7 Symptoms of Low Testosterone in Women

5 Surprising Signs You Have Low Testosterone

what causes low testosterone in females

Thank you for visiting the site! He then told me my testosterone was zero. He is a decorated veteran of the United States Army where he served for nearly 6 years with duty assignments, both here and abroad. We do use different units of measure, but these labs do indicate a free testosterone deficiency, and I would expect that this is contributing to your symptoms. While there are components of TRT that insurances are unlikely to pay for because testosterone is not FDA approved for women , they do often cover the labs and office visits. The question of androgen deficiency has largely been ignored in pre-menopausal women.


If you are considering taking antidepressants to deal with your depression, then you may want to talk to your doctor about the possibility that your testosterone is low. I tried everything out there after having a total hystectomy in Tara, I am very sorry to hear about your troublesome symptoms. Gail, Your testosterone levels definitely seem to be an issue. If my testosterone levels are low, what specific benefits might I see from T replacement? Likewise, testosterone is metabolized through aromatization into estradiol.

Because all of these symptoms are often associated with other types of illnesses, make sure you talk to your doctor before you begin testosterone treatments. If you are experiencing sudden bouts of depression, unexplained mood swings, or a generally low mood, then you may be suffering from low testosterone. If you are considering taking antidepressants to deal with your depression, then you may want to talk to your doctor about the possibility that your testosterone is low.

If you are experiencing these symptoms, talk to your doctor about the possibility of low testosterone. Another possible symptom of decreased testosterone levels is anxiety. Although anxiety caused by low testosterone is usually mild, it can possibly cause panic attacks. If you suddenly experience bouts of anxiety, especially if you have never had anxiety issues in the past, then you may want to talk to your doctor about low testosterone.

If you find that you are having difficulty concentrating on normal tasks, especially when you have always been able to concentrate easily on the task at hand, then you may be suffering from low testosterone. One of the difficulties in detecting low testosterone in women, and in men, is that the symptoms, like difficulty concentrating, often mimic the classic signs of aging. Always check with your doctor before starting a testosterone replacement program to make sure you are not suffering from normal aging symptoms.

Hair loss is one of the more obvious symptoms of low testosterone, so keep an eye out for any hair loss, on your head or otherwise. Although hair loss from low testosterone will be most obvious on the head, hair loss on other areas of the body may also occur. If you notice that you have to shave your legs and armpits fewer times per month than normal, or if you notice that your hair is getting patchy, you may be suffering from low testosterone. This symptom most often manifests as patchy hair cover on the head, or even baldness in women.

Body hair is also affected, though these symptoms are typically less noticeable, particularly in women who regularly shave their legs and armpits. White, PA-C brings over 20 years of surgical experience to our practice. He is a decorated veteran of the United States Army where he served for nearly 6 years with duty assignments, both here and abroad.

He spent the first 10 years of his career in Neurosurgery. Has recommended BioTee pellet treatment. How high does my testosterone need to be and what is the best replacement therapy? Hello Cindy, thank you for visiting the site.

For women, total testosterone levels typically need to be slightly above the normal range. The focus should really be on getting your free testosterone levels in the right spot, but this is a moving target so it needs to be properly monitored and maintained.

We actually recommend against pellet therapy. Keep in mind that there is no time-release property to the pellets they implant. Therefore, they give you 6 months worth of medication, which typically only lasts months because all pellets dissolve at the same rate. This sends your testosterone levels soaring for the first month and then plummeting over the next This not only exposes you to undue and usually un-monitored risk, it also puts your symptoms and response to therapy on a very unpleasant roller coaster ride.

I hope that helps, I will contact you by email as well. The first round worked fine. This is quite common with pellets. When moving from deficient to non-deficient, not much specificity is necessary.

However, if you want a tailored approach to fine tuning BHRT, which I strongly recommend, that is nearly impossible to achieve with a mode of therapy that assumes what your needs will be like months after implantation.

I so disagree with not getting pellets…I am on my 3rd round using pellets an my life has changed significantly…I was on all kinds of medication for anxiety an depression.

Thank you for your comment and your candor. I am always anxious to here opposing views from different points of view. Understand that my issue with pellet therapy has to do with the long term sequelae. It is virtually impossible, in my opinion, to guess, six months in advance, what your hormonal needs will be in the future.

