Ask most people to name a female hormone and they will say estrogen. Ask them to name a male hormone and they will say testosterone. The truth is less tidy: before menopause, a woman’s body produces about three to four times more testosterone than estrogen by weight, and testosterone is doing quiet, important work in her brain, muscles, bones, and sex life the whole time. When it declines, the effects are real, and they are often mistaken for stress, aging, or depression.

This article explains what testosterone does for women, how to recognize when it is low, how low-dose testosterone therapy is prescribed and monitored, and the questions women most often ask before starting.

What Testosterone Does in a Woman’s Body

Testosterone in women is produced by the ovaries and the adrenal glands, and some is also made in peripheral tissues from precursor hormones such as DHEA. It supports sexual desire and arousal, the ability to build and keep lean muscle, bone density, motivation and mental sharpness, and a general sense of energy and well-being. It also works alongside estrogen: some testosterone is converted into estradiol in tissues that need it, which is one reason the two hormones are usually evaluated together.

Levels peak in the twenties and fall gradually from there. By the time a woman reaches her mid-forties, her testosterone is typically about half what it was at 25, and this decline is independent of menopause itself. Menopause adds a second drop as ovarian production slows, and surgical removal of the ovaries causes an abrupt fall, often of 50 percent or more within days.

Signs Your Testosterone May Be Low

Low testosterone rarely announces itself with a single dramatic symptom. It tends to show up as a cluster of changes that build over months or years:

• A noticeable drop in sexual desire, fewer spontaneous sexual thoughts, or difficulty becoming aroused even when you want to be
• Fatigue that does not improve with sleep, and a sense of having less drive or motivation than you used to
• Brain fog, trouble with word recall, or difficulty concentrating
• Loss of muscle tone and strength, or a plateau in the gym despite consistent effort
• Weight gain, particularly around the middle, that resists diet and exercise
• A flatter mood, lower confidence, or increased anxiety that does not have an obvious cause

Many women bring these symptoms to a provider and are told that their labs are “normal.” Standard reference ranges for testosterone in women are wide and were not designed to identify optimal levels, so a result at the bottom of the range can still represent a meaningful decline for the individual. Symptoms, history, and lab values have to be interpreted together.

What the Evidence Says

The strongest evidence for testosterone therapy in women is for hypoactive sexual desire disorder, meaning a persistent, distressing loss of sexual desire, in postmenopausal women. In 2019, an international group of medical societies published a Global Consensus Position Statement concluding that testosterone therapy at physiologic doses improves sexual desire, arousal, orgasm, and sexual satisfaction in this group, and that short-term use at these doses has not been associated with serious adverse effects.

Evidence for other benefits, including energy, mood, cognition, and body composition, is more limited and less consistent in formal trials, though many women and their clinicians report improvements in these areas. It is honest to say that testosterone is well supported for libido and reasonably supported, but less proven, for the rest.

How Testosterone Is Prescribed for Women

The guiding principle is to restore levels to the normal range of a healthy younger woman, not to exceed it. Women are prescribed roughly one-tenth of the dose used for men. In the United States, there is currently no FDA-approved testosterone product formulated specifically for women, so testosterone is prescribed off-label in one of two ways: a carefully measured small dose of a product approved for men, or a compounded cream, gel, or troche made by a licensed pharmacy to a female-appropriate strength. Off-label prescribing is common and legal in medicine when it is supported by evidence and clinical judgment, and your provider should be able to tell you exactly what you are taking and why.

Delivery Methods

• Transdermal cream or gel: Applied daily to the skin. The most widely used and easiest to adjust. Recommended by the consensus statement as the preferred route.
• Sublingual troche: A small lozenge dissolved under the tongue. Convenient, though absorption can be more variable.
• Injection: Used in select cases; produces larger swings in levels between doses.

Each of these methods shares one important quality: the dose can be changed quickly. Because the aim is to keep testosterone within a narrow physiologic range, ForwardFlow Health uses only adjustable delivery methods, so that if your follow-up labs or symptoms call for a change, it can be made right away.

Monitoring

Before starting, your provider will check a baseline total and free testosterone along with SHBG, which affects how much testosterone is actually available to your tissues, and will review your other hormones, thyroid, and metabolic labs. See the full list of labs we check before hormone therapy. Levels are rechecked about [8 to 12] weeks after starting to confirm you are in the target range, then periodically once stable. Dose changes are made based on both your labs and how you feel; the goal is the lowest dose that resolves your symptoms.

Side Effects and Safety

At physiologic doses, side effects are uncommon. The ones that do occur are related to androgen excess and are a signal that the dose is too high for you: mild acne or oily skin, and a small increase in facial or body hair. Both resolve with a dose reduction. Voice deepening and clitoral enlargement are rare, are associated with levels well above the female range, and are the reason regular lab monitoring matters. Transdermal testosterone at appropriate doses has not been shown to raise the risk of breast cancer, heart disease, or blood clots in the studies available to date, though long-term data beyond a few years are limited.

Testosterone is typically prescribed alongside, not instead of, estrogen and progesterone when those are indicated. Read our overview of hormone therapy safety for a fuller discussion of who should and should not use hormone therapy.

Frequently Asked Questions