The Hormone No One Talks About: Why Women Need Testosterone Too

Here’s a fact that might surprise you: Before menopause, your body produces three times more testosterone than estrogen.

Yet when we talk about women’s hormones, the conversation almost always centers on estrogen and progesterone. Testosterone? That’s filed away as the “male hormone”—something women don’t need to worry about.

This massive blind spot in women’s health is causing millions of women to suffer in silence with symptoms they don’t understand and didn’t know could be treated. If you’re experiencing unexplained fatigue, declining muscle mass, diminished libido, brain fog, or mood changes during perimenopause or menopause, low testosterone might be the missing piece of your hormone puzzle.

It’s time we stopped gendering hormones and started talking about what women’s bodies actually need to thrive.

What Is Testosterone and Why Do Women Need It?

Testosterone isn’t a “male hormone”—it’s a human hormone that plays critical roles in both male and female bodies. The difference is dosage, not biology.

How Women Produce Testosterone

In women, testosterone is produced by three main sources:

The Ovaries (approximately 25% of circulating testosterone)
The Adrenal Glands (approximately 25% of circulating testosterone)
Peripheral Conversion (approximately 50%—created when other hormones like androstenedione are converted to testosterone in fat cells, skin, and other tissues)

This distributed production system is important to understand because it explains why both ovarian changes (like menopause) and adrenal dysfunction can impact your testosterone levels.

What Testosterone Does in the Female Body

Testosterone receptors exist throughout a woman’s body—in the brain, bones, muscles, heart, and reproductive tissues. This hormone plays essential roles in:

Physical Health:

Maintaining muscle mass and strength
Preserving bone density
Supporting metabolic function
Regulating energy production
Promoting cardiovascular health

Mental & Emotional Health:

Regulating mood and emotional stability
Supporting cognitive function, memory, and focus
Maintaining motivation and drive
Enhancing mental energy and clarity

Sexual Health:

Driving sexual desire and arousal
Supporting genital tissue health
Enhancing sexual pleasure and orgasm

General Vitality:

Boosting overall energy levels
Supporting recovery from exercise
Maintaining healthy body composition
Promoting general sense of well-being

The bottom line? Testosterone isn’t optional for women—it’s essential for optimal health at every age.

The Menopause Testosterone Crash: What’s Really Happening

Here’s what most women aren’t told: testosterone levels begin declining in your 30s and drop significantly during perimenopause and menopause.

The Timeline of Testosterone Decline

Ages 20-30:
Peak testosterone production. Levels range from 15-70 ng/dL (nanograms per deciliter).

Ages 30-40:
Gradual decline begins. Many women start noticing subtle changes in energy, body composition, and libido.

Ages 40-50 (Perimenopause):
Accelerated decline. Testosterone can drop by 50% or more as ovarian function begins to change.

Ages 50+ (Postmenopause):
Testosterone levels stabilize at much lower levels (typically 5-25 ng/dL)—about half of what they were during reproductive years.

Why Menopause Hits Testosterone So Hard

During menopause, your ovaries significantly reduce hormone production—and that doesn’t just mean estrogen and progesterone. Ovarian testosterone production drops dramatically too. While your adrenal glands continue producing some testosterone, they can’t fully compensate for what’s lost from the ovaries.

The Perfect Storm:

Reduced ovarian production (ovaries contribute 25% of testosterone)
Declining DHEA (a testosterone precursor that also decreases with age)
Increased Sex Hormone-Binding Globulin (SHBG) (estrogen therapy can increase SHBG, which binds to testosterone and makes it unavailable to tissues)
Changes in conversion efficiency (peripheral tissues may not convert precursors to testosterone as efficiently)

The result? Many women experience a testosterone deficit at precisely the time when they need hormonal support the most.

The Silent Symptoms: How Low Testosterone Shows Up

Low testosterone doesn’t announce itself with a clear calling card. Instead, it creates a constellation of symptoms that are often dismissed as “just part of aging” or attributed solely to estrogen deficiency.