I truly hope you continue to do well and I encourage you to follow up with me in months. If you do not recommend pellets … What do you recommend to raise testosterone in women? Please no junk email or sell my info. I treat my female patients with very small weekly doses of testosterone. I do have a few on topical therapy as well. Both are far more specific and safer than pellet therapy. Hi my serum testosterone levels is 8 also having facial hair growth. Can some one suggest how to diagonize this.

You will need more than just total testosterone levels. You need your total and calculated free, and likely a full hormone panel. However, diagnosis will need to be done by an experienced provider. I recently had bloodwork and found that my testosterone is low. My hair has been falling out alot. I always had long thick curls but recently my hair started shedding and I had to cut it.

If my doctor can get my testosterone levels up, will my hair grow back? Thank you For your time…. There is a possibility that normalizing testosterone and other hormone levels, could help with hair growth.

The crown of my head is completely bald, no bangs, nothing from my ears up. No hair on my legs or arms. Still waiting to hear from my new dr. What questions should i be asking? What can i expect? Thyroid is hypo and adrenals are fatigued. Morning temps are in the mid 95 to low 96 range. Feeling so crappy,my bed is my sanctuary. I would suggest that your questions center around your symptoms, what the treatment plan would be and what methods will be used for which specific deficiencies , and how the success of therapy will be monitored over time.

Low body temp is the main red flag that you may have this. It is related to T3 levels thyroid and causes most of the symptoms you have.

Taking Cytomel T3 in. I have used cold-pressed castor oil found at a place like Whole Foods on my scalp, eyelashes amazing! I would rub it in and wait a couple of hours until I washed my hair or I would put it on and cover it overnight. You can also cover eyes and eyebrows at night.

I never had a problem with clogged pores, but that might happen. I hope this helps someone. Well my lvls are between What do you recommend to help? My apologies for the late nature of this reply but your message was forwarded to my inbox today.

The symptoms of testosterone deficiency can often overlap with other medical conditions and disease processes. That being said, the symptoms you outline are certainly suggestive of hormonal deficiency in general. It appears you have already had a total testosterone assessment.

This is arguably more important than the total testosterone level. Based on the symptoms you described, I would advise contacting one of our clinics to arrange for testing of your total and free testosterone levels so that we have a more clear understanding of your testosterone profile.

I will also email this commentary to the email address you provided. Feel free to contact me at that address for more information.

Mine is 20 and i just started the cream. Normal range for a female is according to my doctor. I waa just informed by my doctor there is no normal range. Medical Science does not know what a normal range of testosterone is for women. I agree with this in part. The best studies have not been done and are unlikely to be done. I am 48 years old with normal estrogen and progesterone levels but low testosterone.

Any ideas why this could be? Main symptoms exhaustion Thank you. We often see hormone profiles that are similar to what you are describing in your post and often, we in Medicine do not have a good explanation as to why one may be deficient of one hormone but perfectly fine in another.

That being said, one always has to give consideration to a lab error. This is one of the primary reasons we always advise checking hormone levels on more than one occasion and a key reason we take symptoms into account as well.

If you would like to undergo further evaluation, please contact one of our clinics to arrange for an appointment and bring your old lab results for comparative review.

I will also email this response to you. I just found out that my testosterone is not detectable. What are the possibly treatment options? We are wanting to also try to get pregnant.

Thank you for visiting our website. I apologize for the delay in responding to you but as I mentioned above, I received multiple notifications of comment posts only today. Unfortunately, testosterone replacement therapy TRT is absolutely contraindicated in women who are pregnant or attempting to become pregnant. All prescription medications have something known as a pregnancy category.

I will email this response to the address you provided. It was given to me by an endocrinologist for my low functioning adrenals. It is my life savor…. So many symptoms have been helped but mainly I have more energy for my days. No brain fog, less anxiety and better sleep. I wish you well! Our body is like a garden…if you give it what it needs you will flourish! Keep looking for answers. I am 45 and have been taking ocp for years.

I apologize for the delay in getting back to you regarding your post on our website. Only today did I receive notification that you had made contact. I advise you consider repeating your total testosterone level and also obtain something called a free testosterone level.

The latter represents the amount of testosterone that is considered to be bio-available and ready to go to work for you at the cellular level. I have noticed that my hair is very dry and It seems to be falling out more than usual. My testosterone level is I also have experienced daily panic-anxiety and mild depression. My libido level is almost non-existent. Do you think my level is low?

