Testosterone in Women: The Hormone We Don't Talk About Enough
When we talk about women’s hormones, we usually talk about oestrogen.
Maybe progesterone gets a mention too.
Testosterone?
That's usually filed under “male hormone” and left there.
But women produce testosterone too.
And as a woman and a fitness professional working with women through midlife, I think it's worth understanding what testosterone actually does — and, just as importantly, what it doesn't do.
Because there's a lot of noise online about “low testosterone”, hormone testing and testosterone replacement.
And, as always, I'd rather we looked at what the evidence actually tells us.
Women need testosterone too
Women produce testosterone primarily through the ovaries and adrenal glands.
And despite being present at much lower levels than in men, testosterone is a normal part of female physiology.
It has roles in several areas of health, particularly sexual function, and it interacts with the systems involved in muscle and bone health.
But here's the bit that's important: Testosterone isn't simply the female version of a male hormone. And it isn't a magic midlife hormone that needs “optimising”.
What happens to testosterone during menopause?
This is where things get interesting.
Oestrogen changes dramatically during the menopausal transition.
Testosterone is different.
It generally declines more gradually with age, and the amount and timing of change varies considerably between women.
So if you're in your 40s or 50s and suddenly feeling tired, weaker or noticing changes in your body composition, it isn't automatically because your testosterone has “crashed”.
There are lots of possible reasons.
And that's why I get slightly nervous when I see women being encouraged to diagnose themselves from a hormone panel.
Testosterone and libido
This is probably the area where the evidence for testosterone in women is strongest.
Testosterone plays a role in sexual desire and function.
For appropriately assessed postmenopausal women with hypoactive sexual desire disorder (HSDD), testosterone therapy can provide a moderate improvement in sexual wellbeing.
But low libido is not automatically a testosterone problem.
Stress, poor sleep, mood, relationship issues, medication, pain, vaginal symptoms and other menopause-related changes can all affect sexual desire.
So, if your libido has changed, the answer isn't necessarily: “I need testosterone.”
It may be: “I need to understand what's going on.”
What about muscle and strength?
This is the part that particularly interests me as a PT.
Testosterone and other androgens have roles in maintaining muscle. If a woman in her 40s or 50s loses muscle or strength, it's very tempting to blame hormones. But there are plenty of other factors.
Maybe she's doing less resistance training.
Maybe she's stopped challenging herself with heavier loads.
Maybe she's eating less protein than she needs.
Maybe she's sleeping badly.
Maybe she's under a lot of stress.
Maybe she's simply getting older.
Usually, it's not one single thing but here's the really positive bit: You can do something about many of these factors.
This is why I keep banging on about strength training
You don't need to manipulate your hormones to make your muscles stronger.
You need to give your muscles a reason to adapt.
That's what progressive resistance training does, and the benefits of getting stronger go way beyond having more defined arms.
Strength supports:
Muscle mass
Bone health
Balance
Mobility
Metabolic health
Physical resilience
Running and sporting performance
Everyday function
Independence as you get older
This is why I'm such a big believer in women lifting weights as they move through midlife.
Not because I want every woman to become a powerlifter.
But because I want women to be strong enough for their lives.
Strong enough to carry the shopping.
Strong enough to lift a suitcase.
Strong enough to get off the floor.
Strong enough to keep running, hiking, travelling, playing and doing whatever makes life enjoyable.
That's much more important to me than chasing a particular number on the scales.
What about bone health?
Hormones are part of the bone-health picture, but testosterone isn't a magic answer here either.
Current evidence doesn't support prescribing testosterone simply to increase bone density or prevent fractures; again, I'd come back to the fundamentals.
Lift weights.
Include weight-bearing or impact exercise where appropriate.
Eat a nutritious diet.
Get adequate calcium and vitamin D.
Don't smoke.
Keep alcohol within sensible limits.
And, where appropriate, get your bone health assessed.
It's not particularly sexy advice. But it's the stuff that matters.
“Low testosterone” isn't the answer to everything
This is probably the biggest myth I'd like to challenge. You will find plenty of information online telling women that low testosterone causes:
Fatigue
Brain fog
Weight gain
Low mood
Lack of motivation
Poor concentration
The problem is these symptoms aren't specific to testosterone. They can have many causes.
Perimenopause.
Poor sleep.
Stress.
Low energy intake.
Iron deficiency.
Thyroid problems.
Medication.
Depression.
Reduced activity.
And plenty more.
So if you're exhausted and struggling to recognise yourself, don't automatically assume you need testosterone. You need to investigate.
Can you test your testosterone?
Yes. But interpreting the result isn't as simple as looking at a number and deciding whether you're “low”.
There isn't one blood testosterone level that can reliably distinguish women with and without sexual dysfunction.
Hormone levels vary, testing at the relatively low concentrations found in women has limitations, and symptoms don't neatly correspond to one number.
So a blood test is information. It isn't a diagnosis. This is an important message in an age where you can order almost any hormone test online.
Should women take testosterone during menopause?
For some women, testosterone therapy may be appropriate — particularly appropriately assessed postmenopausal women with HSDD.
But it isn't a general-purpose treatment for:
Losing weight
Getting more energy
Building muscle
“Anti-ageing”
Fixing brain fog
Optimising your hormones
And it certainly isn't something I'd recommend self-prescribing based on symptoms or an online test.
If you're struggling with symptoms that are affecting your quality of life, speak to an appropriately qualified healthcare professional.
What I'd rather you focus on
Here's where I come back to what I do with my clients.
Because sometimes the menopause conversation becomes so focused on hormones that we forget about the basics that have an enormous impact on health.
If you're in your 40s or 50s and you're noticing changes in your body, start here:
Lift weights: Progressively challenge your muscles.
Eat enough protein: Don't let dieting leave you under-fuelled and struggling to maintain muscle.
Eat a balanced diet: Think plants, fibre, quality protein, wholegrains and healthy fats — not endless food rules.
Keep your cardiovascular fitness: You don't have to choose between strength and cardio - you need both.
Move regularly: Your 60-minute workout doesn't cancel out sitting for the other 10 hours of your day.
Prioritise sleep: Poor sleep makes almost everything harder.
Manage stress: You don't need to eliminate stress. You need strategies that help you manage it.
And don't believe everything you see on Instagram - especially when someone is trying to sell you the solution.
Stronger, not hormonally “perfect”
I'm not anti-hormone treatment. I'm not anti-HRT.
And I'm certainly not suggesting that lifestyle changes can replace appropriate medical care.
There are women who benefit enormously from medical treatment, including hormone therapy, and those decisions should be made with a qualified healthcare professional.
What I am against is the idea that women need to constantly find something wrong with their hormones.
That every symptom needs a supplement.
That every change in your body means something is “imbalanced”.
That getting older is a disease that needs fixing.
It isn't.
Your body is changing.That's normal.
Our job is to understand those changes and make sensible decisions about what we can influence.
Your future body is worth investing in
At 51, I'm much less interested in trying to recreate the body I had at 30.
I'd rather build the body I want to have at 60, 70 and beyond.
A body that's strong.
A body that can run, lift, carry and move well.
A body that can cope with life's unexpected demands.
A body that gives me the confidence to keep saying yes to things.
And that's why I don't think the answer to midlife is chasing the “perfect” hormone profile.
And get medical support when you need it. Because ultimately, this isn't about trying to stay young. It's about staying capable.
References
Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Journal of Sexual Medicine. 2019;16(9):1331–1337.
Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women’s Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. Journal of Sexual Medicine. 2021;18(5):849–867.
Hamoda H, Mukherjee A, Morris E, et al. Joint position statement by the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society
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