Why women need testosterone
Testosterone in women is produced by the ovaries and adrenal glands, about 1/10th the amount men produce. It plays critical roles in libido, mood, energy, lean mass, bone density, cognitive function, and assertiveness. The Glaser et al. work and Davis et al. studies established testosterone as a legitimate component of female hormone health, not just a male hormone borrowed.
When and why it declines
Female testosterone peaks in the mid-20s and declines steadily, about 50% by age 50. Surgical menopause (oophorectomy) drops levels acutely. Chronic stress, oral birth control, and chronic illness can suppress production further.
Documented benefits
For women with documented low testosterone and symptoms, supplementation produces:
- Restored libido, most researched effect; well-supported by RCTs in postmenopausal women
- Improved energy
- Better mood, particularly assertiveness and motivation
- Lean mass preservation, supports muscle maintenance with HRT
- Bone density support
- Improved cognitive sharpness
- Possible cardiovascular benefits
Safe dosing
| Form | Typical dose | Notes |
|---|---|---|
| Transdermal cream | 0.5-5 mg/day | Most common; easy to titrate |
| Sublingual troches | 0.25-1 mg/day | Steady delivery |
| Pellets (subcutaneous) | 50-100 mg every 3-4 months | Long-acting; less flexibility |
| Compounded vaginal cream | 0.1-0.5 mg/day | For libido + GSM |
Doses are 1/10th to 1/20th of male TRT doses. The goal is restoring the upper end of the female reference range, not exceeding it.
Side effects
At appropriate doses, side effects are uncommon. At supraphysiologic doses (above the female reference range):
- Acne, oily skin
- Mild hirsutism (facial hair), slow-developing
- Voice deepening (rare and avoidable with proper dosing)
- Clitoral enlargement (rare)
- Hair loss in genetically susceptible women
The first three are typically reversible if caught early. The single best protection is appropriate dosing under physician supervision with regular lab monitoring.
Testing
Standard female testosterone reference ranges: 8-60 ng/dL total; 0.3-1.0 ng/dL free. Optimal target on therapy: total T 30-70 ng/dL, free T 0.5-1.0 ng/dL. Calculated free T (using SHBG) is more reliable than direct measurement.
The clinical pearl: Low female testosterone is one of the most under-treated hormone deficiencies in women's medicine. Most GPs don't test for it, and many don't know it's part of comprehensive HRT.
Bottom line
Testosterone is a legitimate, well-studied component of women's hormone health. At appropriate doses (a fraction of male TRT), it restores libido, energy, mood, and lean mass without meaningful side effects. The challenge is finding a clinician who tests for it, doses it correctly, and integrates it with the rest of HRT. Women's hormone optimization is incomplete without addressing testosterone where indicated.