Testosterone: It’s Not Just a “Male” Hormone

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Testosterone.

The “male” hormone.

Ummmm. No.

Women produce testosterone too—in the ovaries, adrenal glands, fat cells and skin cells.

Sure, most females produce considerably less testosterone than males. BUT did you know that women actually produce more testosterone than estrogen?

A premenopausal woman produces approximately 80–600 picograms/mL of total testosterone compared with 30–400 picograms/mL of estrogen.

I only bring up these numbers to make a point: While estrogen is incredibly important, we shouldn’t ignore the other hormones that play a role in how our bodies function.

What is the role of testosterone?

Testosterone helps support libido and sexual health. I talked about this earlier when I discussed hypoactive sexual desire disorder (https://www.rx4trauma.com/post/let-s-talk-about-sex-baby-the-truth-about-female-sexual-dysfunction)

Testosterone also helps maintain bone density, muscle mass and red blood cells.

And it plays a role in mood, energy and cognitive function—you know, those things that sometimes seem to get sucked right out of us by everyday life.

A lone silhouette stands against a mesmerizing sunset, her hair gently ruffled by the breeze, immersed in the tranquil hues of purple and pink.

What happens to testosterone in perimenopause?

This is not a straightforward answer.

First of all, perimenopause is basically a plethora of confusion because hormone levels are all over the place. One day they’re normal, the next day they’re down, and then the following week they’re back to where they “belong.”

And it’s not just the actual numbers. It’s also the relationship between the different hormones.

Let’s just say—to quote a very Gen X phrase—things are completely out of WHACK.

While testosterone does decrease as we age, the decline is much more gradual than the dramatic fluctuations we see with estrogen during perimenopause.

Even though the ovaries may become less functional, testosterone and its precursors are still produced by the adrenal glands, although adrenal function also declines as we age.

Sigh.

Getting old sucks some days.

Am I right?

(I am writing this on the eve of turning 50 so you can understand my feelings).

Golden balloons shining brightly in the sun celebrate a 50th birthday milestone.

Do perimenopausal women need testosterone replacement?

That is the billion-dollar question.

And unfortunately, I do not have the billion-dollar answer.

The studies are there but with results are mixed. And a lot of the discussion around testosterone in women is based on anecdotes and symptom relief rather than clear, objective criteria.

Is that a problem?

Not necessarily.

Because how you feel matters.

It should absolutely be taken into account.

It’s not always about the numbers.

Am I right?

There are studies showing that testosterone can improve sexual desire and may have benefits for bone density and other aspects of health, particularly in certain women and in conjunction with hormone therapy.

Yet the FDA has still not approved a testosterone formulation specifically for use in women.

Hey, FDA!

I am woman. Hear me roar!

Pay attention to us and our needs!

More and more physicians are prescribing testosterone off-label, particularly for women experiencing sexual dysfunction.

And honestly, I hope that this growing interest leads to more research—and better answers.

Woman passionately advocating for FDA research on testosterone, highlighting the demand for scientific attention.

So what do I do in my practice?

I will use testosterone for symptomatic relief when symptoms are not adequately addressed by estrogen replacement.

I usually start low and go slow.

When you don’t have great data and there is no FDA-approved formulation for women, you want to tread cautiously while also trying to help.

Is testosterone therapy safe?

This is where things get a little more complicated.

We don’t have long-term data on the safety of testosterone therapy in women.

Short-term studies are reassuring in that they have not shown an increased risk of cardiovascular disease, but we need more—and longer-term—data before we can fully understand the risks.

And, like any medication, testosterone can have side effects.

Some of the more common ones include:

• Acne

• Increased sweating

• Changes in body odor

• Increased facial or body hair

There are also side effects that are more concerning and are usually associated with testosterone levels that are too high:

• Scalp hair thinning

• Voice deepening

• Clitoral enlargement

And some of these changes—particularly voice deepening and clitoral enlargement—may be irreversible.

Which brings me back to why I start low and go slow.

The goal isn’t to give you as much testosterone as possible.

The goal is to find the lowest dose that provides benefit while keeping testosterone levels in a safe range and minimizing side effects.

Because when it comes to testosterone, more is definitely not better.

So what do YOU do now?

Well, if you have low libido that has not improved with hormone replacement therapy, talk to your doctor about whether testosterone might be appropriate for you.

While there is no FDA-approved testosterone formulation specifically for women, we do have evidence that testosterone can help with sexual dysfunction in women.

And if you are perimenopausal and having other symptoms like fatigue or decreased muscle mass, start a conversation with your doctor about what might help.

There is evidence that estrogen can be beneficial, but if you are still not feeling like your whole self, it’s worth exploring what else might be contributing to your symptoms.

Because there is one thing I want women to understand:

You are not just one hormone.

Women join hands in solidarity, advocating for health awareness and empowerment.

We spend so much time talking about estrogen during perimenopause that it can be easy to forget that our bodies are not controlled by one hormone.

Hormones work together.

And testosterone is part of that conversation too.