Testosterone for Women: What Your Doctor Probably Never Mentioned

Women produce testosterone. This is not a niche biochemical fact. It is physiologically significant. The ovaries and adrenal glands together produce testosterone at levels that, while lower than men’s, are essential for energy, libido, muscle maintenance, bone density, and cognitive function.

Peak testosterone production in women occurs in the early to mid-20s. By the time a woman reaches her early 40s, her testosterone levels may have declined by 50 percent from that peak. By menopause, they may be a fraction of what they once were.

Despite this, testosterone is rarely discussed in women’s health conversations and almost never measured in routine clinical practice.

What Testosterone Does in Women

Libido and Sexual Function

Testosterone is the primary hormonal driver of sexual desire in women. Estrogen supports lubrication, tissue elasticity, and genital blood flow, but the desire itself, spontaneous interest in sex, is predominantly testosterone-mediated.

The Australian APHRODITE study and the Global Study of Sexual Attitudes and Behaviors have both documented that declining testosterone correlates with declining sexual desire in women, independent of relationship satisfaction and psychological factors.

Women who report that their libido has vanished, that they still love their partner but the physical drive has simply gone quiet, are often describing a measurable testosterone deficit.

Energy and Vitality

Women with low testosterone describe a particular kind of fatigue that is distinct from the exhaustion of sleep deprivation or overwork. It is a diminished baseline, a sense that the engine is running at reduced capacity regardless of rest.

Testosterone supports mitochondrial function, which determines cellular energy production. When levels fall, the subjective experience is a generalized reduction in vitality that does not respond to sleep, caffeine, or willpower.

Cognition

Testosterone supports cognitive processing speed, verbal fluency, and mental clarity. Women in perimenopause who describe brain fog are often experiencing the combined effect of fluctuating estrogen and declining testosterone. Addressing both hormones produces a more complete cognitive recovery than addressing estrogen alone.

Body Composition

Testosterone promotes lean muscle mass and supports the metabolic rate associated with it. As testosterone declines, women often notice that they lose muscle despite maintaining their exercise routine, and that body fat accumulates, particularly around the midsection, in a pattern they have not experienced before.

The shift in body composition is not a failure of effort. It is a change in the hormonal environment that governs how the body allocates resources. The metabolic significance of this shift lies not just in total body weight but in the distribution of fat. Visceral fat, which accumulates preferentially during states of hormonal decline, is metabolically inflammatory and disease-promoting in ways that subcutaneous fat is not. Testosterone’s loss of influence allows the body to preferentially deposit fat in visceral depots rather than maintaining the subcutaneous distribution seen with adequate hormone levels. This distinction is why two women of the same weight but with different body compositions face different disease risks.

Bone Density

Testosterone contributes to bone mineral density through direct stimulation of osteoblasts and through its conversion to estradiol in bone tissue. Declining testosterone in the years before and after menopause contributes to the accelerated bone loss that occurs during this transition.

Why It Gets Overlooked

Several factors contribute to testosterone’s absence from the standard women’s health conversation.

First, no commercially manufactured testosterone product is approved for women in Canada or the United States. Testosterone products are approved and marketed for men. Women who receive testosterone do so through compounding pharmacies, which prepare the hormone at the lower doses appropriate for female physiology.

Second, medical school training on women’s hormonal health focuses on estrogen and progesterone, with testosterone mentioned primarily in the context of androgen excess conditions like polycystic ovarian syndrome. Testosterone deficiency in women is not part of the standard curriculum.

Third, the reference range for testosterone in women is broad and often poorly standardized across laboratories, making interpretation challenging for physicians who do not specialize in hormone optimization.

The result is a significant gap in care. Women with symptomatic testosterone deficiency are either undiagnosed or told that their symptoms are a normal part of aging.

What the Evidence Supports

The Global Consensus Position Statement on the Use of Testosterone Therapy for Women, published in 2019 and endorsed by multiple international endocrine and menopause societies, concluded that testosterone therapy can be beneficial for postmenopausal women with hypoactive sexual desire disorder.

The statement recommended transdermal testosterone at doses that approximate premenopausal physiological levels. It noted that evidence for benefits beyond sexual function (including mood, energy, cognition, and musculoskeletal health) is growing but not yet sufficient to establish formal recommendations for those indications.

In clinical practice, the benefits observed by physicians who routinely prescribe testosterone for women extend beyond libido. Improvements in energy, mood, cognitive clarity, and body composition are consistently reported, though the published literature has been slower to formalize these observations into guideline-level recommendations.

Dosing for Women

The doses of testosterone used in women are a fraction of those used in men. Typical starting doses for transdermal testosterone cream are 0.5 to 2 mg per day, compared to 50 to 100 mg per day for men. Precision matters. Compounding pharmacies prepare creams at concentrations specifically designed for female dosing.

The goal is to restore testosterone to the premenopausal physiological range, not to achieve male levels. Blood work at 6 to 8 weeks after initiation confirms that levels are appropriate and that no excess androgenic effects are occurring.

Monitoring includes free testosterone, total testosterone, SHBG, and estradiol. DHT (dihydrotestosterone) may be monitored in patients who report acne or hair changes, though these side effects are uncommon at physiological replacement doses.

Side Effects at Physiological Doses

At appropriate replacement doses, side effects are uncommon. The most frequently reported are mild acne and subtle changes in hair texture, which are typically transient and dose-dependent.

The fear of virilization (deepening voice, significant hair growth, clitoral enlargement) is understandable but reflects exposure to supraphysiological doses, not physiological replacement. At the doses used in women’s hormone therapy, these effects are exceedingly rare and, when they do occur, are reversible with dose reduction.

How This Fits into Comprehensive Care

Testosterone is one component of a complete hormonal picture. At Manus Solis, women’s hormonal assessments include estradiol, progesterone, total and free testosterone, SHBG, DHEA-S, thyroid markers, and metabolic indicators.

The Sensus domain captures the symptoms most influenced by testosterone: libido, energy, cognitive clarity, and motivation. The Pulsus domain tracks the blood markers. The Virtus domain measures body composition, grip strength, and physical capacity, all of which respond to testosterone optimization.

Treatment is individualized and iterative. Some women benefit from testosterone alone. Many benefit from testosterone alongside estradiol and progesterone as part of a comprehensive BHRT protocol. The protocol is determined by the clinical picture, not by a one-size-fits-all formula.

Continue Reading

If you found this useful, these related articles may deepen your understanding:

• Perimenopause: The Symptoms Most Women Don’t Recognize
• BHRT vs. Conventional HRT
• Grip Strength, Mortality, and What Your Body Is Telling You

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Dr. Handsun Xiao is a McGill trained physician (MD, CCFP) practicing functional medicine and bioidentical hormone therapy in Toronto, with virtual consultations available to patients across Ontario. He holds advanced BHRT certification through WorldLink Medical and IFM AFMCP training. Manus Solis offers physician led BHRT consultations with custom compounding through a dedicated Ontario pharmacy partner. To learn more or book a virtual consultation, visit manussolis.ca.