When you think of testosterone, you probably picture bodybuilders, male athletes, or perhaps aggressive behavior. The label “male hormone” has been so firmly attached to testosterone that most women are shocked to learn they produce it too. Even more surprising is that women need testosterone for far more than just sex drive, and declining levels during perimenopause and menopause can dramatically affect how you feel every single day.

If you’re in your forties or beyond and struggling with exhaustion that never seems to lift, brain fog that makes simple tasks feel impossible, muscle weakness despite your best efforts at the gym, or a complete loss of motivation and drive, low testosterone might be the missing piece of your puzzle. Yet most conventional doctors never test for it, and when they do, they often dismiss results that fall within a broad normal range without considering whether those levels are optimal for you.

The Testosterone Truth Women Aren’t Told

Here’s what nobody explains about testosterone in women. Before menopause, your body actually produces three times more testosterone than estrogen. Yes, you read that right. Three times more. Testosterone is the most abundant biologically active hormone in women throughout most of their lives.

Your ovaries produce testosterone, along with your adrenal glands and even your brain. This hormone has receptors throughout your entire body, from your muscles and bones to your brain and cardiovascular system. When testosterone levels are adequate, you feel energized, motivated, and capable. Your thinking is sharp. Your body stays strong. You have interest in sex and enjoy it when you have it. You wake up ready to tackle your day.

During perimenopause, testosterone levels begin declining gradually. By the time you reach menopause, your testosterone can drop to levels significantly lower than what you had in your twenties and thirties. If you’ve had your ovaries removed surgically, the drop is even more dramatic and sudden. Women who undergo surgical menopause can experience testosterone levels that are 50% lower than women who go through natural menopause.

The decline happens so gradually that many women don’t realize what’s changing. You might think you’re just getting older, becoming lazy, or losing your edge. You blame stress, poor sleep, or just being busy. Meanwhile, declining testosterone is quietly affecting nearly every system in your body.

Beyond Libido: What Testosterone Actually Does

When doctors do acknowledge testosterone for women at all, it’s usually only in the context of sexual desire. The current medical guidelines suggest considering testosterone supplementation for menopausal women with low libido if hormone replacement therapy with estrogen and progesterone alone hasn’t helped. This narrow focus on sexual function misses the vast majority of what testosterone does in the female body.

Low testosterone in women causes fatigue that goes beyond normal tiredness. We’re talking about the kind of exhaustion where getting through a grocery store trip feels like climbing a mountain. The kind where you need a nap after doing basically nothing. Where your energy crashes in the afternoon and never recovers. Many women describe feeling like they’re moving through molasses, like everything takes twice the effort it used to require.

Brain fog is another hallmark symptom of low testosterone in women. You walk into rooms and forget why you’re there. You can’t find words that used to come easily. Your concentration evaporates after a few minutes. You read the same paragraph three times and still don’t absorb it. You forget names, appointments, and tasks you’ve done a thousand times. This cognitive decline isn’t inevitable aging. It’s often inadequate testosterone affecting your brain function.

Testosterone plays a crucial role in maintaining muscle mass and strength. As levels decline, you might notice your muscles getting weaker even if you’re exercising regularly. Your upper body strength diminishes noticeably. You struggle with tasks that used to be easy, like opening jars, carrying groceries, or doing pushups. You might also notice more body fat accumulating, particularly around your midsection, even though your diet and activity level haven’t changed.

Bone health depends on adequate testosterone too. While estrogen gets most of the attention for bone density, testosterone is equally important for building and maintaining strong bones. Low testosterone contributes to the increased fracture risk that postmenopausal women face.

Mood changes are another significant effect of declining testosterone. Many women describe feeling flat, unmotivated, or just going through the motions. You might feel irritable, anxious, or mildly depressed without any obvious reason. Your usual enthusiasm for activities you love just isn’t there anymore. This isn’t clinical depression necessarily, though it can contribute to it. It’s the loss of vitality and drive that testosterone normally supports.

Why Your Doctor Probably Won’t Test for It

Most conventional doctors don’t routinely test testosterone in women. If they do test it, they’re often looking at total testosterone only, which doesn’t give you the complete picture. The majority of testosterone in your bloodstream is bound to proteins, particularly sex hormone binding globulin, making it unavailable for your body to use. It’s the free testosterone, the portion that’s not bound to proteins, that actually matters for how you feel.

