Low Testosterone in Women: The Hormone Almost No One Checks
She’s forty-four. She’s exhausted in a way that sleep doesn’t fix. She’s foggy. She’s flat. Her drive is gone — and not just in the bedroom; she means the get-up-and-go that used to be automatic. She’s still going to the gym, and her muscle is quietly disappearing anyway.
So she does the responsible thing and asks her doctor. They check her thyroid. They check her estrogen. Everything, they tell her, “looks normal.”
Nobody checked the one hormone her body actually makes the most of.
If you’ve lived some version of that story, this is for you. Because “low testosterone in women” isn’t a fringe idea or a men’s-clinic upsell — it’s an under-recognized, under-tested piece of women’s health that got buried under one very old labeling mistake.
Isn’t testosterone a “male” hormone?
That’s the assumption, and it’s wrong.
When these hormones were first named a century ago, the science was young and the story was tidy: testosterone went in the “male” column, estrogen in the “female” column. Clean, easy to teach — and quietly, that filing system became the way medicine actually practiced for the better part of eighty years.
Here’s the fact that breaks the tidy story: testosterone is the most abundant biologically active hormone in a woman’s body. For most of her life, a woman circulates more testosterone than she does estradiol (Glaser & Dimitrakakis, Maturitas 2013). A landmark review in The Lancet Diabetes & Endocrinology put it plainly — testosterone is an essential hormone for women, acting all over the body both directly and as the raw material her body converts into estrogen (Davis & Wahlin-Jacobsen, 2015).
So the label wasn’t just incomplete. For half the population, it was pointing at the wrong hormone entirely.
What does testosterone do for women?
A lot of the things women actually walk into the office complaining about: sexual desire and arousal, mood, mental clarity, energy, and lean muscle and bone. That’s the same list that so often gets waved off as “just stress” or “just getting older.”
This isn’t a hunch. Testosterone’s role in women is one of the better-studied questions in hormone medicine — which brings us to what low levels look like.
Signs and symptoms of low testosterone in women
There’s no single symptom that proves it, and every one of these can have other causes — which is exactly why it takes a clinician, not a self-diagnosis. But the pattern women describe again and again includes:
Low or absent sex drive — often the first and most distressing sign
Persistent fatigue that rest doesn’t fix
Brain fog — trouble with focus, word-finding, mental sharpness
Low or flat mood, loss of motivation and sense of well-being
Loss of muscle tone or strength despite training
Reduced exercise capacity or slower recovery
Notice how much of that list overlaps with what most women are simply told is perimenopause, menopause, thyroid, or aging. Sometimes it is. Sometimes it’s a hormone that never made it onto the lab slip.
Why testosterone drops
Testosterone doesn’t wait for menopause to decline. It falls gradually with age — by her forties, a woman’s level is often roughly half what it was in her twenties (Davis & Wahlin-Jacobsen, 2015). Estrogen gets all of the menopause conversation, so testosterone’s slower slide tends to go unnoticed and unmeasured. (Surgical menopause — removal of the ovaries — is different: it can cut testosterone abruptly.)
What the research actually shows
In 2019, researchers pooled every solid randomized trial they could find on testosterone in women: 36 trials, 8,480 women — the biggest, cleanest look we have (Islam et al., Lancet Diabetes & Endocrinology 2019).
What they found: testosterone significantly improved sexual desire, arousal, orgasm, and sexual self-image — and significantly reduced the distress that comes with losing those. Real effect sizes, across thousands of women, not anecdotes.
Then the part that matters most for safety: how you take it changed everything. Testosterone taken as a pill worsened cholesterol numbers. The same hormone delivered through the skin — a cream or patch — did not; it was neutral on lipids. And across all 36 trials there were no serious adverse events; the side effects that showed up were minor, like a little acne or extra hair at the application site (Islam et al., 2019).
Sit with that contrast, because it’s the whole ballgame: the route — pill versus skin — mattered more than the hormone itself. A separate study of more than 500 peri- and postmenopausal women also reported that transdermal testosterone improved mood and cognitive symptoms (Archives of Women’s Mental Health, 2024).
None of this makes testosterone a magic fix, and it isn’t right for everyone. It means the symptoms many women are told to just live with deserve a real evaluation — not a shrug.
The myths that keep women from it
Someone actually sat down and catalogued the fears. The 2013 Maturitas review took the ten most common ones and walked through them (Glaser & Dimitrakakis):
“It’ll masculinize me.” At physiologic doses — restoring a woman to her own healthy range — the research says no.