Common Signs of Low Testosterone in Women

Physical Symptoms:

Persistent, unexplained fatigue that doesn’t improve with rest
Loss of muscle mass and tone (despite exercise)
Increased body fat, especially around the midsection
Decreased strength and endurance
Reduced bone density
Joint pain and stiffness
Thinning hair
Dry, thin skin

Cognitive & Mood Symptoms:

Brain fog and difficulty concentrating
Memory lapses (beyond normal “where did I put my keys?”)
Feeling mentally sluggish or “flat”
Low motivation or loss of drive
Increased anxiety or irritability
Feelings of depression or low mood
Reduced confidence or assertiveness

Sexual Health Symptoms:

Significantly decreased libido (not just “less than before,” but a noticeable absence of sexual desire)
Reduced arousal and sensitivity
Difficulty achieving orgasm
Decreased sexual pleasure
Vaginal dryness (often alongside estrogen deficiency)
Discomfort during sex

The “I Don’t Feel Like Myself” Symptom: Perhaps the most common complaint? A generalized sense of diminished vitality—feeling like a dimmer version of yourself without being able to pinpoint exactly what’s wrong.

The Estrogen Connection

Here’s where it gets tricky: many low testosterone symptoms overlap with low estrogen symptoms. This is why comprehensive hormone testing is so important. You might be on estrogen replacement therapy and still feel “off” because your testosterone levels haven’t been addressed.

The Research: What Science Says About Testosterone in Women

For years, testosterone therapy in women was an afterthought in menopause research. That’s finally changing.

Groundbreaking 2024 Study: Mood and Cognitive Improvements

A landmark 2024 study published in Archives of Women’s Mental Health examined 510 perimenopausal and postmenopausal women who were already using hormone replacement therapy (HRT) but still experienced persistent symptoms. These women added transdermal testosterone therapy for 4 months.

The Results Were Striking:

47% of women reported mood improvement (34% decrease in mean mood symptom scores)
39% reported cognitive improvement (22% decrease in mean cognitive symptom scores)
52% reported improved libido (33% decrease in symptoms related to low sexual desire)

All nine cognitive and mood symptoms measured—including difficulty concentrating, forgetfulness, feeling tense or nervous, feeling tired or lacking energy, and irritability—showed significant improvement (Glynne et al., 2024).

What This Means:
Testosterone improved mood as much as it improved libido. This challenges the outdated assumption that testosterone is only relevant for sexual function. The cognitive benefits were also substantial—addressing the brain fog and memory issues that plague so many women in midlife.

Long-Term Safety Data

One of the biggest barriers to testosterone therapy has been concerns about safety. Here’s what the research actually shows:

What We Know About Transdermal Testosterone Safety:

No increased risk of cardiovascular events (Davis, 2021)
No adverse effects on lipid profiles (when used transdermally)
No negative impacts on liver or kidney function
No endometrial stimulation (doesn’t increase uterine cancer risk)
Short-term studies (up to 2 years) show no increased breast cancer risk (Scott & Newson, 2020)

Common Side Effects (When They Occur):

Mild acne at application site (reversible)
Localized hair growth at application site (reversible)
These side effects are uncommon when testosterone levels are kept within normal female physiological ranges

What We Don’t Know: Long-term safety data beyond 2-3 years is still limited, which is why ongoing monitoring is essential.

The Global Consensus

In 2019, an international task force of experts from leading medical societies—including the International Menopause Society and the Endocrine Society—produced a Global Consensus Position Statement on testosterone therapy for women.

Their Conclusions:

Testosterone therapy is effective for improving sexual wellbeing in postmenopausal women with hypoactive sexual desire disorder (HSDD)
Benefits include improved sexual desire, arousal, orgasm, pleasure, and reduced distress about sex
Transdermal testosterone is the preferred delivery method
Therapy should be individualized with ongoing monitoring (Davis et al., 2019)

Who Should Consider Testosterone Therapy?