Even when testing is done, the reference ranges for women are extremely broad, and what’s considered normal may not be optimal for you. A woman with testosterone at the low end of normal might feel terrible while another woman at the high end feels great. The ranges also don’t account for where you are in your menopausal transition or what your levels were before they started declining.

Another problem is that testosterone can fluctuate significantly during perimenopause, just like estrogen and progesterone do. Testing on one day might show adequate levels, while testing a few weeks later could reveal a significant drop. This variability makes it even harder to get an accurate picture from a single blood draw.

Most importantly, conventional medicine hasn’t caught up to the research showing benefits of testosterone for women beyond just sexual function. Despite studies demonstrating improvements in energy, mood, cognition, bone density, and muscle strength, current guidelines remain narrowly focused on libido alone. This leaves many women suffering needlessly because their doctors don’t recognize or address testosterone deficiency.

The Real Benefits of Optimal Testosterone

When testosterone is adequately replaced in women who need it, the changes can be remarkable. The most commonly recognized benefit is improved sexual desire and satisfaction. Women report increased interest in sex, greater arousal, more intense orgasms, and overall better sexual experiences. For women who’ve lost their libido and are distressed by it, testosterone replacement can be life changing for their intimate relationships.

But the benefits extend far beyond the bedroom. Energy levels often improve dramatically. Women describe finally feeling like themselves again, having the stamina to get through their days without collapsing. That crushing afternoon fatigue lifts. You can exercise without feeling wiped out for days afterward. You have energy left at the end of the day for the things you actually enjoy.

Mood improvements are frequently reported as well. In one study of 510 women using testosterone cream or gel, 47% reported improvement in mood symptoms, with an average 34% decrease in symptom scores. Women describe feeling more positive, motivated, and engaged with life. The flatness and lack of enthusiasm lifts. Anxiety often decreases. You feel more like the person you used to be before perimenopause changed everything.

Cognitive function can improve with testosterone therapy too. Brain fog clears. Your thinking sharpens. Memory improves. Concentration comes back. You can focus on tasks without your mind wandering. The mental clarity you thought was gone forever returns. While the improvements in cognition aren’t always as dramatic as the mood benefits, many women notice a meaningful difference.

Muscle strength and body composition often improve as well. You can build and maintain muscle more easily. Your workouts become more effective. Body fat, especially around the midsection, may decrease. You feel stronger and more capable physically. Tasks that had become difficult become manageable again.

Bone density benefits from adequate testosterone levels too. This is particularly important for postmenopausal women at increased risk for osteoporosis and fractures. Testosterone works alongside estrogen to maintain bone strength and reduce fracture risk as you age.

How Testosterone Works Differently in Women

Testosterone doesn’t work in isolation. It interacts with estrogen and progesterone in complex ways. The ratio of testosterone to estrogen matters, not just the absolute level of either hormone. Some research suggests that times when the testosterone to estrogen ratio is higher may be associated with certain symptoms, which is why balancing all your hormones is crucial.

This is also why testosterone replacement in women should never be considered without addressing estrogen and progesterone first. Most experts recommend that women should be adequately estrogenized before adding testosterone. This usually means you’re no longer experiencing hot flashes or vaginal dryness from low estrogen. Only after estrogen levels are optimized should testosterone be considered.

The doses used for women are also dramatically different from those used for men. Women need only a tiny fraction of the testosterone that men require. Using male doses or formulations can lead to unwanted side effects like voice deepening, clitoral enlargement, acne, and hair loss. These side effects are why careful dosing and monitoring are essential.

Transdermal testosterone, applied to the skin as a cream or gel, is generally considered the safest and most effective method for women. It allows for precise dosing and can be adjusted or stopped immediately if side effects occur. Testosterone pellets implanted under the skin are used by some practitioners, but they can’t be removed if problems arise and may release too much testosterone at once.

The Testing You Actually Need

If you’re experiencing symptoms of low testosterone, proper testing is essential before starting any treatment. Comprehensive testing should include total testosterone, free testosterone, and sex hormone binding globulin. These markers together give you a complete picture of how much testosterone you’re producing and how much is actually available for your body to use.

