Women Produce Testosterone Too — and It Matters More Than You Think
Testosterone is routinely called the “male hormone” — and this simplistic label has done enormous damage to women’s healthcare. Women produce testosterone. They need testosterone. And when their testosterone levels decline — which begins in the 20s and accelerates through the 30s and 40s — the effects can be profound and frequently misattributed to other causes.
This article examines the role of testosterone in women’s health, the symptoms of female testosterone deficiency, and the current evidence for testosterone therapy in women.
Testosterone in Women: The Basics
Women produce testosterone primarily in the ovaries and adrenal glands. In fact, healthy premenopausal women have higher circulating testosterone levels than estrogen levels on a molar basis — though absolute testosterone concentrations are roughly 10-15 times lower than in men.
Testosterone production in women peaks in the mid-20s and begins declining steadily thereafter. By the time a woman reaches her 40s, her testosterone levels may be less than half of what they were at their peak. Surgical menopause (removal of both ovaries) causes an immediate and dramatic 50% decline in testosterone, with significant symptomatic consequences.
What Testosterone Does in Women
Libido and Sexual Function
Testosterone is the primary driver of sexual desire in women — perhaps even more so than in men, where both estrogen and testosterone contribute to libido. Multiple randomized controlled trials have demonstrated that testosterone therapy significantly improves sexual desire, arousal, frequency of sexual activity, and sexual satisfaction in women with hypoactive sexual desire disorder (HSDD).
Energy and Vitality
Low testosterone in women is strongly associated with persistent fatigue, low motivation, and diminished drive — the kind of fatigue that doesn’t respond to adequate sleep or rest. Women with testosterone deficiency often describe feeling flat, unmotivated, and lacking the zest for life they once had. Testosterone restoration frequently brings marked improvement in these symptoms.
Muscle Mass and Bone Density
Like in men, testosterone plays an important anabolic role in women, supporting maintenance of lean muscle mass and bone mineral density. As testosterone declines with age — and particularly after menopause — women are at increased risk of sarcopenia (age-related muscle loss) and osteoporosis. Testosterone therapy supports maintenance of musculoskeletal health in postmenopausal women.
Cognitive Function
Testosterone receptors are present throughout the brain, and testosterone has neuroprotective and pro-cognitive effects in women. Research suggests associations between low testosterone and cognitive decline, while testosterone therapy shows promise for maintaining cognitive function in postmenopausal women.
Mood and Wellbeing
Testosterone contributes to mood regulation, confidence, and psychological resilience. Women with low testosterone frequently report feeling emotionally flat, experiencing increased anxiety, and lacking the confidence and assertiveness they previously had. Restoring testosterone to optimal levels can meaningfully improve mood, emotional resilience, and overall sense of wellbeing.
Diagnosing Testosterone Deficiency in Women
Diagnosing testosterone deficiency in women is challenging because there are no universally agreed-upon reference ranges for female testosterone, labs vary significantly, and symptoms often overlap with other conditions. A thorough evaluation should include free and total testosterone measurement using sensitive assay methods (mass spectrometry-based testing is preferred), SHBG, DHEA-S, and comprehensive assessment of symptoms.
Testosterone Therapy in Women: The Evidence and Options
The evidence for testosterone therapy in women has grown substantially. A Lancet review concluded that testosterone therapy is effective and safe for postmenopausal women with hypoactive sexual desire disorder. Multiple society guidelines now acknowledge the role of testosterone in managing HSDD in women.
Treatment options include low-dose topical testosterone creams or gels (applied to the inner thigh or labia), testosterone pellets, and injectable forms — with topical preparations being most commonly used due to ease of dose adjustment. Dosing must be carefully calibrated — female physiological testosterone needs are far lower than male needs, and supraphysiological doses can cause virilizing side effects (acne, hair growth, voice changes) that are generally reversible with dose reduction.
The Takeaway for Women
If you’re a woman experiencing low libido, persistent fatigue, reduced motivation, or mood changes that haven’t responded to other interventions, testosterone deficiency may be a significant contributing factor — and one that deserves clinical attention. Find a practitioner who assesses and understands female hormone health comprehensively, including testosterone.