Testosterone therapy isn’t for everyone, but it may be worth discussing with your healthcare provider if you:

✓ Are perimenopausal or postmenopausal
✓ Experience significantly diminished libido that causes personal distress
✓ Feel persistent fatigue despite adequate sleep and lifestyle management
✓ Have brain fog, poor concentration, or memory issues not explained by other factors
✓ Are experiencing mood changes, depression, or anxiety
✓ Notice declining muscle mass and strength despite exercise
✓ Are already on estrogen/progesterone HRT but still don’t feel like yourself
✓ Have had your ovaries removed (surgical menopause)
✓ Have been diagnosed with premature ovarian insufficiency

Who Might Not Be a Candidate

Testosterone therapy may not be appropriate if you:

Are pregnant or breastfeeding
Have active breast cancer or other hormone-sensitive cancers (requires case-by-case evaluation with oncologist)
Have certain liver or kidney conditions
Have cardiovascular disease (requires medical evaluation)

Always discuss your complete medical history with your healthcare provider to determine if testosterone therapy is safe for you.

Understanding Testosterone Testing

If you suspect low testosterone, testing is the first step—but it’s more complex than many women realize.

What Gets Tested

Total Testosterone:
Measures the total amount of testosterone in your blood, both bound and unbound. This is the most common test.

Free Testosterone:
Measures the testosterone that’s not bound to proteins and is biologically available to your tissues. However, this test is less reliable for women due to the small amounts involved.

Sex Hormone-Binding Globulin (SHBG):
A protein that binds to testosterone and makes it unavailable. Elevated SHBG (often caused by estrogen therapy) can create symptoms of low testosterone even when total testosterone looks normal.

Normal Ranges (But There’s a Catch)

Premenopausal Women: 15-70 ng/dL
Postmenopausal Women: 5-25 ng/dL

Important: These “normal” ranges are extremely broad and don’t account for individual variability. A woman at 15 ng/dL might feel terrible, while another at the same level feels fine. This is why treatment should be based on symptoms plus testing, not testing alone.

When to Test

Timing matters: Testosterone levels can vary throughout the menstrual cycle in premenopausal women
Baseline before treatment: Knowing your starting point is essential
3-6 weeks after starting therapy: To assess dosing
Every 6 months during treatment: To ensure levels stay in the healthy female range

The Testing Challenge

Here’s the frustrating truth: most commercial labs use testosterone assays designed for men, which aren’t accurate at the lower levels found in women. This can lead to unreliable results.

What This Means:

Don’t rely solely on numbers—clinical symptoms matter more
Work with providers experienced in women’s hormone health
Consider specialty labs that use sensitive assays for female testosterone measurement

Treatment Options: How Testosterone Therapy Works

If you and your healthcare provider determine that testosterone therapy is appropriate, several delivery methods are available.

Transdermal Options (Preferred)

1. Testosterone Gel or Cream

How It Works:
Applied daily to the skin (typically inner thigh or lower abdomen). Absorbed through the skin into the bloodstream.

Pros:

Easy to adjust dosing
Can be stopped immediately if side effects occur
Maintains steady levels throughout the day
Most studied form in women

Cons:

Daily application required
Risk of transfer to others (wash hands, cover application site)
May cause mild skin irritation

Typical Dosing for Women:
5-10 mg daily (much lower than male dosing)

2. Compounded Testosterone Cream

Some providers prescribe compounded (custom-made) testosterone creams specifically dosed for women.

Pros:

Can be customized to individual needs
May be more affordable than brand-name products

Cons:

Quality can vary between compounding pharmacies
Less regulatory oversight than FDA-approved products
Absorption rates can be less consistent

Options to Approach With Caution

Testosterone Pellets:

Small pellets inserted under the skin that release testosterone over 3-6 months.

Concerns:

Cannot adjust dosing or stop treatment once implanted
Higher risk of supra-physiological (too high) levels
Some women experience a “roller coaster” of levels
Not recommended as first-line treatment

Oral Testosterone:

Available in some countries but not commonly used for women.

Concerns:

Significant first-pass metabolism through the liver
Adverse effects on lipid profile
Less predictable dosing

What About “Male” Testosterone Products?

