Testosterone in women: the hormone nobody ever talks about (yet essential)

When people talk about female hormones, two names always come up: estrogen and progesterone. Testosterone, for its part, stays in the shadows, associated in the collective imagination with beards, muscles and male testosterone. Yet your body produces it every day, and it plays a real part in your balance. In quantity, it is even one of the most abundant androgens in a woman's blood.

This silence has a concrete consequence: many women do not know that this hormone exists in them, that it declines with age, and that it is the subject of serious research. But beware: a great many excessive promises also circulate around it (energy regained, muscles, cast-iron morale). In this article, we sort things out, clearly distinguishing what is proven from what is not.

Testosterone, a female hormone too

Let us start by dismantling the myth. Testosterone belongs to the family of androgens, often called "male hormones". But that classification is misleading: a woman's body makes it and needs it. Two main sources are at work, the ovaries and the adrenal glands (located above the kidneys), to which is added "peripheral" production from other hormonal precursors in the tissues.^[5]

The concentrations are far lower than in men, but that does not make them trivial. For a long time, the difficulty was measuring these low levels precisely. Modern assay techniques (such as mass spectrometry) have made it possible to establish more reliable reference values, and to observe that levels vary with age and even over the course of the menstrual cycle.^[4] In other words, there is no universal "right number": interpreting a measurement depends on each woman's age and context.

What it really does in your body

Testosterone takes part in several physiological functions in women. It contributes notably to sexual function (desire, arousal), and it interacts with other hormonal systems. Some of the testosterone is, moreover, converted into estrogen in the body, which shows how much these hormones work together rather than in sealed silos.^[5]

This is where we have to be honest. You often read that testosterone is "the hormone of energy", "of muscle" or "of self-confidence" in women. These appealing ideas rest mainly on extrapolations from men, or on individual impressions, not on solid evidence. The real physiological role of testosterone in women remains, on many points, still incompletely understood.^[5] We come back to this below, because this distinction between "plausible" and "proven" is at the heart of the subject.

The decline with age: a gentle slope, not a cliff

Unlike estrogen, which falls quite markedly around menopause, testosterone follows a different trajectory. Its levels decrease gradually with age, and this decline begins early, from the thirties onwards, continuing slowly over the years.^[4] It is more a gentle slope than a cliff.

An important point: menopause in itself does not cause an abrupt collapse of testosterone, unlike what happens with estrogen. So a woman of 50 has, on average, lower testosterone levels than at 25, but that fall is mainly explained by age, not by periods stopping.^[4][5] This nuance matters: it explains why a simple blood measurement is not enough, on its own, to decide on a treatment.

What studies prove (and what they do not prove)

Here is the heart of the article. Faced with all the promises in circulation, what does good-quality science, that of randomized trials and the syntheses that pool them, really say?

Libido: yes, a real but modest effect

This is the only area where the evidence is solid. A large meta-analysis published in The Lancet Diabetes & Endocrinology, bringing together the data from dozens of randomized trials, concluded that testosterone significantly improves sexual function in postmenopausal women: more satisfying sexual episodes, more desire, more orgasms and less distress related to sexuality.^[2] Another meta-analysis focused on testosterone patches in postmenopausal women with hypoactive sexual desire disorder (HSDD) confirms this improvement.^[3]

These results are important, but two clarifications are needed. First, the effect is real but moderate: it is not a spectacular transformation. Second, it concerns mainly postmenopausal women with a drop in desire that bothers them, not the general population nor younger women, for whom the data are insufficient.^[1]

Energy, muscle, mood, memory: insufficient evidence

This is where public discourse strays furthest from the data. The 2019 international consensus (signed by the main learned societies in menopause and endocrinology) is unambiguous: the only evidence-based indication is sexual desire disorder. For everything else, the data are insufficient.^[1]

In concrete terms, the experts find that there is not enough evidence to recommend testosterone with the aim of improving general well-being, mood (including depressed mood), cognitive performance or memory.^[1] Likewise, at so-called "physiological" doses (close to what the female body produces naturally), no significant effect has been reliably demonstrated on muscle mass, fat mass or strength.^[1] That does not necessarily mean that testosterone has no effect at all on these aspects: it means that current studies do not allow us to assert it, often because they are too few or too small. In science, absence of evidence is not evidence of absence, but neither is it a licence to promise.

Caution: no approved form, always a medical decision

An essential point, often passed over in silence: in many countries, no testosterone product is officially approved for women. When testosterone is prescribed in this setting, it is generally done "off-label", using forms originally designed for men, aiming at doses adapted to the female body.^[1][6]

This situation calls for several precautions. International guidelines formally advise against forms that lead to excessively high levels, such as certain implants (pellets) or injections, because they expose women to supraphysiological concentrations and to side effects.^[1][6] Likewise, "bioidentical" preparations compounded to order in a pharmacy, with no rigorous dose control, are not recommended.^[6]

The possible side effects are generally linked to excess: acne, increased hair growth. At physiological doses and over the short term, trials have not shown serious effects, but long-term safety data remain limited.^[2] In other words: testosterone in women is neither a miracle product nor a danger to run from. It is a treatment to be considered, in a precise setting, only with a doctor, with follow-up and regular measurements. Never as self-medication.

In conclusion

Testosterone deserves better than its status as the forgotten hormone. It is indeed female, it declines gently with age, and it has a real physiological role. But between "essential hormone" and "miracle solution" there is a world of difference. Science is clear on one point: in postmenopausal women with a desire disorder, it can bring a moderate but real benefit. For energy, muscle or morale, the evidence is lacking and, caution obliges, no form is approved in many countries.

So the best reflex remains a conversation with a health professional, able to place your symptoms back in the overall picture of your hormonal balance, rather than betting on a single hormone. That global view is precisely what we stand for at VivanaFem: understanding before acting.

⚠️ This article is provided for informational and educational purposes only. It does not replace medical advice, diagnosis or treatment. Always consult your doctor or a qualified health professional with any questions about your health.

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