Testosterone Is Not Just a Male Hormone
When most people hear "testosterone," they think of men. But testosterone is an essential hormone for women too — produced in the ovaries and adrenal glands, and present in the female body at concentrations that are actually higher than estradiol on a molar basis throughout most of the reproductive years.[1] It plays a critical role in libido, energy, muscle mass, bone density, mood, and cognitive function.
Despite this, testosterone is rarely included on standard hormone panels ordered for women. The result is that testosterone deficiency in women is chronically underdiagnosed — and the women living with its symptoms are often told their labs are "normal" and their fatigue or low libido is simply a normal part of aging.
It is not.
How Testosterone Changes Over a Woman's Lifetime
Testosterone levels in women are not static. They peak in the mid-20s and then decline gradually — by approximately 50% between age 20 and natural menopause, according to a large population study published in the Journal of Clinical Endocrinology and Metabolism.[2] This decline is gradual and continuous, unlike the more abrupt hormonal shifts of perimenopause and menopause.
Certain events accelerate this decline significantly. Surgical menopause — the removal of both ovaries (bilateral oophorectomy) — causes an acute drop of approximately 50% in circulating testosterone, because the ovaries are a primary production site.[2] Oral contraceptive pills also suppress testosterone by increasing sex hormone-binding globulin (SHBG), which binds free testosterone and reduces its bioavailability. Chronic stress, poor sleep, and metabolic dysfunction further suppress production.
The practical implication is that many women in their 30s and 40s — not just those in menopause — are already experiencing meaningful testosterone deficiency, often without knowing it.
What Low Testosterone Actually Feels Like in Women
The symptoms of low testosterone in women overlap with many other conditions, which is part of why it goes unrecognized. The most well-documented and consistently reported symptoms include:
- Reduced libido and sexual satisfaction — the most studied and best-established symptom, supported by multiple randomized controlled trials[3]
- Persistent fatigue and low energy — not explained by thyroid dysfunction or anemia
- Loss of muscle mass and strength — despite adequate exercise
- Increased body fat, particularly around the abdomen
- Brain fog and difficulty concentrating — clinical trials have shown that testosterone therapy improves verbal learning and memory in postmenopausal women[1]
- Depressed mood, irritability, and reduced sense of wellbeing
- Reduced bone density — testosterone contributes to skeletal health independently of estrogen[1]
None of these symptoms is unique to testosterone deficiency. But when they cluster together — particularly in a woman who has had her thyroid and estrogen evaluated and found to be "normal" — low testosterone deserves serious consideration.
Why Standard Lab Panels Miss It
There are two reasons testosterone deficiency in women is so frequently missed. The first is that most standard panels simply don't include it. Testosterone is not part of a routine metabolic panel, a standard women's health panel, or even most hormone panels ordered in a general medical setting. If you don't test for it, you won't find it.
The second reason is that the reference ranges used in most commercial labs are calibrated for men. A woman's testosterone level that appears "normal" by a male-calibrated reference range may be significantly low for her biology. Additionally, total testosterone is often less clinically relevant than free testosterone — the fraction not bound to SHBG and therefore biologically active. Standard panels that measure only total testosterone can miss deficiency in women who have elevated SHBG (common with oral contraceptive use, liver conditions, and aging).
Accurate assessment requires measuring both total and free testosterone using a sensitive assay — ideally liquid chromatography-tandem mass spectrometry (LC-MS/MS), which is more accurate than standard immunoassays at the low concentrations typical in women.[4]
What the Research Says About Testosterone Therapy in Women
The evidence base for testosterone therapy in women has grown substantially over the past two decades. A 2019 systematic review and meta-analysis published in The Lancet Diabetes & Endocrinology, covering 36 randomized controlled trials and more than 8,000 women, concluded that testosterone is effective for postmenopausal women with hypoactive sexual desire disorder (HSDD) — the clinical term for low libido causing personal distress — with a favorable safety profile when administered via non-oral routes such as transdermal gels or creams.[3]
A Global Consensus Position Statement, endorsed by multiple international endocrinology and sexual medicine societies, affirmed this evidence and recommended transdermal testosterone as the preferred delivery method, noting that oral testosterone should be avoided due to adverse lipid effects.[5] The statement also noted that, at physiological doses, testosterone therapy in women has not been associated with increased risk of breast cancer or cardiovascular events — two concerns that are sometimes raised by patients and clinicians unfamiliar with the literature.[5]
Beyond sexual function, clinical trials have shown improvements in cognitive performance (verbal learning and memory), musculoskeletal health, and general wellbeing in postmenopausal women treated with testosterone.[1] Research in premenopausal women is more limited, but the physiological rationale and clinical experience support evaluation in symptomatic women of any age.
An Important Nuance: No FDA-Approved Formulation Exists for Women
Despite the evidence, no testosterone product has been approved by the FDA specifically for use in women in the United States. This does not mean testosterone therapy is experimental or unsafe — it means that the commercial incentive to fund the expensive approval process for a low-dose female formulation has not materialized, in part because testosterone is inexpensive and widely available as a generic.[6]
As a result, testosterone therapy for women is prescribed off-label — typically as a compounded transdermal cream or gel at doses far lower than those used in men. This is standard practice in integrative and functional medicine, and it is supported by the international medical literature. The key is that it should be prescribed by a physician who understands the appropriate dosing, monitoring, and clinical context for women — not as a blanket prescription, but as part of a comprehensive hormonal evaluation.
How PeakLAB Approaches Low Testosterone in Women
At PeakLAB, testosterone is always evaluated as part of a comprehensive hormone panel — not in isolation. A woman presenting with fatigue and low libido needs a full picture: estrogen, progesterone, testosterone (total and free), SHBG, thyroid (including free T3, free T4, and antibodies), cortisol, DHEA-S, and relevant metabolic markers. Symptoms don't exist in silos, and neither do hormones.
When testosterone deficiency is identified and clinically appropriate, treatment is individualized — the right dose, the right delivery method, and the right monitoring schedule. Follow-up lab work is essential to ensure levels are optimizing appropriately without overshooting physiological ranges.
If you've been told your labs are normal but you still feel exhausted, foggy, and unlike yourself — it may be time to ask whether testosterone was actually part of that panel.
References
- Davis SR, Wahlin-Jacobsen S. Testosterone in women — the clinical significance. Lancet Diabetes Endocrinol. 2015;3(12):980–992.
- Davison SL, Bell R, Donath S, et al. Androgen levels in adult females: changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab. 2005;90(7):3847–3853.
- Islam RM, Bell RJ, Green S, et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754–766.
- Rothman MS, Carlson NE, Xu M, et al. Reexamination of testosterone, dihydrotestosterone, estradiol and estrone levels across the menstrual cycle and in postmenopausal women measured by liquid chromatography-tandem mass spectrometry. Steroids. 2011;76(1–2):177–182.
- Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Sex Med. 2019;16(9):1331–1337.
- Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(10):3489–3510.
This content is for educational purposes only and does not constitute medical advice. Hormone therapy decisions should be made in consultation with a qualified physician who can evaluate your individual health history, symptoms, and lab results.
PeakLAB Medicine is an independent integrative medicine practice in Fort Collins, Colorado. Dr. Lindsey Bailey, DO is board certified in Emergency Medicine and Integrative Medicine and sees patients via telemedicine across Colorado, Arizona, Nebraska, and Wyoming. To schedule a consultation, visit peaklabmed.com.
