Testosterone

By Sophora Health Editorial Team  ·  Medically reviewed  ·  Published July 2026  ·  Last reviewed July 2026

Here is the hormone that women are almost never told about until they go looking for it themselves. Testosterone, specifically. The one described as a male hormone so reflexively that most people have forgotten women have it too. Which is quite the oversight, given that in your 20s and 30s you produce three to four times more of it than oestrogen. Women produce testosterone in their ovaries, adrenal glands, and brain. It has receptors from your brain to your bones to your bladder. And when it declines, which it does gradually across your whole adult life rather than suddenly at menopause, you tend to feel it in places that nobody connects to a hormone.

What does testosterone actually do in women?

What testosterone is running

Libido and sexual function

This is the one most people know about, and the one that gets the most clinical attention. Testosterone is the primary hormonal driver of sexual desire in women. It influences whether you want sex, how responsive your body is, how easily aroused, and how much pleasure you feel. When testosterone falls, desire tends to go quiet in a way that is different from simply not being in the mood. It is more like the signal is not arriving at all. The interest that used to arise without effort stops arising. Some women describe it as the radio going off. The station is still there. The receiver has gone quiet.

Energy and motivation

Testosterone plays a significant role in cellular energy production and in the brain circuits that generate motivation. The fatigue that comes with low testosterone is distinct from the fatigue of poor sleep or oestrogen decline. It has a particular quality: tasks that used to feel energising feel flat. Projects that used to matter feel effortful to start. The drive that pushed things forward has reduced. Women often describe this as losing their edge, or feeling like a slightly diluted version of themselves, without being able to point to why. They are working just as hard. Caring just as much. But the fuel behind it has reduced. That is testosterone.

Muscle mass and physical strength

Testosterone is anabolic: it builds and maintains muscle tissue. This matters during perimenopause and menopause for several compounding reasons. Muscle mass declines naturally with age. Oestrogen decline also contributes to muscle loss. And declining testosterone means the body becomes less efficient at building muscle in response to exercise. Women who notice that exercise stopped producing the same results, that they are working just as hard but the body is changing anyway, are often experiencing this triple effect of age, oestrogen, and testosterone all reducing at once. It is not that exercise stopped working. It is that three things that supported the results have all handed in their notice at the same time.

Brain function and mood

Testosterone strengthens neural connections in the brain and regulates serotonin uptake. It also supports blood flow to brain tissue. When it falls, some women notice a fogginess that is slightly different from oestrogen-related brain fog. It is less about forgetting words and more about reduced mental sharpness, reduced clarity of thought, and a low-grade flatness in mood that does not quite qualify as depression but does not feel like themselves either.

A real-world audit of 510 women given testosterone alongside their existing HRT found the biggest improvements were not in libido but in mood and anxiety-related symptoms. 56% reported improvement in loss of interest in most things. 55% reported improvement in crying spells. 52% reported improvement in sex drive. Mood and libido improved to a similar degree, which surprised many clinicians who expected libido to lead.

Bone density

Testosterone contributes to bone density independently of oestrogen. This adds another layer to the bone health conversation during the menopausal transition. Most people hear about oestrogen and bone loss. Testosterone’s role is real but rarely discussed, particularly because it is harder to separate the two effects in clinical settings where both are declining simultaneously.

When does testosterone decline, and does menopause make it worse?

Here is where the honest answer is more nuanced than the social media version.

Testosterone declines gradually across your reproductive life, by about 1 to 2% per year from your early 30s onwards. By the time menopause arrives, levels may already be roughly half of their peak. A 2026 study published in The Lancet found that testosterone does not drop sharply at perimenopause the way oestrogen does. It follows a slow, age-related decline rather than a menopause-specific crash.

However, and this matters, there are important exceptions. When the ovaries are removed surgically, testosterone can fall by up to 50% acutely because the ovaries are a significant source of testosterone production. Women who have had surgical menopause experience a much more abrupt testosterone decline than those going through natural perimenopause, and this is clinically relevant when planning their hormone care.

Perimenopause itself does not dramatically accelerate testosterone decline in most women, but it does change the hormonal context in which testosterone operates. As oestrogen and progesterone fluctuate and decline, the relative balance shifts, and symptoms that were manageable may become more noticeable even without testosterone itself falling further.

Testosterone is not the hormone that crashes at menopause. It is the hormone that has been declining since your early 30s. By the time you notice it, it has been going for a while.

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What the evidence actually says about treatment

This is the part where honesty matters most, because the online conversation about testosterone in menopause ranges from carefully evidenced to enthusiastically fictional.

What is well-evidenced: testosterone therapy improves low libido in postmenopausal women. This is the most robustly demonstrated benefit, supported by multiple randomised controlled trials and acknowledged by the Global Consensus Position Statement on the use of testosterone in women. The International Society for the Study of Women’s Sexual Health has also endorsed this use. It works. There is good evidence for it.

What is less certain: the benefits for energy, cognition, mood, muscle mass, and brain fog that many women and clinicians report are real in clinical practice but not yet supported by the controlled trial data that regulators use for formal approval. The International Menopause Society notes that current evidence does not support recommending testosterone for these symptoms at a population level. Which is probably true at the level of large randomised controlled trials. But the 510-woman audit showing mood as the biggest improver suggests the formal evidence is lagging behind what is actually happening in consulting rooms. This is an active area of research and the picture is likely to sharpen in the next few years.