Please accept my apology for the delayed response to your post. The symptoms you mentioned can overlap with multiple medical conditions.

You should also have a free testosterone assessment so that we know approximately how much of the hormone is available for you at the cellular level. That being said, I would recommend you discuss obtaining a Thyroid Hormone panel with your primary care physician and undergo a complete physical examination as an overactive thyroid gland can also cause the symptoms you described.

I will email this article to you as well. Also is bio identical progesterone another form of testosterone? I feel I have better luck with oral hormones.

I have been losing all muscle mass. I have lost a lot of weight and upper arms and chest drape in long lines and my thighs. Very ugly to me as I look down.

Dont know where to start with help. I am 75 years old and this last year, my body has changed a lot. Starting with the weight loss. Can anyone advise me? I emailed my response to your inquiry at the address you provided. Please contact me directly if I can be of further assistance.

I could have written the above email as I also lost weight rapidly including muscle strength. My shins and shoulders peel. My hair is falling out. My breast and skin sagged rapidly. Most of this took place in about a month — 24 pounds lost in total. I am worn out and walking with a walking stick because of left hip pain. I am on Bio HRT — estradial, progesterone and estriol.

I suspect it is rapid loss of testosterone? Hello, I have 65 yo with symptomes you describe above, is acceptable and safe in my age use low testosterone to reduce this bad symptomes? Thank you for your help Best regards. Please let me know at 65 yo with clear symptoms describe here, is it reasonable to follow testosterone treatment? Thank you for your help Mary Cardoso. I just had my testosterone level come back at a level of 5.

The range being above I suffer from NO libido, struggle with losing weight and male pattern baldness. Should I ask for a hormone replacement. One FNP has told me that this is normal in a surgical menopause patient at the age of I would like your opinion. While it is an expected reaction to surgical menopause, having deficiencies in testosterone, estrogen, and progesterone at the age of 41 is not normal. It does appear that you have symptoms that are related to your testosterone levels being low.

I am 28 years old and found out my testosterone level is a Doctor told me they want it around and for my age this is low. I have been getting migraines, do you think this could be coming from my levels being so low? It is possible that low testosterone levels contribute some to your migraines, but also remember that if your testosterone levels are low, you very well may have deficiencies in other hormones like estrogen, progesterone, and thyroid hormone.

Read more about migraines and low progesterone, here http: Make sure that if you are contemplating TRT, that you evaluate both benefits AND risks and only trust your care to someone who look at the whole picture and help you manage it appropriately. So I went to my doctor yesterday who did some labs and the only abnormality was my testosterone level which was low at a I had no idea.

Should I be worried? What should I do? Someone mentioned protein, does that help? Your symptoms are certainly consistent with a low testosterone level. At your age, assuming you would want to maintain fertility, now would not be a good time to consider TRT for you.

However, there are other steps you could take. You may also want to try these dietary tips! That level is definitely low. If it is coupled with symptoms such as fatigue, decreased libido, loss of muscle mass, difficulty concentrating, and irritability, I would say that is is too low. I also have Low thyroid. They are calling in a supplement for under the tongue. I have all the symptoms listed above.

And what should my levels be? Thank you for your question! If properly managed, you should be feeling improvements in the second month of therapy after starting testosterone therapy.

That being said, you will definitely want to make sure somebody properly addresses your thyroid issues as well. I am experiencing muscle and joint pain and my hair has been falling out the past year. Is this low level causing these problems? I would certainly suspect that levels that low are at least contributing to your issues. You would likely benefit from a thorough hormonal status evaluation. Hello, i am 38 and I am waiting on my levels to come back from doctor, but was curious if low-T could contribute to dry hair, face breaking out, very low sex drive, fatigue, and most concerning… painful joints?

Your symptoms seem to divide into two separate groups, so lab results should help render some much needed insight. Low testosterone levels can certainly cause a decreased libido, fatigue, dry skin, and I have seen it associated with generalized joint pain. However, increased testosterone or more specifically, increased DHT levels could cause acne. It will be important to also assess your estrogen, progesterone, and thyroid hormone levels as well.

Hello I wanted to let you know that I got my hormones back and everything is normal but my testosterone level is an eight. That being said, your free testosterone is most important and the best way to asses that is to run an SHBG and albumin so that it can be calculated.

