Testosterone Therapy for Women: What You Need to Know (And Why Most Doctors Miss It)

Testosterone shapes how women feel, function, and age, yet it is the hormone most often left out of the conversation. When levels fall, the effects reach energy, libido, mood, strength, and cognition. Here is what the research shows, why it is so often missed, and how we approach it at The Lamkin Clinic.

Why Women Need Testosterone

Most people file testosterone under men’s health. Women produce it too, primarily in the ovaries and adrenal glands, and it plays a central role in how they feel, function, and age.

Before menopause, women actually produce about three times as much testosterone as estrogen. That ratio shifts with age, and by the time a woman reaches menopause her testosterone may have fallen to roughly half of its earlier level, according to the Cleveland Clinic.

In women, testosterone supports:

• Libido and sexual function. It is a primary driver of sexual desire.
• Mood and mental clarity. Low levels are associated with low mood, difficulty concentrating, and reduced motivation.
• Muscle tone and physical strength. Testosterone is anabolic and contributes to muscle protein synthesis and physical resilience.
• Bone health. Androgens play a role in maintaining bone mineral density, which matters more as women age.
• Energy. Testosterone contributes to mitochondrial function and day-to-day vitality.
• Menstrual cycle and fertility. In younger women, androgen balance influences cycle regularity.

When testosterone falls too low, those systems lose ground, and the change tends to show up in energy, mood, strength, and cognition at the same time.

Symptoms of Low Testosterone in Women

Low testosterone in women is easily attributed to stress, aging, or low mood, which is part of why it goes unaddressed for years. The symptoms are real, and they have a hormonal explanation.

Common signs include:

• Persistent fatigue that does not improve with sleep
• Low or absent sex drive, the most frequently reported complaint
• Difficulty building or holding muscle despite regular exercise
• Brain fog, poor memory, and difficulty concentrating
• Low or flat mood and anxiety that is hard to shake
• Vaginal dryness and discomfort during sex
• Thinning hair or dry, brittle skin
• Disrupted or poor-quality sleep
• Joint pain or general achiness
• Irregular menstrual cycles in premenopausal women
• Loss of motivation and a general sense of not caring about things that used to matter

Testosterone begins its natural decline in the 30s and continues falling with age. The decline accelerates around perimenopause, and women who have had their ovaries removed experience an immediate and significant drop, since removing the ovaries roughly halves testosterone production. (Cleveland Clinic)

Other contributors to low testosterone in women include:

• Oral contraceptive use, which raises sex hormone-binding globulin and lowers free testosterone
• Oral estrogen therapy
• Corticosteroid medications
• Opioid use
• Hypothalamic amenorrhea from extreme stress or overtraining
• Adrenal insufficiency
• Premature or surgical menopause

Why Conventional Medicine Often Misses It

A common scenario in the clinic: a woman arrives having already seen two or three physicians. She has been told her labs are normal. She has been offered an antidepressant. She has been reassured that what she is feeling is stress or age.

The underlying issue is that most standard panels do not measure testosterone in women at all. When it is measured, there is no single agreed-upon reference range for women, so a result that sits technically within range but far from optimal for that individual is easy to pass over.

Timing adds another layer. Testosterone fluctuates across the menstrual cycle and over the course of a single day, so a borderline value taken at the wrong moment gets dismissed without further thought.

This is where a functional approach earns its keep. The goal is not to chase one number. It is to read the full picture: your symptoms, your cycle, your free versus total testosterone, your sex hormone-binding globulin, and how your hormones interact with your thyroid and metabolic health.

What the Research Actually Says

The evidence on testosterone in women has strengthened over the past several years, and it also warrants an honest read.

A 2020 review in the British Journal of General Practice confirmed that testosterone contributes to bone density, muscle mass, cognitive function, mood, sexual function, and energy in women. It noted that a systematic review and meta-analysis of testosterone treatment in women found improvements across several domains of sexual response, including desire, arousal, orgasm, and self-image, with additional reported benefits in psychological and somatic symptoms and bone density when combined with estrogen. (British Journal of General Practice, 2020)

Worth stating plainly: the formal, guideline-endorsed indication for testosterone therapy in women is currently hypoactive sexual desire disorder in postmenopausal women. That is where the randomized-trial evidence is strongest. Benefits for energy, mood, and cognition are supported by observational data and some trials, and major consensus bodies consider the evidence in those areas still developing. (ISSWSH Clinical Practice Guideline)

A study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology: X, accepted in December 2025, reviewed 100 women treated with subcutaneous testosterone pellet therapy over a ten-year period. Among the 78 patients who completed the validated Menopausal Rating Scale before and during treatment, 71 (91 percent) showed meaningful improvement. Median symptom scores fell from 17.0 at baseline to 7.0, with statistically significant improvement across all 11 symptom categories, including sexual problems, depressive mood, vaginal dryness, anxiety, irritability, sleep, and physical and mental exhaustion. Notably, benefit was independent of patient age and of peak testosterone level. (Eur J Obstet Gynecol Reprod Biol X, 2026)

The same study reported the side-effect profile that comes with pellets. Facial hair accounted for over half of side-effect complaints, and acne for most of the remainder. These were managed by lowering the testosterone dose, and, for patients whose symptoms persisted, by adding spironolactone. This is the practical reason dosing and monitoring matter so much: pellets can produce early supraphysiologic peaks, and androgenic effects are dose-dependent.

