Testosterone matters for women too, from desire to muscle to the estrogen you make. Here’s what it does, what lowers it, and why it’s so often overlooked.
You asked about your energy. Your drive. Your desire.
You were told it was stress. Or perimenopause. Or a busy season of life. Or “just how it is.”
Almost no one mentioned testosterone.
That isn’t an accident. Testosterone has been framed as the male hormone for so long that most women (and plenty of providers) never think to ask about it. There are FDA-approved testosterone products for men. For women, there are none. When the system doesn’t build a product for you, it also stops building the conversation.
So let’s have the conversation. This post covers where women make testosterone, what it does, what lowers it, and what I look at from a functional medicine perspective. Numbers in brackets point to the references at the end.
In a woman’s body, testosterone circulates at higher levels than estradiol does. It’s one of your major hormones, not a rounding error. You make it in three ways:[1]
made directly
made directly
converted from DHEA and androstenedione in fat, skin, and muscle
Its pattern over a lifetime is also not what most women expect:
Levels are highest in your 20s and slide through your 30s and 40s, well before menopause.[2]
Your ovaries keep making testosterone after menopause. But surgical removal of the ovaries drops levels by about half.[2]
DHEA and related hormones fall steadily through midlife, which matters because your tissues rely on them as raw material.[3]
Androgen receptors are found throughout your body: your brain, muscle, bone, fat, skin, and the tissues of the vagina and vulva.[4] So testosterone has plenty of places to work. What we can say with confidence varies a lot by area:
| Where | What It Does | Evidence in Women |
|---|---|---|
| Sexual desire and arousal | Supports desire, arousal, and satisfaction | Strongest Best supported in postmenopausal women with low desire[4] |
| Muscle and bone | Supports muscle maintenance and bone | Limited Plausible biology, limited evidence in women |
| Mood, energy, and thinking | Linked to wellbeing and drive | Mixed Not firmly established[4] |
| Your estrogen supply | Converted to estradiol by the enzyme aromatase | Well Established After menopause, much of your estrogen comes from converting androgens in tissue[5] |
Testosterone and its precursors are raw material for your estrogen. After menopause, when the ovaries stop making much estradiol, this conversion is one of your main remaining sources. So an androgen problem can quietly become an estrogen problem.
And the first row is why many women ask about testosterone in the first place: low desire is the symptom with the clearest evidence behind it. For energy, motivation, and body composition, the honest answer is that research in women is still catching up. I’d rather tell you that than overpromise.
Testosterone is one piece of a bigger hormone picture. My free Hormone Type Assessment is a short quiz that helps you see whether your symptoms point toward:
This is where functional medicine thinking helps, because low testosterone in women is rarely just about age. These are the factors I look for:
Oral contraceptives raise SHBG (the protein that binds testosterone) and lower the amount free to act. In a meta-analysis, combined oral contraceptives lowered both total and free testosterone.[6]
Like the pill, it can raise SHBG and leave less testosterone available. It’s a route-of-delivery detail many women never hear about.
Removing the ovaries or losing ovarian function early lowers levels more abruptly.[2]
Your adrenals make a good share of your androgen precursors. Long-term stress and steroid medications such as prednisone can suppress them.
Both influence SHBG. Insulin resistance tends to lower it, an underactive thyroid lowers it, and an overactive thyroid raises it. That shifts how much testosterone is free. (More on the thyroid connection.)
Not enough fuel for the amount of exercise you do can suppress your whole hormone system, not just one hormone.
Poor sleep disrupts your hormone rhythms across the board.
Some medicines, such as certain antidepressants and opioids, can lower desire or hormone levels.
Testosterone in women isn’t a more-is-better situation. The opposite problem is common, and I see it often in younger women.
When testosterone runs high, it shows up as jawline acne, coarse chin or body hair, scalp thinning, and irregular cycles. The most common cause is polycystic ovary syndrome (PCOS), where insulin resistance pushes the ovaries to make more androgens.[7]
That’s a metabolic problem, and it responds to metabolic care: blood sugar, strength training, sleep, and a proper workup.
If your concern is low desire or low energy, please don’t skip straight to testosterone. These commonly overlap, and I check them first:
Often it’s several of these at once. I cover this overlap, and how to check testosterone properly, in my post on how low testosterone gets missed.
There’s no single “perfect” testosterone number for women, and no agreed-upon cutoff that defines a deficiency. A major Endocrine Society guideline even advises against diagnosing “androgen deficiency” based on a lab value alone.[8] So I look at patterns, not one number:
Low levels are hard to measure accurately. I prefer a sensitive method (LC-MS/MS) and look at total testosterone together with SHBG, then calculate free testosterone from there.
To see what’s available, what the adrenals are contributing, and what testosterone may be converting to.
TSH, free T3 and T4, ferritin, fasting glucose, fasting insulin, and A1c, because they overlap with the same symptoms and influence SHBG.
Birth control, oral estrogen, steroids, and where you are in your cycle or stage of life.
Sleep, stress, mood, desire, energy, recovery, and what has changed.
I also use my four hormone patterns to organize the questions:
Low drive, slow recovery, losing muscle, dry skin
Wired and tired, poor sleep, high stress load
Insulin resistance, stubborn midsection weight, acne or hair changes
High SHBG, sluggish hormone processing, bloating
These are clues that organize questions. They don’t diagnose a cause.
Whatever your numbers show, these support healthy androgen balance:
Here’s the short version. There are no FDA-approved testosterone products for women in the United States, so any prescription is off-label, often a much lower dose of a men’s product or a compounded preparation. The best evidence supports it for low sexual desire in postmenopausal women, and expert groups recommend it for that reason and not for other uses.[4], [9] Long-term safety data is still limited.
That doesn’t take it off the table. It means it needs a knowledgeable provider, appropriate labs, and ongoing monitoring. Whether it’s right for you is a conversation for you and your prescriber.
Please talk with your healthcare provider if you notice new facial or body hair, a deepening voice, rapid hair loss, missed periods, or symptoms like persistent fatigue, low mood, or loss of desire that don’t improve. Don’t wait for it to pass.
If you haven’t yet, start with the free Hormone Type Assessment. And if you’d rather talk through what’s going on with your energy, drive, and hormones, I offer a free discovery call. No pressure, just a conversation about whether functional medicine is the right next step for you.
Book Your Free Discovery Call →To your health and vitality, Dr. Ryan
Yes. Women make testosterone in the ovaries, adrenal glands, and tissues, and it circulates at higher levels than estradiol. It supports sexual desire and serves as raw material for estrogen, especially after menopause.
Low sexual desire is the symptom with the strongest evidence. Fatigue, low drive, and slower recovery are often reported, but they overlap with thyroid, iron, sleep, mood, and blood sugar problems, which should be checked too.
Combined oral contraceptives raise SHBG, the protein that binds testosterone, and a meta-analysis found they lower both total and free testosterone. Oral estrogen can have a similar effect on SHBG.
The most common cause is polycystic ovary syndrome (PCOS), where insulin resistance drives the ovaries to make more androgens. Signs include jawline acne, coarse facial or body hair, scalp thinning, and irregular cycles.
Not in the United States. There are no FDA-approved testosterone products for women, so prescriptions are off-label. Expert guidelines support it mainly for low sexual desire in postmenopausal women, with careful monitoring.
For educational purposes only. Not a diagnosis, and not a substitute for care from your healthcare provider. Talk with your provider before starting, stopping, or changing any medication or supplement.