That would give much better insight into whether your symptoms are related to your testosterone level. I am experiencing lots of hair loss, anxiety, and fatigue and a low sex drive.

My doctor recommended Bio T hormone pellet therapy. What would you suggest. It would be best to also have your estrogen and progesterone levels evaluated. Based on the results you have, it appears that testosterone deficiency is certainly present, and I would expect many of your symptoms to improve with TRT. That being said, I recommend against BioT pellet implantation.

Admittedly, their marketing pitch is fantastic, but in reality they fail to live up to the hype. Where they claim to be natural and bio-identical, this is rather misleading. First, when it comes to testosterone, there is no functional difference in bio-identical and synthetic forms.

This is very important in estrogen and progesterone therapy, but not for testosterone. But, the real issue is patient safety. The testosterone we use starts in a lab and finishes in a lab, and is the best pharmaceutical grade, name-brand medication available.

This is then shipped to whichever local compounding pharmacy is chose and all pellets are made exactly the same way. After, usually incomplete, testing patients are told that they are being implanted with 6 months worth of medication. The problem is that the pellets have no time-release property to them.

This means that they all dissolve at the same rate. This leads to levels that are very high; most typically, too high. Then, your levels plummet over the next several months.

Ultimately, patients need implantation again in months and their hormone levels go on a dangerous roller coaster ride during the cycle. Most concerning, is the fact that the vast majority of patients receiving pellets do not receive adequate oversight and monitoring.

I would suggest finding someone who can treat all aspects of your hormonal health. I tried everything out there after having a total hystectomy in The biote pellets were the only thing that made me feel good again. They literally gave me my life back. They are the best thing I could have done for my health. I am constantly re-evaluating. However, the practices that I see offering it in my area are not at all focused on TRT, and therefore, quality of care suffers.

Thank you for your input, I will definitely keep an open mind! She found that my testosterone was low at 11 as well as my progesterone was low. She is starting me on testosterone sublingual 10mg tabs once a day as well as progesterone mg oral tabs daily. They are both bioidentical from a compounding pharmacy. Should I be concerned about the proper absorption? Any insight is appreciated! Thank you for visiting the site! I am glad that you are on track to improve your hormonal health.

Managing hypothyroidsim can be tricky but either a naturally desiccated thyroid product like Nature-Throid or time-released compounded option is best. For these oral preparations work well. When it comes to testosterone, bio-identical vs. Keep in mind, that even bio-identical hormones are man-made and are therefore synthetic. These have metabolites that are harmful to the body.

For estrogen and progesterone, topical administration of bio-identicals have proven to be the safest route. As for testosterone, there is no issue with the metabolites of commercially available or compounded preparations. However, oral testosterone has historically been the most dangerous route of testosterone delivery.

We recommend either topical application, or injections given directly into the muscle, and we heavily favor testosterone replacement therapy via intramuscular injection. I hope this helps! I just started on sub lingual testosterone. I had a partial hysterectomy in Feb I have been on HRT for 27 yrs as I started memo early. I have been a athlete all my life , never really had a period and started on HRT at I just started to have anxiety which i never did before.

My GYN prescribe 2 mg of compounding Troche for 5 days then off 2 I am also taking Mg natural compounding progesterone 4 x daily and I am on a 1. I feel it is too much testosterone and have cut it down to. Do need a different T? You have many medication that could exacerbate anxiety, but if you have a history of being sensitive to medications, it is always best to start low and slow and titrate dosing based on your symptoms and safety.

I have been experiencing weight gain, difficulty losing weight, hair loss, inability to concentrate, fatigue and very low libido.

My doctor just recently checked my Testosterone levels and the results came back as the following. Everything I can find on this says these are technically normal levels though 1. Could my symptoms be caused from these levels and would you consider them low? I would recommend ensuring that your free testosterone level was not derived from the direct test.

This is what is commonly ordered, and per The Endocrine Society, it should not be used clinically. Your calculated free testosterone cFT will be much more accurate. Making sure that your TSH is below 3. I have just had my hormones tested at 41 42 in a few months. I have hashimotos hypothyroid and have been managing that for years. I am still suffering hair thinning, and mild fatigue, and no libido at all.

