Do Women Need Testosterone? The Complete Guide

Testosterone isn't just a male hormone. Women make it, our bodies depend on it, and for most of us it starts declining in our 30s, long before anyone mentions perimenopause.

There is so much talk about the chaos of estrogen and progesterone in perimenopause, yet most women know little to nothing about testosterone.

This guide covers what testosterone is and does, where it comes from, why it declines, why it's so hard to get tested and treated, and how therapy actually works for women. By the end, you'll understand this hormone better than most women walking into a doctor's office.

Prefer a printable version? Download the free PDF guide here.

What testosterone is and what it does

Testosterone belongs to a group of hormones called androgens. Androgens often get labeled as "male," but every body makes them.

Hormones work like messengers. Testosterone delivers its message by docking onto receptors, like a key fitting into a lock. As women, we have those receptors all over our body, including in our brain, muscles, bones, blood vessels, and skin. That's why testosterone plays a role in so many things:

• Libido. Desire, arousal, and sensation. The role with the strongest research behind it.

• Muscle and strength. Building muscle and keeping it.

• Bone. Supports bone density, a bigger priority heading into menopause.

• Energy and motivation. That drive to get up and get things done.

• Mood and focus. Confidence and mental sharpness.

• Estrogen. Your body converts some testosterone into estradiol, your main estrogen.

Testosterone is not the only thing that drives these. Your libido, for example, involves testosterone (and it's important!), but so do your estrogen level, how much stress you're carrying, how you're sleeping, what medications you're on, how you feel about your body, and what's going on in your relationship. None of these come down to just one thing. "Fixing" one hormone is never the whole picture, but it could be part of it.

One honest note: researchers agree testosterone plays a role in all of these. But for testosterone therapy, low libido is the only use backed by current guidelines. The other benefits are still being studied.

Where it comes from

Your body makes testosterone in three ways:

• Your ovaries make about a quarter directly.

• Your adrenal glands make about a quarter directly. These small glands sit on top of your kidneys. They also make cortisol, your main stress hormone.

• Your tissues finish the other half. Your ovaries and adrenals release "starter" hormones, and tissues like fat, skin, and liver convert them into testosterone.

That last part is the one most women never hear about. Testosterone isn't just made in one place and shipped out. Much of it is assembled close to where it's used. It also means your testosterone depends on a supply chain. When your glands send out fewer starter hormones, your tissues have less to work with.

Most of your testosterone is "on hold"

Only a small fraction of your testosterone is available to your cells at any moment. About 80% is tightly bound to a protein called SHBG (sex hormone-binding globulin). Most of the rest is loosely bound to another protein. Only about 1% floats free.

Think of SHBG as a sponge. When SHBG rises, it soaks up more testosterone, and less is available to do its job. That's why some common medications can lower the testosterone your body can actually use.

The slow slide

Estrogen and progesterone get all the attention in perimenopause. They swing hard: spikes, crashes, irregular cycles, hot flashes, sleep changes. That part we can't blame on testosterone.

Testosterone doesn't swing. It slides.

It peaks in your 20s and then declines steadily. Research tracking women by age found that by their 40s, women had about half the testosterone of women in their early 20s.

Why the slide? Both parts of the supply chain slow down. Your ovaries make less, and your adrenal glands make less of a key starter hormone called DHEA as you age. Less raw material means less testosterone.

That also means perimenopause and menopause aren't a cliff for testosterone. Your ovaries keep making some after menopause, unless they've been surgically removed, which causes a sudden drop.

Because the natural decline is slow, it's easy to miss. You don't wake up one day feeling different. You just gradually feel less like yourself, and you blame being busy, tired, or getting older.

What pushes it lower

• Birth control pills. They quiet your ovaries' production and raise SHBG. That's a double hit.

• Oral estrogen. Estrogen pills pass through the liver first, which raises SHBG. Patches and gels have much less of this effect.

• Under-eating. When your body senses fuel is low, especially if you're training hard, it pulls back on hormone production.