On safety, transdermal testosterone dosed to keep levels within the female physiological range has a reassuring profile, with no demonstrated adverse effect on blood pressure, kidney, or liver function at those doses. The most common effects across the literature are androgenic, with meta-analysis showing modestly increased rates of acne and hair growth, both dose-dependent and generally reversible. Lower-dose protocols show substantially lower rates. One long-term series of low-dose pellet therapy reported new facial hair in roughly 5 percent of patients and no evidence of erythrocytosis. (Long-term low-dose pellet series) Oral testosterone, by contrast, can affect lipids and is generally avoided.

How The Lamkin Clinic Approaches Testosterone Optimization for Women

We have practiced functional and regenerative medicine since 2007. Done correctly, hormone optimization is not a fixed prescription. It is a protocol built around one patient.

Comprehensive Lab Evaluation

We begin with a full hormone panel that goes well beyond a standard office order. It includes total testosterone, free testosterone, sex hormone-binding globulin, estradiol, progesterone, DHEA-S, thyroid markers, cortisol, and relevant metabolic indicators.

Sex hormone-binding globulin matters because testosterone binds tightly to it, and only the free fraction is biologically active. A woman can have a technically normal total testosterone and still feel unwell because most of it is bound and unavailable to her cells. SHBG itself is influenced by thyroid status, estrogen exposure, and insulin sensitivity, which is why we read it alongside the rest of the metabolic picture rather than in isolation.

Symptom-First Interpretation

Lab values guide the assessment. Your symptoms tell us whether the numbers actually match how you feel and function. Read together, they give a far more accurate account than either one alone.

Individualized Protocol Design

Testosterone for women can be delivered as a low-dose topical cream, as pellets placed under the skin every few months, or as other compounded preparations, and the right choice depends on your history, preferences, and response. Delivery method sits within a broader bioidentical hormone optimization plan when estradiol, progesterone, or DHEA also need attention.

Female dosing follows female physiology. Women reach physiological testosterone levels at a fraction of a male dose, and the protocol is built around that from the start. For men, hormone optimization runs on a different physiology and a different protocol, which we cover under men’s health.

Ongoing Monitoring

We recheck labs at follow-up visits, watch for androgenic effects, and adjust the dose in small increments. Where body composition is a goal, we can track lean mass and fat mass objectively with a DEXA body composition scan rather than relying on the scale, and we fold in nutrition and strength training through our medical weight loss support when appropriate. Getting the dose right, and keeping it right as your body changes, is an ongoing clinical partnership.

What to Expect

Timeline. Many women notice changes in energy, mood, and mental clarity within the first few weeks. Libido and sexual function often improve over the following one to three months. Changes in muscle tone and body composition take longer, usually several months of consistent treatment paired with appropriate nutrition and strength training.

Side effects. The most common are acne and fine facial hair. They are dose-dependent and generally reversible, and we manage them by keeping levels within the female physiological range and adjusting the dose. Voice change and other pronounced androgenic effects are rare at physiological dosing and are not the expected course of well-monitored care.

What it is. The aim is restoration of what has declined, giving your body the hormonal environment it needs to function well. It is a clinical process that unfolds over months, with dosing kept in the female range rather than pushed toward male levels.

Frequently Asked Questions

Is testosterone therapy safe for women?

At physiological doses and with proper monitoring, current evidence supports the safety of testosterone therapy in women. Transdermal delivery dosed to female physiological levels has not shown adverse effects on blood pressure, kidney, or liver function. The most common effects are androgenic, chiefly acne and fine facial hair, and they are dose-dependent and generally reversible with adjustment. As with any hormone therapy, ongoing monitoring is part of the protocol, and the decision is made collaboratively based on your individual health history.

Will testosterone therapy make me look or sound more masculine?

Pronounced effects such as voice deepening are rare and are not seen with physiological dosing across the literature. The common androgenic effects are acne and fine facial hair, which are dose-dependent and reversible, and lower-dose protocols reduce their frequency considerably. Appropriate dosing and regular monitoring keep levels within the female physiological range, which is central to how we run these protocols.

Do I have to be in menopause to benefit from testosterone therapy?

No. Women in their 30s and 40s who are still cycling can also have low testosterone, particularly on hormonal contraceptives, under significant stress, or with adrenal or ovarian issues. If your symptoms fit, your labs warrant it, and your clinical picture supports it, testosterone optimization may be appropriate regardless of your stage of life.

How is testosterone different from estrogen therapy?

Estrogen therapy addresses symptoms such as hot flashes, vaginal dryness, and some mood shifts. Testosterone works on libido, energy, muscle, cognitive sharpness, and motivation, areas that estrogen alone often does not fully reach. Many women do best with both as part of a comprehensive hormone optimization plan.

How do I know if I need testosterone therapy?

The way to know is a thorough clinical evaluation with proper lab testing. A symptom checklist is a starting point, not a conclusion. The symptoms of low testosterone overlap with thyroid dysfunction, low iron, and sleep disorders, which is why a complete workup matters before starting therapy.

Find Out Where Your Levels Stand

If persistent fatigue, low libido, brain fog, or mood changes have not been explained, your hormones may be part of the answer. Testosterone is one of the most overlooked measures in women’s health, and we evaluate it seriously. We have helped women across Edmond, Oklahoma City, and beyond get real answers through individualized hormone optimization.

Request an appointment at The Lamkin Clinic

Written by Brian Lamkin, DO, founder of The Lamkin Clinic in Edmond, Oklahoma. Dr. Lamkin has practiced functional and regenerative medicine since 2007, with a focus on hormone optimization, longevity, and individualized patient care. This article is educational and is not a substitute for a clinical evaluation.