Gyn ran some tests and has prescribed testosterone cream -would you agree that my results are low and that. My results were taken during ovulation in the morning:. Given your symptoms, that is certainly likely. With progesterone and estrogen levels, it is vitally important to know when in your cycle, blood was drawn to accurately assess the numbers. Additionally, with testosterone, it is vitally important to know what your. Typically, most providers order the direct, free testosterone test which is clinically useless.

We do use different units of measure, but these labs do indicate a free testosterone deficiency, and I would expect that this is contributing to your symptoms. Topical testosterone therapy is an option, but in my experience, it is not the best one.

Consistent application, proper monitoring, and time will tell if you are on the right dose, but that seems like a good starting point.

I am currently working in the Middle East expat and we only have access to the topical treatment. Not sure what these mean but I will start to use the cream in the vaginal area as advised and see if I notice any difference in the next few months? Next time you have labs done, you may want to ask them to run an albumin and SHBG so that you can calculate your free testosterone.

Also, you may want to be careful with vaginal application as this may worsen the potential side effect of clitoral enlargement. Thank you for a great article. My obgyn checked my levels after my complaints of stalled weight loss despite effort being made. She said that's considered undetectable. Tired and gained 14lbs in 5 days. Another possible course of action is taking a testosterone precursor in supplement form. While there are plenty of supplements that raise T levels in men, almost all of them work by coaxing the testes either directly or indirectly to produce more testosterone.

No such known equivalent coaxing the ovaries or adrenals to produce more testosterone exists in women. However, women have the option of using DHEA. The substance is a hormone secreted by the adrenals and it's a precursor to estrogen and testosterone. As with testosterone, levels of this hormone peak in the 20's and start to decline every decade.

Using this over-the-counter supplement, however, can quickly elevate flagging testosterone levels. A study on women between 35 and 55 reported increases in desire, arousal, lubrication, and orgasm in women who took 50 mg. Similarly, an article in a edition of the World Journal of Urology suggested that women with low T start with 50 mg. If, in months, there's no improvement they recommended having T levels tested by a physician, of course , the dosage could be increased to 75 mg.

DHEA is no low-T panacea, though. It may not raise levels significantly, or the bulk of the chemical may be converted to estrogen instead of testosterone.

There are several relatively simple lifestyle changes a woman can make that might elevate T levels. Most obviously, if a woman believes her birth control pills are causing a problem and she feels she can adjust to a different type of birth control, she might stop using them if indeed she's using them exclusively to prevent conception.

She might also reevaluate her need for any of the various medications I mentioned, and perhaps seek alternatives that might not affect testosterone levels. For instance, there's some evidence that the antidepressant wellbutrin actually increases libido, but whether it helps the sex mojo through raising T levels or by some other mechanism isn't well understood.

Exercise, specifically weight training, is also reported to raise T levels in women and men. The results seem to be transient in that it only lasts a few hours, but even a transient rise in T, if repeated daily or near daily, might have far-reaching effects. Sex itself is even reported to elevate T levels, but whether this rise is more pronounced in women who are in a caring relationship as opposed to those just tearing one off with a one-night stand isn't known.

It is known, however, that women who are in a committed relationship often experience a rise in T, whereas, seemingly paradoxically, and perhaps evidence that nature is one smart but sometimes cruel bitch, T levels in men in committed relationships often drop precipitously perhaps to make sure the male doesn't stray. There are also somewhat less clear psychological approaches to raising T in women.

Men often experience a rise in T after winning a competition of practically any kind. Similarly, if men are living stress-free lives and feel good about themselves, T levels rise accordingly. Hell, a man can win a ping-pong game and suddenly feel like having any woman near him scrubbed and brought to his victory tent for some celebratory sex. Self-esteem seems to play a powerful role in T levels in women, too, and while there's not much research to support this, my experience as a writer on many aspects of behavioral endocrinology for the last 15 years leads me to believe that these things are true of women, too.

Winning a competition would likely lead to an increase in T, however transient. In fact, anything done to reinforce the notion of being a "winner" might go a long way. I even suspect, perhaps nuttily, that if a low-T woman simply dressed better, or even did something as seemingly inconsequential as wearing sexy underwear that would perhaps be seen by no one but the wearer, might have slight psychological effects that provoked positive physiological effects, i.