FDA-approved testosterone products in the U.S. are designed for men and contain doses far too high for women. However, some providers prescribe them “off-label” for women at fractional doses (for example, using 1/10th of a male dose).

This Approach Requires:

Very experienced prescriber
Careful monitoring
Understanding that this is off-label use
Regular testosterone level checking

What to Expect: The Reality of Testosterone Therapy

Let’s set realistic expectations about what testosterone therapy can and cannot do.

Timeline for Results

Weeks 1-4:
Most women don’t notice significant changes yet. Your body is adjusting to new hormone levels.

Weeks 4-12:
This is when many women start to notice improvements:

Increased energy and reduced fatigue
Improved mood and motivation
Better mental clarity
Enhanced libido and sexual response

Months 3-6:
Benefits typically continue to build:

More noticeable improvements in muscle tone (when combined with resistance training)
Sustained energy improvements
Stable mood and cognitive function
Consistent improvements in sexual desire and satisfaction

What Testosterone Will Do

When properly dosed and monitored, testosterone therapy can:

✓ Significantly improve sexual desire and satisfaction
✓ Enhance energy and reduce fatigue
✓ Improve mood, motivation, and sense of well-being
✓ Support cognitive function and mental clarity
✓ Help preserve muscle mass (especially with resistance training)
✓ May support bone density
✓ Restore a sense of vitality and feeling like yourself again

What Testosterone Won’t Do

❌ It won’t cause dramatic physical masculinization when used at appropriate female doses
❌ It won’t cause significant facial hair growth or voice deepening at physiological doses
❌ It won’t replace the need for estrogen and progesterone in menopause management
❌ It won’t solve relationship, stress, or lifestyle issues affecting libido
❌ It won’t work if you’re sleep-deprived, chronically stressed, or nutritionally depleted

Managing Expectations Around Libido

While testosterone can significantly improve sexual desire, it’s important to understand that libido is multifactorial. Testosterone addresses the hormonal component, but other factors also matter:

Relationship dynamics and communication
Body image and self-confidence
Stress levels and mental health
Physical comfort during sex (vaginal estrogen may be needed too)
Time, energy, and life circumstances
Past trauma or negative sexual experiences

Think of testosterone as one important piece of a larger puzzle, not a magic solution.

Monitoring and Safety: Doing Testosterone Therapy Right

If you start testosterone therapy, ongoing monitoring is essential for both safety and effectiveness.

What Your Provider Should Monitor

Every 3-6 Months:

Testosterone levels (total testosterone)
Assessment of symptoms and treatment response
Check for signs of excess testosterone (acne, hirsutism, voice changes)
Evaluation of any side effects

Annually:

Complete metabolic panel (liver and kidney function)
Lipid panel
Complete blood count (to check for elevated red blood cells)
Blood pressure
Physical exam

Signs You Might Need Dosing Adjustment

Dose May Be Too High If You Experience:

Acne (beyond occasional breakouts)
Increased facial or body hair
Scalp hair thinning
Increased aggression or irritability
Voice changes
Clitoral enlargement

Dose May Be Too Low If You Experience:

No improvement in symptoms after 3-6 months
Initial improvement that fades
Testosterone levels at the very bottom of the reference range

When to Stop or Pause Therapy

Consider discontinuing or pausing testosterone if:

You’re not experiencing benefits after an adequate trial (6 months at therapeutic levels)
Side effects are unmanageable
You develop contraindications (like hormone-sensitive cancer)
You become pregnant
Your symptoms resolve and you want to try a break

Important: Testosterone therapy doesn’t have to be forever. Many women use it for specific life stages and may later decide to stop or take breaks.

Beyond Testosterone: The Complete Picture

Testosterone therapy works best as part of a comprehensive approach to hormone health and overall wellness.

Optimize Estrogen and Progesterone First

If you’re perimenopausal or postmenopausal and haven’t addressed estrogen and progesterone deficiencies, start there. Many women find that optimizing these hormones first significantly improves energy, mood, and even libido—and some may not need testosterone at all.