• Poor sleep. Your body does a lot of hormone work overnight. Short sleep disrupts it.

• Chronic stress. Ongoing stress keeps cortisol elevated, which is linked to lower sex hormone production.

• Some medications. Opioids and steroid medications can lower testosterone. Spironolactone blocks its effects.

  
  

Why you can't self-diagnose

Low libido. Fatigue. Low mood. Stalled strength. Brain fog. These can come from low testosterone. They can also come from thyroid issues, low iron, blood sugar problems, poor sleep, or depression. Often it's more than one cause. That's why guessing doesn't work. You need the full picture.

Why it's so hard to get tested and treated

If testosterone is that important, why is it so hard to get tested? And why do so many women get brushed off when they ask? Here's what we're up against.

There is no FDA-approved testosterone for women

There are more than a DOZEN brand-name testosterone products for men (plus many generics) across six delivery methods. For women, there are zero.

Providers who do prescribe testosterone for women have to get creative. Sometimes they prescribe a small fraction of a men's product, or they have it compounded. Most insurance plans don't cover it.

Testosterone is also a controlled substance, which puts it in a different legal category than estrogen and progesterone. That classification came about in 1990, when there was a lot of anabolic steroid abuse in bodybuilding. It had nothing to do with women using small, physiologic doses, but it can make testosterone harder to get when it's warranted.

The good news: things are starting to move. On September 17, 2026, the FDA held a public workshop on testosterone use in menopausal women, the first serious public look at this in over 20 years. The FDA called on drug makers, researchers, and insurers to help develop approved options for women.

Medicine moves slowly. Women's hormone research moves slower.

It's commonly understood that it takes around 17 years for research to become routine practice. That means when research shows safety and benefit, it can take almost two decades to become standard care.

And when it comes to testosterone in women, the research itself is thin. Even the FDA acknowledged major gaps: how testosterone affects mood, brain health, and muscle and bone; how to measure it accurately in women; and what long-term use means for heart and breast health.

"Normal" isn't the same as optimal

There is no agreed-upon definition of "low testosterone" in women, and lab ranges vary widely. One major lab lists normal total testosterone for women as 2 to 45 ng/dL. Another lists 8 to 60. One widely used range starts at zero.

Read that again. On some lab reports, having essentially no testosterone is flagged as normal.

Why? Those ranges were largely built to catch too much testosterone, like in PMOS (formerly PCOS). They weren't designed to catch too little. But women's bodies are designed to make testosterone. A number at the bottom of a range isn't the same as a number that's working for you.

Many providers push back

Many providers simply weren't trained on testosterone in women. Current guidelines only support treating low libido in postmenopausal women, so testing can seem unnecessary. Some providers, especially in gynecology and menopause care, are open to testing and treating, but they're the exception more than the rule.

What you can say to your provider:

"I've been experiencing [low libido, fatigue, low motivation, etc.]. From what I've read, these can be linked to low testosterone. I'd like to have my total testosterone, free testosterone, and SHBG tested."

Watch out for the surprise bill

If your provider isn't on board, or your insurance decides the test isn't "medically necessary," you can end up with a surprise bill. I've seen this happen with clients more times than I'd like to admit. They did everything right, went through their provider, and still got stuck with an unreasonable cost.

There's a simpler path. Direct-to-consumer labs let you get tested without needing your own provider to order them or fighting with insurance, and they're often very reasonably priced.

Lifestyle comes first

Testosterone is not a fix for a lifestyle that's working against you.

Women usually start wondering about testosterone because something feels off. Low desire. Low energy. Stalled strength. No drive. Not feeling like themselves.

Those symptoms are legitimate and worth digging into, but they're almost never about one thing. Sleep, stress, how much you're eating, how you're training (or not), your other hormones, your relationships, your mental load. All of it plays a BIG role.

Just like estrogen or progesterone, testosterone works best on a solid foundation. Adding a hormone on top of a lifestyle that isn't supporting your health won't get you where you want to go. It might help a little, but it won't fix what's underneath. As a coach who works with women in this exact situation all the time, I have to shoot you straight.

