting from excessive carbohydrate intake. What's more, considering that the Standard American Diet (SAD) has become an excess of carbohydrates and seed oil intake, the consequences of this overconsumption is disastrous on our metabolic health.
Insulin is the hormone that serves as the critical transporter of glucose from circulation into all living tissues throughout the body—including muscle, adipose tissue, bone, brain, and every other cellular structure. After glucose passes through the cell membrane and enters the cell, mitochondria converts this glucose-based energy into various forms of biological fuel. This fuel then powers all physical activity, cellular growth, thermogenesis, or additional white adipose tissue accumulation.
Carbohydrates and seed oils contribute to insulin resistance through two basic pathways:
When carbohydrate consumption chronically exceeds the body's needs, cells begin blocking insulin's effects, causing glucose to remain in circulation rather than entering cells. This defensive mechanism prevents mitochondrial overwork and results in potential damage to mitochondrial DNA. Insulin resistance may represent the body's protective mechanisms against reactive oxygen species generated during rapid glucose metabolism. However, this protection comes at a cost— elevated blood glucose negatively impacts practically every other function in the body over time.
Oils derived from seeds (including soybean, cottonseed, peanut, grapeseed, and corn oils) contain substantially higher concentrations of linoleic fatty acids compared to oils from fruits (such as coconut, olive, and avocado) or animal fats. Although humans require some linoleic acid for proper function, the amount contained in seed oils far exceed the body's needs. Consequently, cell membranes—which incorporate fatty acids as crucial structural components—become disproportionately saturated with linoleic acids at the expense of other essential fatty acids. This then potentially contributes to insulin resistance by reducing the membrane's capacity for glucose transport, further elevating blood glucose levels.
Adapting a regular cold plunge practice can reverse insulin resistance, even once it has progressed into it's more severe state of Type 2 Diabetes. Improving insulin sensitivity-- for instance, via a program of cold plunge therapy--can reverse PCOS, restore fertility, and normalize testosterone levels (Ye et al. 2021 [in rats]). What's more, researchers found that "cold treatment can restore ovarian cyclically and reverse hyperandrogegism", along with discovering an increase in twice the rate of successful pregnancies for the cold-treated group of female rats (Ye et al. 2021). This could be why in pregnant women, cold plunge is associated with better birth outcomes.
Brown fat improves metabolic function
The mechanism in which cold plunge acts upon insulin resistance is activation of brown fat through cold exposure. Brown fat cells, also known as brown adipose tissue (BAT) serve a much different purpose in the body than white fat. While white fat stores energy in the form of lipid droplets, which can be released into the bloodstream during times of energy deficit, brown fat instead consumes caloric energy. Brown fat cells are packed with thousands of extra mitochondria that are activated by the sympathetic division of the autonomic nervous system when thermoreceptors in the skin detect temperatures dropping. Once exposed to cold, the body initiates a process called cold thermogenesis—where white fat releases lipids into circulation to fuel heat generation in brown fat cells. Despite drawing heat from the body through cold exposure, activated BAT cells help to maintain the body's core temperature. This thermogenic response clears glucose from the bloodstream, consumes triglycerides, promotes endogenous ketone production, increases caloric expenditure, and can persist for several hours after cold exposure ends.
Human babies possess abundant quantities of brown fat to keep them warm in the cold. As they mature and their muscles develop, that brown fat slowly diminishes. Eventually, shivering thermogenesis dominates brown fat thermogenesis. By the age of 40, over 90% of American adults have no detectable brown fat. Regardless, cold exposure will stimulate the body to recruit new brown fat, restoring some of the capacity for non-shivering thermogenesis that was lost.
Brown fat provides profound metabolic advantages.. Not only does brown fat help to maintain insulin sensitivity, it also secretes hormones that modulate other metabolic functions — including the thyroid. Loss of brown fat can result in a dysregulated thyroid, including a condition called Hashimoto's hypothyroidism, while restoration of brown fat can resolve Hashimoto's.
This brings me to my final point that,
Mitochondria are crucial for testosterone synthesis
Cold plunge therapy can support healthy testosterone levels and sexual function through improving mitochondrial health, along with correcting metabolic disorders.
Beginning with the process of steroidogenesis, testosterone production in the body relies on cholesterol as its essential building block. Without adequate levels of both HDL and LDL cholesterol circulating in the bloodstream, the body's ability to synthesize testosterone becomes compromised. This relationship was confirmed in a large-scale Korean study examining blood work from thousands of middle-aged men. The researchers found that participants with low LDL cholesterol correspondingly showed reduced total testosterone levels. Conversely, men with elevated HDL cholesterol demonstrated the highest total testosterone measurements. These findings align perfectly with our understanding that cholesterol serves as the fundamental metabolic precursor for testosterone production (Lee et al. 2023).
