Testosterone for Women: The Most Underdiagnosed Hormone in Female Medicine

Ask any woman over 40 if she has ever had her testosterone checked. Most will say no. Ask her doctor why, and the answer will usually be some version of: "That's a male hormone."

It is not. Testosterone is a woman's hormone too — and it is the one we are most likely to ignore. By a wide margin. Of women diagnosed with HSDD (low sexual desire that causes distress), only about 2.5% receive a testosterone prescription. There is, to this day, not a single FDA-approved testosterone product for women in the United States. Despite that, off-label prescribing has grown 15-fold between 2015 and 2025 — driven not by guidelines, but by women who finally found a clinician who would listen.

Women produce testosterone in the ovaries and adrenal glands throughout their lives. Levels peak in the 20s and decline steadily — so that by menopause, a woman has roughly half the testosterone she had at 20. This is not a side detail of menopause. It is part of the hormonal landscape that shapes how a woman feels every day.

When testosterone is optimized, women report:

• Clinical Note: Sexual desire and arousal — the only indication recognized by the global consensus position statement, with strong meta-analysis support.
• Clinical Note: Energy and motivation — the British Menopause Society explicitly extends testosterone to women experiencing fatigue alongside low desire.
• Clinical Note: Lean muscle and bone density — combined estradiol + testosterone increases hip and lumbar bone density more than estradiol alone.
• Clinical Note: Mood and cognition — a 2024 pilot study reported improvements in mood (47%), cognition (39%), and libido (52%) after four months of transdermal testosterone.

The data has caught up with what women already know about their own bodies. The current major position statements:

• Clinical Note: Global Consensus Position Statement (Endocrine Society, NAMS / Menopause Society, IMS, ISSWSH) — testosterone is evidence-based for HSDD in postmenopausal women; transdermal route preferred; physiologic premenopausal range targeted.
• Clinical Note: British Menopause Society (July 2024) — supports testosterone when HRT alone has not resolved low desire, fatigue, or both, and reaffirms the safety of physiologic dosing.
• Clinical Note: NICE (UK, 2024) — testosterone "can be considered" if HRT alone hasn't resolved low desire.
• Clinical Note: NAMS Practice Pearl (2024) — off-label use of male formulations at roughly one-tenth the male dose is considered acceptable; compounded pellets are not recommended due to safety and efficacy data gaps.

Most women who turn out to have low testosterone do not walk in saying "I think my testosterone is low." They walk in with a constellation of symptoms that have been brushed off for years:

• Clinical Note: Sexual desire that has flatlined despite a happy relationship.
• Clinical Note: Fatigue that is more "lack of drive" than "lack of sleep."
• Clinical Note: Difficulty building or holding muscle, even with the same workouts that used to work.
• Clinical Note: Mood that has become flatter, less ambitious, less her.
• Clinical Note: Word-finding and short-term memory glitches.
• Clinical Note: Decreased confidence and competitiveness — the social signal a lot of women miss until it's gone.

If three or more of these sound familiar, testosterone deserves to be on the lab order — not a quiet assumption.

Whichever route is used, monitoring matters: baseline plus 3–6 week total testosterone, SHBG, and lipids. If androgenic signs (acne, hirsutism) appear, the dose comes down.

Mainstream medicine still hesitates on testosterone for women. Here is what the data actually says:

• Clinical Note: "It will masculinize you." Not at physiologic doses. The whole point of monitoring is to keep levels in the female range.
• Clinical Note: "It causes hair loss." No causal evidence at proper dosing.
• Clinical Note: "It increases breast cancer risk." A 9-year retrospective cohort of 2,377 women on testosterone reported a 35.5% lower rate of invasive breast cancer versus the SEER population average.
• Clinical Note: "It hurts the heart." Transdermal testosterone has shown no cardiovascular signal in meta-analyses.
• Clinical Note: "There's no long-term data." True for cognition and bone as primary endpoints — but plenty of secondary data, and a growing body of clinical experience.

Testosterone is not a trend in our practice. It is a routine part of how we evaluate hormonal health in women, alongside estradiol, progesterone, thyroid, and metabolic markers.

Our approach:

• Clinical Note: Comprehensive labs — total and free testosterone, SHBG, DHEA-S, estradiol, progesterone, thyroid panel, lipids, fasting insulin.
• Clinical Note: Symptom and sexual-function review — this is a clinical diagnosis, not a number-on-a-page diagnosis.
• Clinical Note: Transdermal-first protocols — compounded cream dosed to physiologic range, with re-testing at 6 weeks.
• Clinical Note: Re-evaluation every 8–12 weeks — adjusting dose, route, or formulation as your body and your goals tell us what is working.

If you have been brushed off, told it's "just menopause," or never had testosterone tested at all — this is the conversation worth having.