Even the clinical guidelines say this. They recommend ruling out other factors first, like relationship issues, mental health, and other medical conditions, before starting testosterone. Your doctor should have that discussion with you.

So the question isn't just "Do I need testosterone?" It's "What's the whole picture of my lifestyle telling me?"

What the guidelines actually cover

The current guidelines for testosterone in women are written for one specific use: low sexual desire that causes distress in postmenopausal women. The medical term is hypoactive sexual desire disorder, or HSDD. It's the only use with strong research behind it so far.

That doesn't mean it is or should be the only reason women use testosterone.

Prescribing medications "off-label," meaning for uses beyond their official approval, is very common across medicine. With testosterone, it happens a lot, and many women find it extremely valuable to their quality of life.

The honest truth is that for women, the research just hasn't caught up yet. We don't have large studies on testosterone for energy, mood, muscle, or bone density in women. That doesn't mean it doesn't help. It means we don't have the data, which makes working with someone who knows what they're doing even more important.

How testosterone therapy works for women

The goal: a woman's range, not a man's

Testosterone therapy for women should aim to bring levels back to the normal range for a premenopausal woman. Not higher. Generally, that takes about one-tenth of a typical male dose. But no type of HRT is one-size-fits-all. With testosterone, more isn't better. More usually means more side effects and no additional benefit.

The forms at a glance

• Creams and gels: recommended in current guidelines. Small dose, easy to adjust. Watch out: can rub off onto partners, kids, and pets, and absorption varies.

• Injections: not in guidelines yet. Small doses 2 to 3 times a week can keep levels steady. Watch out: needs a provider who knows female dosing.

• Pellets: not supported by guidelines. Set it and forget it. Watch out: pushes levels far above the female range, and they can't be removed.

• Oral: the least recommended option. Watch out: liver or blood pressure effects, male doses only, and expensive.

Creams and gels

This is what the current guidelines recommend. The dose is small and easy to adjust. One important caution: creams and gels can rub off onto your partner, kids, and pets. If you use this method, wash your hands, let it dry, and keep the area covered. People also absorb creams differently, so this method may not work as well for everyone.

Injections

The guidelines don't currently recommend injections, mostly because they haven't been studied in women at female doses. But small doses given two to three times a week can keep levels steady when they're prescribed by someone who knows how to dose for women.

That's the catch. Many providers only know male dosing, and a female dose is a fraction of that. That's why most providers don't prescribe injections for women. I have worked with many women who prefer injections and do quite well with them, but follow-up labs and dialing in dosing are super important (as with all methods).

Pellets

Ahhh, the pellet. This is the one I want you to really understand.

Pellets are small implants placed under the skin that release testosterone over a few months. They're heavily marketed by med spas and wellness clinics, and they're a big moneymaker. They're also the most expensive way to get testosterone. If your provider is directly profiting off of a medication they're recommending, that's a BIG RED FLAG to me. I have yet to meet a legitimate, evidence-based provider who recommends only pellet therapy.

Here's why they're so popular: a lot of women feel amazing on them. They're set it and forget it, which is so EASY. And most women have nothing to compare it to. Many didn't try other methods first with an experienced provider who worked with them to dial in their dosage.

In one study, women's testosterone four weeks after pellet insertion averaged about 300 ng/dL. The normal female range tops out around 45 to 60. As the pellet wears off, levels drop and symptoms come back. But when women felt their symptoms return and wanted their next pellet, their levels still averaged about 170 ng/dL. That's still significantly higher than normal, and not a level any legitimate provider should be targeting for a woman.

So women can feel like they're crashing when their levels are still sky high. That sets up a cycle of chasing higher and higher levels, which can mean more side effects, some of them irreversible.

Once pellets are in, they can't come out. If side effects show up, you wait. Some of those side effects, like a deeper voice or clitoral enlargement, may not reverse. The international guidelines don't support pellets for women, because they push levels above the normal female range.

And I don't know about you, but that's a big fat PASS for me.