Any way you look at it, despite its reputation in literature, folklore, and popular culture, testosterone is not strictly the purview of sweaty men for whom grunting has displaced several hundred vocabulary words. It plays a huge rule in women's health, psyche, and libido, just as it does in men. It's high time that testosterone came out of the female closet, put on some Louboutins, and strutted her stuff.

If my testosterone levels are low, what specific benefits might I see from T replacement? Generally, women who increase their testosterone might experience an increase in bone and muscle mass, loss of excess body fat, and an increase in sexual desire and sexual satisfaction, along with more energy, ambition, and enjoyment of life.

Are there any dangers associated with taking prohormones or using testosterone? If a female takes too much testosterone or its precursors, it can result in unwanted body hair growth and, in extreme circumstances taking way too much testosterone over an extended period of time result in a deepening of the voice, growth of the clitoris, acne, shrinking breast size, alopecia loss of hair on the head , and unwarranted anger.

It might also lead to other more serious side effects, as often happens when you poke Mother Nature with too big of a stick. Studies on women who replace their testosterone to clinical levels , however, generally haven't experienced any adverse effects on lipid levels, carb metabolism, or blood pressure or cardiovascular health in general. Neither have there been any reported increases in breast cancer that were associated with T replacement.

Yes, women with low levels of testosterone often find it more difficult to put on muscle, burn fat, or succeed at athletics. Consider that female bodybuilders, figure athletes, and even bikini competitors often use varying degrees of steroids, which are nothing but synthetic versions of testosterone.

Obviously, almost all female bodybuilders are using amounts that cause societally undesirable and generally irreversible physical changes like those mentioned above. Only if T levels are raised well above normal for an extended period of time. However, T therapy might well affect the sex of a child. Conversely, women in occupations with typically high estrogen levels and low testosterone levels, like beauty queens, usually have twice as many female babies as male babies. Are there any women who shouldn't consider testosterone replacement under any circumstances?

Women who are pregnant or could become pregnant should refrain from using testosterone replacement of any kind. Similarly, those with high cholesterol, liver or heart disease, or breast or uterine cancer should avoid it. Regardless, any woman considering testosterone replacement or therapy should consult her physician.

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Most people won't want to hear it. That's why most people are weak. Bodybuilding is full of programs used by "enhanced" lifters, but most people don't take drugs and can't get good results. This effective program is for them. Don't let the fitness police keep you from doing this safe and proven strength-building lift. Gain an inch on your biceps while building a rock-solid upper body with simple chin-up progressions. Therefore when the body has low levels of progesterone it cannot sufficiently produce enough testosterone for normal physical functions.

This can happen naturally, women above 40 years old tend to have lower levels, or it can be linked to a hormone deficiency which would need to be medically diagnosed. Oral contraceptive suppresses the production of sex hormones such as estrogen, progesterone and testosterone. Taking the pill for a long period of time can upset the body's balance of producing the sex hormones naturally.

According to a study in the January issue of the "Journal of Sex Medicine," women who used the pill may be exposed to long term problems with low testosterone. A protein called sex hormone binding globulin is found in the pill and binds with testosterone to stop it being used.

Users of the pill have shown continued high levels of sex hormone binding globulin in their body after stopping use. Age is a major cause of lower testosterone levels, but it is not directly linked to menopause.

By menopause, the level of testosterone in women may have declined by as much as 50 percent, according to WomensInternational. At menopause, ovaries no longer produce testosterone and the adrenal glands stop producing hormones that convert to testosterone. Removing the ovaries at a later stage in life will also decrease the level of testosterone in the body.

Iamges: what causes low testosterone in females

what causes low testosterone in females

It's high time that testosterone came out of the female closet, put on some Louboutins, and strutted her stuff.

what causes low testosterone in females

There are many mitigating factors.

what causes low testosterone in females

Anne, That level is definitely low. Same goes for TRT; if your symptoms indicated that testosterone deficiency can i take proviron with anavar causing issues, treatment may have been warranted even efmales what causes low testosterone in females low normal free testosterone. Therefore, this test is often performed in the morning between 7: I would recommend ensuring that your free testosterone level was not derived from the direct test. While drugs and diet are clearly potential causes of low T in women, simply being obese or chronically avoiding exercise might also cause low levels. This is one what causes low testosterone in females the primary reasons we always advise checking hormone levels on more than one llw and a key reason we take symptoms into account as well.