Why This Matters:

Estrogen supports testosterone’s effectiveness
Estrogen addresses vaginal dryness that can impact sexual desire
Progesterone supports mood and sleep

Address Lifestyle Factors

No amount of hormone therapy can compensate for:

Poor Sleep:
Chronic sleep deprivation tanks all hormone production and regulation. Prioritize 7-9 hours of quality sleep.

Chronic Stress:
Elevated cortisol competes with sex hormone production. Stress management isn’t optional—it’s essential.

Inadequate Nutrition:
Your body needs adequate protein, healthy fats, and micronutrients to produce hormones. Restrictive dieting makes hormonal problems worse.

Sedentary Lifestyle:
Resistance training is particularly important for maintaining muscle mass and optimizing testosterone’s effects.

Inflammatory Diet:
Excess sugar, processed foods, and alcohol create hormonal chaos. Clean up your diet to support hormone balance.

The Role of DHEA

DHEA (dehydroepiandrosterone) is a precursor hormone that your body converts to testosterone and estrogen. DHEA levels decline with age, and some practitioners recommend DHEA supplementation as an alternative to or alongside testosterone therapy.

What to Know:

DHEA is available over-the-counter in the U.S.
Typical dosing for women: 5-25 mg daily
DHEA can raise testosterone and estrogen levels
Not appropriate if you have hormone-sensitive conditions
Should be monitored just like prescription testosterone

The Bottom Line: DHEA may be an option for women with very low testosterone who want a gentler approach, but it’s less predictable than prescription testosterone therapy.

Having the Conversation With Your Healthcare Provider

Many women struggle to get their doctors to take testosterone concerns seriously. Here’s how to advocate for yourself.

Prepare Before Your Appointment

Document Your Symptoms:

Keep a symptom journal for 2-4 weeks
Note frequency, severity, and impact on daily life
Track patterns related to your menstrual cycle (if still cycling)

Track What You’ve Already Tried:

List current medications and supplements
Note whether estrogen/progesterone therapy improved some symptoms but not others
Document lifestyle interventions you’ve implemented

Know Your Questions:

“Could testosterone deficiency be contributing to my symptoms?”
“What are the benefits and risks of testosterone therapy for me specifically?”
“What would treatment and monitoring look like?”
“Are there alternatives I should consider first?”

What to Say

Frame It This Way:

“I’m experiencing [specific symptoms: low libido, fatigue, brain fog] that are significantly impacting my quality of life. I’ve optimized my sleep, nutrition, and exercise, and I’m already on estrogen/progesterone therapy, but I’m not feeling like myself. I’ve read recent research showing that testosterone plays important roles in women’s energy, mood, cognition, and sexual function. I’d like to have my testosterone levels tested and discuss whether testosterone therapy might be appropriate for me.”

If Your Provider Dismisses Your Concerns

Unfortunately, not all providers are knowledgeable about testosterone in women. If you encounter resistance:

Red Flags That Suggest Finding Another Provider:

“Testosterone is only for men”
“Low libido is just part of aging—deal with it”
Refusal to test testosterone levels without good reason
Dismissiveness about symptoms that are affecting your quality of life

Consider Seeking:

Menopause specialists certified by The Menopause Society
Providers trained in bioidentical hormone replacement therapy
Functional medicine practitioners with hormone expertise
Integrative gynecologists

Resources to Find Providers:

The Menopause Society provider directory
HealthyWomen Menopause Map
American Academy of Anti-Aging Medicine (A4M)

The Bigger Picture: Reclaiming Women’s Hormonal Health

The fact that we’re only now, in 2024, having mainstream conversations about testosterone in women speaks volumes about the gaps in women’s health research and care.

Why This Matters

For decades, women’s hormonal health has been:

Understudied in clinical research
Oversimplified in medical education
Dismissed in clinical practice
Stigmatized in cultural conversations

The assumption that women only need estrogen and progesterone has left millions of women suffering with treatable symptoms—told that feeling terrible in midlife is just something they need to accept.