Testing should also include a full thyroid panel, not just TSH. Thyroid function affects how your body responds to and uses testosterone. Cortisol testing, ideally a four point saliva test throughout the day, helps identify whether chronic stress is affecting your hormone production. Remember that your body makes both cortisol and sex hormones from the same precursor. If you’re under chronic stress and demanding constant cortisol production, less is available for testosterone synthesis.

Estrogen and progesterone should be tested as well. You need to know the complete picture of your hormone balance, not just one piece of it. DHEA, which serves as a precursor to testosterone, is also worth measuring. Sometimes supporting DHEA production helps boost testosterone naturally.

Timing of testing matters too. For women still having periods, testing should ideally occur at specific times in the cycle for the most accurate results. For women in menopause, timing is less critical, but consistency in testing protocol helps track changes over time.

What Functional Medicine Does Differently

Functional medicine practitioners approach testosterone deficiency in women completely differently than conventional doctors. Instead of waiting until you meet strict diagnostic criteria for a disease, functional medicine asks whether your hormones are optimized for you to feel your best.

Testing is comprehensive from the start. Beyond just checking testosterone, functional medicine looks at all your hormones, your nutrient levels, inflammatory markers, gut health, and metabolic function. Everything is viewed as interconnected because that’s how your body actually works.

When testosterone is low, functional medicine investigates why. Are you under chronic stress that’s stealing precursors away from sex hormone production? Do you have nutrient deficiencies affecting hormone synthesis? Is gut dysfunction interfering with hormone metabolism? Are inflammatory processes disrupting your endocrine system? Addressing these root causes alongside hormone replacement leads to better, more sustainable results.

Treatment is personalized based on your specific test results, symptoms, and life circumstances. You’re not given a standard protocol that everyone gets. Your doses are tailored to your body’s needs and adjusted based on how you respond and what follow-up testing shows.

Support extends beyond just prescribing hormones. Functional medicine includes dietary recommendations to support hormone production and metabolism, stress management strategies to protect your hormone levels, sleep optimization to improve hormone synthesis, and supplement protocols to address deficiencies and support your endocrine system.

The Safety Question

One concern that stops many women from considering testosterone is fear about safety. The research on testosterone for women is still more limited than for estrogen and progesterone, which understandably makes some women nervous.

Current evidence suggests that testosterone, when used appropriately in physiologic doses that mimic what your body would naturally produce, appears to be safe for most women. Studies haven’t shown increased cardiovascular risk, and some research suggests potential cardiovascular benefits. There’s no evidence of increased breast cancer risk with testosterone therapy.

The key is appropriate dosing and monitoring. Using male testosterone products or doses is dangerous and can cause permanent side effects. But when women use formulations designed for female physiology at appropriate doses, serious adverse effects are rare.

The most common side effects at proper doses are mild and reversible. You might experience some acne, particularly if you’re prone to it. You might notice slightly increased facial hair growth. Your voice might deepen very slightly, though this is uncommon at appropriate doses. If any of these occur, reducing the dose usually resolves them.

Regular monitoring helps catch any issues early. This typically means checking testosterone levels three to six months after starting treatment to ensure you’re in the optimal range, then annually or as needed after that. Your provider should also monitor for any side effects and adjust your dose accordingly.

Alternatives and Complementary Approaches

Not every woman needs or wants testosterone replacement. There are ways to support your body’s natural testosterone production through lifestyle and nutritional interventions.

Adequate protein intake is essential for hormone production. Many women in perimenopause don’t eat enough protein, which can affect testosterone synthesis. Aim for at least 20 to 30 grams of protein at each meal.

Strength training is one of the most effective ways to naturally support testosterone levels. Resistance exercise signals your body to produce more testosterone to build and maintain muscle. You don’t need to lift heavy weights necessarily, but some form of regular strength training is beneficial.

Stress management is crucial because chronic stress depletes the precursors needed for sex hormone production. Whatever helps you actually manage stress, whether meditation, yoga, time in nature, therapy, or something else, is worth prioritizing.

Quality sleep is when much of your hormone production happens. Poor sleep directly impacts testosterone levels. Addressing sleep problems should be part of any approach to optimizing hormones.