“It’ll deepen my voice.” No good evidence of hoarseness at those doses.
“It causes aggression.” The data points the other way — toward mood stabilization. The rage stories come from bodybuilders using ten to twenty times a normal dose. That is not this.
“Won’t it cause breast cancer?” This is the one that ends conversations. In the work of these same clinicians — including a review of subcutaneous testosterone therapy used since the 1930s — testosterone did not increase breast cancer risk, and in their data was associated with a lower risk (Glaser & Dimitrakakis, Androgens 2021).
To be honest about that last point: the long-term trials in women are still maturing, so it’s not a promise. But “testosterone gives women breast cancer” is not what the evidence says. If anything, the arrow may point the other way.
How testosterone for women is actually prescribed
Here’s the strange part. There’s an international expert consensus formally endorsing testosterone for women (for low sexual desire that causes distress) — and yet, walk into a U.S. pharmacy and ask for the FDA-approved testosterone made for a woman, and there isn’t one. Not a single approved product. No “pink box” on the shelf (Davis et al., Global Consensus 2019; Davis & Wahlin-Jacobsen 2015).
But that gap is not the barrier it’s made out to be. A woman doesn’t need an FDA-approved product — she needs a clinician who understands the art of testosterone therapy and how to work with a compounding pharmacy. A simple compounded testosterone cream, made specifically for a woman’s body, is easy and reliable (roughly $30–40 for about a four-month supply). The evidence favors transdermal delivery for exactly the safety reasons above.
The real barrier isn’t the FDA. It’s that most providers were never trained in this — they never did the reading. That’s fixable.
Is it too late? What to ask your provider
Here’s the through-line of everything we teach: we treat the person and the symptoms — not just a number a lab decided was “normal” for a 60-year-old. Normal for the population is not the same as optimal for you, and it is almost never too late to ask a better question.
This isn’t a push to run out and demand testosterone. It’s permission to ask. You’re allowed to get the number checked. You’re allowed to work with someone who actually reads the research. “That’s a men’s hormone” was never a good enough reason for the conversation to never happen.
Frequently asked questions
Does testosterone help with menopause symptoms?
The strongest randomized-trial evidence is for sexual desire and arousal. Some studies also report improvements in mood and mental clarity. It’s not a cure-all and isn’t for everyone — it’s one piece of a broader, individualized plan.
What are the signs of low testosterone in women?
Low sex drive, persistent fatigue, brain fog, flat mood, and loss of muscle or strength are the most common. All can have other causes, so they warrant a clinical evaluation rather than self-diagnosis.
Is testosterone cream safe for women?
In the pooled trials, transdermal testosterone (cream/patch) was neutral on cholesterol and produced no serious adverse events, with minor side effects like application-site acne or hair. Delivery and dose matter — this belongs with a trained clinician.
Can testosterone cause breast cancer in women?
The available research does not show an increased risk, and some data associate it with lower risk. Long-term trials are still maturing, so it’s framed honestly as reassuring data, not a guarantee.
I’m past menopause — is it too late to start?
It is almost never too late to evaluate symptoms and hormones. Age alone isn’t a reason to skip the conversation.
Get the full breakdown — watch it or listen to it
This post is the companion to Episode 3 of Exposing Outdated Dogma — “Testosterone Isn’t a Male Hormone.” Take it in whichever way fits your day:
Watch the full breakdown on YouTube: youtu.be/V3hgG5gb5lo
Listen to the full episode on This Isn’t Your Grandma’s Health Podcast: listen on Spotify
Book a consultation (DNP-led telehealth): withinyou.health/links
Written by Luke Swift, DNP. Educational content, not individualized medical advice. Hormone decisions belong in a one-on-one conversation with a qualified clinician who knows your history.
References
Glaser R, Dimitrakakis C. Testosterone therapy in women: myths and misconceptions. Maturitas 2013.
Davis SR, Wahlin-Jacobsen S. Testosterone in women — the clinical significance. Lancet Diabetes & Endocrinology 2015.
Islam RM, et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis (36 RCTs, 8,480 women). Lancet Diabetes & Endocrinology 2019.
Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. 2019.
Glaser R, Dimitrakakis C. Testosterone-implant therapy in women with and without breast cancer. Androgens 2021.
Transdermal testosterone and mood/cognitive symptoms in peri- and postmenopausal women. Archives of Women’s Mental Health 2024.