It’s time to change this narrative.

You Deserve More Than “It’s Just Menopause”

Your symptoms are real. Your declining quality of life matters. And you deserve access to all the tools that can help you feel like yourself again—including testosterone therapy when appropriate.

Knowledge Is Power

The more women understand about comprehensive hormone health—including testosterone—the more we can advocate for ourselves and push for better research, better training for providers, and better access to treatment.

You are not imagining your symptoms. You are not “too young” for hormone issues. You are not being dramatic or difficult. And you absolutely do not have to just accept feeling diminished in midlife.

The Bottom Line

Testosterone isn’t a male hormone—it’s a human hormone that women need too.

If you’re experiencing unexplained fatigue, brain fog, mood changes, or diminished libido during perimenopause or menopause, low testosterone may be part of the problem. Testing your levels and exploring testosterone therapy with a knowledgeable provider may be the missing piece in your hormone puzzle.

The research is clear: when used appropriately and monitored carefully, transdermal testosterone therapy can significantly improve quality of life for women who need it—enhancing energy, mood, cognition, and sexual well-being.

Your vitality matters. Your mental clarity matters. Your sexual health matters. And comprehensive hormone care—including testosterone—should be available to every woman who needs it.

At Island Wellness, we believe in treating the whole picture of women’s hormonal health—not just part of it. If you’re ready to explore whether testosterone therapy might be right for you, we’re here to help you navigate this journey with expertise, compassion, and individualized care.

You deserve to feel like yourself again.

References

Davis, S. R. (2021). Use of testosterone in postmenopausal women. The Journal of Clinical Endocrinology & Metabolism, 106(8), e3298-e3301. https://doi.org/10.1210/clinem/dgab393

Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Islam, R. M., Kaunitz, A. M., Kingsberg, S. A., Lambrinoudaki, I., Liu, J., Parish, S. J., Pinkerton, J., Rymer, J., Simon, J. A., Vignozzi, L., & Wierman, M. E. (2019). Global consensus position statement on the use of testosterone therapy for women. Climacteric, 22(5), 429-434. https://doi.org/10.1080/13697137.2019.1637079

Glynne, S., Kamal, A., Kamel, A. M., Reisel, D., & Newson, L. (2024). Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: A pilot study. Archives of Women’s Mental Health, 28(3), 541-550. https://doi.org/10.1007/s00737-024-01513-6

Islam, R. M., Bell, R. J., Green, S., Page, M. J., & Davis, S. R. (2019). Safety and efficacy of testosterone for women: A systematic review and meta-analysis of randomised controlled trial data. The Lancet Diabetes & Endocrinology, 7(10), 754-766. https://doi.org/10.1016/S2213-8587(19)30189-5

Parish, S. J., Simon, J. A., Davis, S. R., Giraldi, A., Goldstein, I., Goldstein, S. W., Kim, N. N., Kingsberg, S. A., Morgentaler, A., Nappi, R. E., Park, K., Stuenkel, C. A., Traish, A. M., & Vignozzi, L. (2021). International Society for the Study of Women’s Sexual Health clinical practice guideline for the use of systemic testosterone for hypoactive sexual desire disorder in women. The Journal of Sexual Medicine, 18(5), 849-867. https://doi.org/10.1016/j.jsxm.2021.03.002

Scott, A., & Newson, L. (2020). Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care. British Journal of General Practice, 70(693), 203-204. https://doi.org/10.3399/bjgp20x709265

DISCLAIMER: This article is for educational and informational purposes only and is not intended as medical advice. Testosterone therapy is a prescription treatment that should only be initiated and monitored by a qualified healthcare provider. Always consult with your doctor before starting any hormone therapy. The information provided is based on current scientific research but should not replace personalized medical guidance. Individual results may vary.

About Island Wellness: We specialize in comprehensive hormone care for women at every stage of life. Our approach goes beyond symptom management to address the root causes of hormonal imbalance, helping you reclaim your energy, vitality, and quality of life through perimenopause, menopause, and beyond.