Certain nutrients support testosterone production. Zinc, magnesium, vitamin D, and healthy fats are all necessary for adequate synthesis. Deficiencies in any of these can impair testosterone production. Testing and supplementing as needed can help.

DHEA supplementation is sometimes used to support testosterone levels, as your body can convert DHEA into testosterone. However, this should only be done under medical supervision with appropriate testing, as DHEA can also convert into estrogen.

Getting the Support You Need

If you suspect low testosterone is contributing to how terrible you feel, the first step is finding a practitioner who will take you seriously. Not all doctors are comfortable prescribing testosterone for women, and some remain skeptical despite the research supporting its use.

Look for practitioners with specific training or experience in menopause care. Menopause specialists, functional medicine doctors, or providers associated with women’s health clinics focused on midlife health are more likely to be knowledgeable about testosterone therapy for women.

When you meet with a provider, be specific about your symptoms. Describe how your energy, mood, motivation, strength, and yes, libido have changed. Explain what you’ve already tried that hasn’t helped. Ask specifically about testosterone testing and whether it might be relevant for your situation.

Don’t be discouraged if the first provider you see isn’t helpful. Many women have to advocate firmly for themselves or find different providers before getting appropriate testing and treatment. You know your body. If something feels wrong, keep looking for answers.

Be aware that testosterone for women is often prescribed off-label in the United States, meaning there aren’t FDA approved formulations specifically for women. Providers typically use compounded preparations or low doses of products approved for men. This is standard practice but can sometimes create insurance coverage challenges.

The Bottom Line

Testosterone isn’t just a male hormone. It’s essential for women’s health, energy, strength, mood, cognition, and yes, sexual function too. The gradual decline during perimenopause and menopause can rob you of your vitality and leave you feeling like a shell of your former self.

Conventional medicine’s narrow focus on testosterone only for libido issues means countless women are suffering unnecessarily with symptoms that could be helped by appropriate hormone optimization. The exhaustion, brain fog, muscle weakness, mood changes, and loss of drive you’re experiencing aren’t inevitable. They’re not just part of getting older. And they’re definitely not all in your head.

Comprehensive testing can reveal whether low testosterone is contributing to your symptoms. Working with a knowledgeable practitioner who understands hormone optimization in women can help you determine whether testosterone therapy might be beneficial for you. And addressing root causes through functional medicine approaches ensures the best possible outcomes.

You deserve to feel strong, energized, mentally sharp, and engaged with your life. You deserve to feel like yourself. Testosterone might be the missing piece that helps you get there.

References

1. Scott A, Szwarc A, Purdy L. 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. 2020;70(693):203-204.
2. Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Journal of Clinical Endocrinology & Metabolism. 2019;104(10):4660-4666.
3. Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes & Endocrinology. 2019;7(10):754-766.
4. Newson L, Nalliah S. Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study. Archives of Women’s Mental Health. 2024;27:891-899.
5. National Institute for Health and Care Excellence. Menopause: diagnosis and management. NICE guideline [NG23]. Updated December 2024.
6. The British Menopause Society. BMS consensus statement: Testosterone replacement in menopause. 2016.
7. Panay N, Al-Azzawi F, Bouchard C, et al. Testosterone treatment of HSDD in naturally menopausal women: The ADORE study. Climacteric. 2010;13(2):121-131.
8. Cappola AR, Maggio M. The complicated relationship between sex hormones, sleep, and bone health during midlife. Menopause. 2021;28(7):847-849.
9. Davis SR. Cardiovascular and cancer safety of testosterone in women. Current Opinion in Endocrinology, Diabetes, and Obesity. 2021;28(3):215-221.
10. Weiss RV, Dalla Corte RR, de Souza RM, Nardi AE. Testosterone therapy for women with low sexual desire: A position statement from the Brazilian Society of Endocrinology and Metabolism. Archives of Endocrinology and Metabolism. 2019;63(3):190-198.
11. Simply You Wellness Clinic. Testosterone and DHEA: A Guide for Women in Perimenopause and Menopause. May 2024.
12. Women’s Health Alliance. How testosterone hormone therapy can help menopause symptoms. December 2024.
13. Newson Health. The importance of testosterone for women. Updated 2024.
14. Midi Health. Testosterone for Menopause: How This Hormone Helps Women. October 2024.
15. Winona. Understanding Testosterone During Menopause. 2024.