What to take from this practically: if low libido is a specific complaint, testosterone has solid evidence behind it and is worth raising with your doctor directly. If the complaint is more diffuse, flat mood, loss of drive, reduced sharpness, it is worth raising testosterone alongside oestrogen and progesterone in the conversation, with the honest acknowledgement that the evidence is less definitive for those symptoms but real-world experience is broadly positive.

How testosterone is prescribed

There is no testosterone product specifically licensed for women in the United States. Treatment is prescribed off-label, typically as a transdermal gel or cream applied to the skin at doses approximately one tenth of those used in men. In the UK, Testogel and AndroFeme are available for women off-label. The goal is to restore testosterone to the upper end of the normal female range, not to the male range. Supraphysiological doses, the high-testosterone approaches promoted by certain corners of the wellness world, are outside evidence-based practice and carry side effects including acne, facial hair, voice changes, and clitoral enlargement that are not always reversible. This is not a theoretical risk. It is a documented one. More is not better here.

Testosterone is almost always considered after oestrogen has been optimised, not instead of it. Many symptoms attributed to low testosterone turn out to improve when oestrogen is properly addressed first. Testosterone is the next conversation, not the first one.

What about testing

There is no universally agreed blood level that defines testosterone deficiency in women. Unlike oestrogen testing, where reference ranges are at least broadly established, the definition of low testosterone in women varies between labs and between clinicians. Symptoms alongside laboratory results are what guide decisions, not a threshold number.

Testing is most useful for monitoring once treatment has started, to confirm levels are within the normal female range rather than drifting somewhere inadvisable. It is less useful as a standalone diagnostic tool, because there is no agreed threshold that defines low testosterone in women. Which is one of many ways the research into women’s hormonal health has room to improve.

Not the same experience everywhere

Testosterone levels vary by ethnicity in ways that affect both baseline experience and treatment context.

SWAN data found that Hispanic women had lower unadjusted testosterone levels than other ethnic groups during the menopausal transition, while DHEAS, the precursor hormone that converts to testosterone, was highest in Chinese and Japanese women and lowest in African American and Hispanic women. The Multiethnic Cohort Study found that Native Hawaiian women had the highest mean testosterone levels of all groups studied, followed by Japanese Americans, Whites, African Americans, and Latinas.

These differences are not well-reflected in clinical guidelines developed primarily in white Western populations. What they mean practically is that baseline testosterone levels vary, the decline looks different across ethnicities, and the threshold at which symptoms appear may differ between women in ways that a single reference range cannot capture.

Access to testosterone treatment varies dramatically by geography. In many countries it is not available at all. In others it is available but only through private prescriptions that many women cannot afford. In some communities, the conversation about sex drive, energy, and hormonal health in midlife women is culturally suppressed, meaning low testosterone goes undiagnosed and untreated not because the biology is different but because the conversation has never been allowed to happen. The biology is the same. The silence is not.

When to raise it with your doctor

If the symptoms you are experiencing include low or absent libido, persistent fatigue that has not improved with oestrogen and progesterone management, flat mood, loss of motivation, and reduced mental sharpness, testosterone is worth raising specifically. The most useful thing you can say is: “I have addressed oestrogen and progesterone, these specific symptoms are still present, and I would like to discuss whether testosterone is appropriate for me.”

Sophora’s Doctor Prep document can help you put your symptom pattern into clear, organised language before that appointment so you arrive with a specific, well-framed question rather than a general sense that things are still not right.

Questions you are probably asking

Do women really need testosterone?

Yes. It is not a male hormone that has strayed into the wrong body. Women produce it throughout their lives, in quantities three to four times greater than oestrogen in younger years, and it drives multiple systems that affect quality of life. The fact that it has historically been described primarily as a male hormone reflects a research gap, not biology.

Will testosterone give me facial hair or a deeper voice?

At the low physiological doses used for women, these side effects are uncommon but possible. They are more likely with high doses or supraphysiological preparations. Any prescribing clinician should monitor for these and adjust dose accordingly. This is one reason why compounded high-dose testosterone preparations sold without medical supervision carry real risks.

My doctor says there is no evidence for testosterone in menopause. Are they wrong?

They are partly right and partly out of date. The evidence for libido is now strong and recognised by international menopause societies. The evidence for mood, energy, and cognition is real in clinical experience but not yet fully established in controlled trial data. A clinician who is not across the current evidence may be working from information that has since been updated. It happens. Asking specifically about the Global Consensus Position Statement on testosterone in women is a reasonable way to move the conversation forward without making it awkward.

Should I try testosterone before HRT?

No. Oestrogen is optimised first. Many symptoms attributed to low testosterone improve when oestrogen is adequately replaced. Testosterone is the next step after oestrogen, not a replacement for it.

Someone important to you needs this too.

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Testosterone is not the hormone that crashes at menopause. It is the hormone that has been declining since your early 30s. By the time you notice it, it has been going for a while.

Last reviewed: July 2026  ·  Review due: September 2026  ·  Not therapy. Not medical advice. For your own use and understanding only.  ·  mysophora.com