Oral

Pills are the least recommended option for women:

• Older oral forms are hard on the liver.

• Newer oral forms carry a boxed warning for raising blood pressure.

• They have to be taken twice a day with food, and they're expensive.

• They only come in male doses, so they can't be adjusted down to a woman's dose the way a cream can.

How it should be monitored

Every provider has their own way of monitoring, so make sure you understand their process and ask questions. After working with many women on testosterone and helping them partner with their providers, here's what I recommend:

1. Before starting: baseline labs. 100% absolutely necessary, no questions asked.

2. About 6 weeks in: follow-up labs once your body has had time to adjust, to make sure you're in the female range, not above it. A good time to check in on symptoms, though some effects take longer.

3. Ongoing: periodic labs and symptom check-ins every few months while you dial in your dose.

4. At 6 months: reassess. If it's not helping, it's time to rethink the plan.

What's misunderstood

"It'll fix everything." Social media sells testosterone as a cure for fatigue, weight gain, brain fog, and more. It can be one piece of the puzzle. It's not the whole puzzle.

"A blood test will tell me if I need it." A lab number alone can't tell you whether low testosterone is causing your symptoms. It has to be looked at alongside your symptoms, your other labs, and your life.

"It'll make me lose my hair, get acne, or make me aggressive." At appropriate female doses, these are not expected. Problems like hair thinning, acne, and unwanted hair growth show up when levels go too high. Some women are more sensitive, though, and may get breakouts and other symptoms at lower levels.

What to watch out for

• Signs your dose is too high: acne, oily skin, new facial or body hair, scalp hair thinning, or voice changes. Tell your provider right away.

• Transfer: keep creams and gels away from kids, partners, and pets.

• Clinics that lead with pellets before trying or offering anything else. They are GREAT at selling these.

• Not having a good provider partnership. The most important thing is finding a provider, and ideally a coach, who has your best interests and goals in mind. Someone who looks at your whole picture, not just one number. Unfortunately, you're unlikely to find that through insurance-based care, so set your expectations going in.

Where to start

Knowing your numbers is step one. Total testosterone, free testosterone, and SHBG all tell part of the story. Your symptoms, medications, goals, the rest of your lab panel, your current health, and your lifestyle tell the rest. Because low testosterone symptoms overlap with so many other issues, having someone who knows what they're doing assess your labs and lifestyle is so important.

Personalized Lab Insights: your results plus a summary of what's out of range, so you can walk into your appointment with real data to discuss alongside your symptoms.

1:1 Coaching: we look at your labs in the context of your lifestyle, symptoms, and goals, build the foundation that makes any hormone therapy work better, and prepare you to advocate for yourself with your provider. Part of your lab cost can be credited toward a coaching package.

Ready to talk it through? Book a free discovery call. We'll talk about where you are, what you want to change, and whether 1:1 coaching is a good fit.

Want this guide to keep or print? Download the free PDF version here.

Sources

• Global Consensus Position Statement on the Use of Testosterone Therapy for Women (2019)

• ISSWSH Clinical Practice Guideline for the Use of Systemic Testosterone for HSDD in Women (2021)

• EMAS Menopause Essentials: Testosterone (2026)

• Burger HG. Androgen production in women. Fertility and Sterility, 2002.

• Zumoff B, et al. Twenty-four-hour mean plasma testosterone concentration declines with age in normal premenopausal women. Journal of Clinical Endocrinology & Metabolism, 1995.

• Glaser R, et al. Study of serum testosterone levels in women using testosterone pellets.

• FDA public workshop on testosterone use in menopausal women (September 17, 2026)

• Hanney SR, et al. How long does biomedical research take? (the 17-year lag)

• Quest Diagnostics: testosterone testing and female reference ranges

• Reuters: Testosterone scripts for women rise, along with denials and delays (2026)

This post is intended for informational and educational purposes only. It is not a substitute for medical advice and is not intended to diagnose, treat, prevent, or cure any disease. I'm not diagnosing or prescribing. Consult with your healthcare provider before making any changes to your routine or treatment.