Ice Baths Boost Women's Hormonal Health
- Thomas P Seager, PhD
- Apr 10
- 11 min read
Updated: Sep 12
How can cold plunge therapy 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 stimulate secondary sources of testosterone in women, even in those women who are post-menopausal.
Testosterone plays a vital role in women's hormonal & reproductive health
The most abundant sex hormone in a healthy woman's body is testosterone. It was a lecture by Sleep Doctor Kirk Parlsey MD that first pointed that out for me, and it was a surprise.
Because 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. For example, on the Danny Jones podcast, Mark Bell mentions how healthy testosterone levels not only help with menopause, but testosterone also plays a role in women's libido, bone density, and muscle mass. Sustaining stable hormone levels is fundamental for healthy development in women, not only through-out adolescence but well past child-bearing years, and many benefits can be derived from women optimizing their hormonal health.
Insufficient testosterone levels can result in various health issues
The primary indication for the prescription testosterone replacement for women is loss of sexual desire (Davis et al. 2015). However, other negative health consequences also result from low total testosterone 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 risk of osteoporosis due to compromised bone density (Al-Azzawi and Palacious 2009). In general, testosterone has all the same health benefits in women as it does in men. However, a study by Rohr (2002) reveals another important point--testosterone imbalances have negative consequences in women both lower and higher than healthy testosterone levels.
When a woman's testosterone is too high, called hyperandrogenism, it signals that something is wrong with sex hormone metabolism. That thing is typically polycystic ovarian syndrome (PCOS), which is a metabolic disorder associated with insulin resistance. In PCOS, cysts appear adjacent to the ovaries, impinge upon them, and cause them to over express testosterone. The resolution of PCOS is to fix the underlying metabolic dysfunction.
Cold plunge therapy correct sex hormone disorders in women
There is only one clinical study of cold stimulation and testosterone in women, and it involved 32 undergraduate women participated in a cold pressor test of pain tolerance. The 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 up to five minutes.
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 nearly twice as much as it does in men (Archey et al. 2019).
Although the researchers didn't explicitly discuss the therapeutic potential for naturally enhancing testosterone production in menopausal women, their findings 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
For women with low testosterone, the best way to stimulate activity in the testosterone-producing skin cells, fat cells, and adrenal glands is whole-body cold plunge therapy. As I documented in Do Ice Baths Increase Testosterone? two women, one post-menopausal, both increased their total testosterone levels after adopting a regular practice of cold plunging. 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. Back then, 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. W hen 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. 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. This prompted her endocrinologist to recommend discontinuing testosterone supplementation.
The other case study is Elise DeSoutter, a 32-year old nulliparous (has never given birth) had similar findings. 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 boost fertility
PCOS is the leading cause of infertility in women of child-bearing age is polycystic ovarian syndrome. PCOS is associated with obesity, high body mass index, and actually originates in insulin resistance, a result of metabolic dysfunction.
In Cold Plunge Sex Health, I explained 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 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 the ATP that supports almost all bodily functions, including growth, wound repair, and exercise.
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. 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 of the phospholipids from which those membranes are made—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.
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. 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 [in rats]). 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. T his 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.
Testosterone synthesis originates in mitochondria
All sex hormone synthesis originate at the inner mitochondrial membrane, where cholesterol is converted to a sex steroid called pregnenolone. Without adequate levels of both 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 are the site of all steroidogenesis (Papadopoulos et al. 2012). 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.
A typical lipid panel blood test will report both triglycerides and HDL cholesterol levels. The ratio serves as a reliable indicator of mitochondrial health. 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.
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.
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.
References
Al-Azzawi F, Palacios S. Hormonal changes during menopause. Maturitas. 2009 Jun 20;63(2):135-7.
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.
Burger HG. Androgen production in women. Fertility and sterility. 2002 Apr 1;77:3-5.
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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