The Hormone Nobody Told Women They Were Supposed to Have

At some point in your late 40s or early 50s, something can shift in a way that's hard to describe and even harder to explain to a doctor in a ten minute appointment. It's not exactly sadness or exhaustion, it's more like someone quietly turned your volume down. You're showing up, you're functioning, and life on paper looks fine. But the drive and motivation are gone, and you stop feeling like yourself without being able to point to a single reason why.

A lot of women I talk to have been here. A lot of them have been told it's stress, or getting older, or depression. A lot of them have ended up on antidepressants that helped a little but never quite got them back to themselves. And a surprising number of them have never had a conversation with their doctor about testosterone.

That last part is what I want to talk about today, along with everything I've learned and wish someone had laid out for me clearly before I spent years figuring it out the hard way.

What Testosterone Actually Does in a Woman's Body

Testosterone is not just a male hormone. Women actually have more testosterone in our bodies than we have estrogen. If you measured both hormones in the same unit, testosterone would be the higher number. Your body cannot make estrogen without first making testosterone. It is technically our dominant sex hormone and we have been almost entirely left out of the conversation about it for decades because women were not mandated to be included in pharmaceutical research until the mid 1990s.

When testosterone drops, which it does gradually throughout your 30s and more significantly around perimenopause and menopause, the effects are not limited to your sex drive. Testosterone works in your brain, not just your reproductive system. 

Here is what low testosterone can actually look like in women:

• Persistent low energy that sleep doesn't fix
• Loss of motivation and drive
• Difficulty building or maintaining muscle despite consistent exercise
• Mental fogginess
• Mood flatness
• Loss of libido that goes beyond just not being in the mood

Around 60% of women going through menopause say they don't feel like themselves anymore, and because these symptoms can look so much like depression from the outside, many women end up on antidepressants when what they actually needed first was a hormone conversation.

What You Need to Know About the Blood Test

This is where a lot of women get tripped up and walk away thinking everything is fine when it isn't. Women have about 10% of the testosterone that men have, which means standard blood tests are often not built to measure in the right range for women. You can go in, get tested, be told your levels are normal, and that test may have genuinely not been measuring accurately. 

Ask specifically for a testosterone test designed to measure women's levels and be direct with your doctor about why you're asking. There is also no magic number that tells you definitively whether you need it. The conversation should be about your symptoms and what has shifted from your personal baseline, not just a number on a lab report. The test gives you a useful starting point, but your symptoms tell the full story.

Why Your Doctor May Never Have Brought This Up

There are no FDA approved testosterone products specifically for women in the United States. A testosterone patch for women was studied, the data showed it worked, and the FDA still said no. 

In Australia there has been one approved for women since 2020. Here, when your doctor prescribes testosterone it is off label. That is completely legal and happens all the time, but most women are never told this going in. And because there is no approved product, many doctors simply never bring it up. 

It is entirely possible to be on hormone therapy for years and never once have a testosterone conversation. Most doctors also recommend getting stable on estrogen and progesterone first and then adding testosterone separately if needed, so the sequencing matters too.

The Delivery Options and What to Know About Each

The most common approach is using a small percentage of a male testosterone gel, roughly one tenth of the male dose, applied to the skin daily. It is relatively affordable, the dose is adjustable, and it is absorbed well through the skin. You apply a pea sized amount to an area like the back of the calf or inner arm, let it dry before getting dressed, and alternate sides. This is the most flexible option because if something feels off, the dose can be adjusted easily.

Compounded creams are available through compounding pharmacies and work in essentially the same way at a lower cost, often around sixty dollars for a ninety day supply.

Pellets are inserted under the skin and release a higher dose up front. The significant downside is that they are not removable. If your levels get too high or you experience side effects, you cannot adjust and you have to wait it out. Most doctors who specialize in this area recommend knowing you can tolerate testosterone in a lower adjustable dose before ever considering pellets as an option.

Side Effects

Side effects like voice changes, unwanted facial hair, and breakouts are real but they happen when levels get too high. At the right dose they are rare. The important thing is regular blood work so your doctor can monitor your levels and adjust if anything shifts. This is not a one and done conversation. Ongoing monitoring is part of doing this responsibly and it's worth building that expectation in from the start.

What to Actually Say to Your Doctor

Ask specifically about testosterone, not hormones generally. Many doctors default to the estrogen and progesterone conversation and testosterone never comes up unless you bring it up. 

Ask for a testosterone test that measures women's levels and ask about your symptoms directly and describe what has changed from your baseline. If your doctor doesn't know how to have this conversation or dismisses it, that is useful information. You are allowed to find a doctor who takes it seriously and there are provider search tools available to help you do that.

The research on testosterone and libido in postmenopausal women is actually strong enough that there is global agreement among major medical organizations that it helps, which Dr. Kelly Casperson has said it is rare because we don't agree globally on almost anything. 

The research on energy, muscle, mood, and brain fog is compelling and the doctors working in this space say they see it every day, even if the major organizations haven't officially stamped those benefits yet. Given how long women have been understudied, you can draw your own conclusions about why that might be.

You deserve to have this conversation and you deserve to feel like yourself again.

Listen to Testosterone 101: Everything You Need to Know in 20 Minutes here or you can watch it here.

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