What remains less widely understood is that mitochondria—the cellular powerhouses—are actually responsible for steroidogenesis (Papadopoulos et al. 2012). This crucial process converts cholesterol into pregnenolone, the foundational precursor molecule required for testosterone synthesis. Because mitochondria perform this vital transformation, their optimal functioning directly determines the body's capacity to produce adequate testosterone levels. Maintaining mitochondrial health is therefore fundamental to sustaining healthy testosterone production. Cold exposure therapies like ice baths can support mitochondrial function, providing a modulating effect on testosterone levels in women—reducing it in unhealthy women when it is already too high, and raising it in healthy women who might benefit from the boost.
This leads to the question,
What markers indicate healthy mitochondrial function?
The triglyceride to HDL cholesterol ratio serves as a key indicator of mitochondrial efficiency. When this ratio rises above three (3), it signals compromised mitochondrial quality and correlates with insulin resistance, cardiovascular disease (Luz et al. 2008), and higher mortality rates. Healthy individuals typically maintain ratios below two (2). For context, my personal triglyceride/HDL measurements consistently range between 0.5 and 0.7, reflecting optimal mitochondrial performance.
For example, Chung et al. (2020) found that men with elevated triglyceride to HDL ratios typically exhibit lower testosterone levels due to the crucial role mitochondrial quality plays in testosterone synthesis. While testosterone decline is often observed as characteristic of aging men in industrialized nations, it probably stems not from age itself, but rather from cumulative mitochondrial damage. This damage often results from insufficient cold exposure, consumption of seed oils, disrupted sleep patterns, and improper light exposure.
In Ice Baths for Mitochondrial Therapy, I explained that cold plunge therapy stands as one of the most effective methods for enhancing both mitochondrial quality and quantity. While exercise likely ranks as the second most powerful intervention, research suggests that combining physical activity with cold exposure delivers superior results compared to either approach alone.
Another example of this is when Korean researchers conducted a study examining the separate and combined effects of exercise, cold water immersion, and both interventions together in young mice (five weeks old). Their findings revealed that the combined approach—exercise plus cold water exposure—led to enhanced expression of genes associated with mitochondrial biogenesis in both muscle and adipose tissue (Chung et al. 2017). If these results translate to humans, they would support the precooling protocols that yielded testosterone increases in the case studies mentioned previously. In Precool Your Workout, I explore these case studies more in depth, along with suggested ice bath protocols to enhance performance.
References
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Archey M, Goldey K, Crockett E, Boyette-Davis J. An investigation of the effects of testosterone and behavioral expressions of pain on sex/gender differences in pain perception. Psychological Reports. 2019 Jun;122(3):826-40.
Bikman B. Why We Get Sick: The Hidden Epidemic at the Root of Most Chronic Disease--and how to Fight it. BenBella Books; 2020 Jul 21.
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Chen W, Thiboutot D, Zouboulis CC. Cutaneous androgen metabolism: basic research and clinical perspectives. Journal of Investigative Dermatology. 2002 Nov 1;119(5):992-1007.
Chung N, Park J, Lim K. The effects of exercise and cold exposure on mitochondrial biogenesis in skeletal muscle and white adipose tissue. Journal of exercise nutrition & biochemistry. 2017 Jun 6;21(2):39.
Chung TH, Kwon YJ, Lee YJ. High triglyceride to HDL cholesterol ratio is associated with low testosterone and sex hormone-binding globulin levels in middle-aged and elderly men. The Aging Male. 2020 Apr 2.
Davis SR, Wahlin-Jacobsen S. Testosterone in women—the clinical significance. Lancet Diabetes Endocrinol. 2015;3(12):980-992.
Lee JH, Jung HD, Choi JD, Kang JY, Yoo TK, Park YW. Non‐linear association between testosterone and LDL concentrations in men. Andrology. 2023 Sep;11(6):1107-13.
Luz PL, Favarato D, Faria-Neto Junior JR, Lemos P, Chagas AC. High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease. Clinics. 2008;63:427-32.
Papadopoulos V, Miller WL. Role of mitochondria in steroidogenesis. Best practice & research Clinical endocrinology & metabolism. 2012 Dec 1;26(6):771-90.
Rohr UD. The impact of testosterone imbalance on depression and women's health. Maturitas. 2002 Apr 15;41:25-46.
Ye R, Yan C, Zhou H, Huang Y, Dong M, Zhang H, Jiang X, Yuan S, Chen L, Jiang R, Cheng Z. Brown adipose tissue activation by cold treatment ameliorates polycystic ovary syndrome in rat. Frontiers in Endocrinology. 2021 Oct 14;12:744628.
About the Author
Thomas P Seager, PhD is an Associate Professor in the School of Sustainable Engineering at Arizona State University. Seager co-founded the Morozko Forge ice bath company and is an expert in the use of ice baths for building metabolic and psychological resilience.
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