Testosterone in women: what it does and why it matters
Testosterone is not just a male hormone. What it does in women, how levels change with age, and what low or high levels can mean.
Reviewed by Emma Carter, Senior Health & Nutrition Editor
Testosterone gets labeled a male hormone, but you make it too and rely on it. It shapes your libido, energy, mood, and the strength of your muscle and bone. Your levels are far lower than a man's, yet when they drift too low or too high, the effects are easy to feel.
What testosterone does in women
You produce testosterone in your ovaries and adrenal glands. It is an androgen, and it works alongside estrogen and progesterone rather than against them. Its main jobs:
- Libido, one of the strongest drivers of sexual desire in women
- Energy, mood and motivation
- Muscle strength and lean mass
- Bone density, working with estrogen against thinning
- Red blood cell production
Because it touches so many systems, a dip can show up as tiredness or low desire long before anyone thinks to test it.
How levels change with age
Testosterone peaks in your early 20s, then declines slowly over the decades. By your 40s it is often about half what it was at 20. This is gradual and normal, and separate from the sharper estrogen drop at menopause. Having both ovaries removed causes a sudden fall instead, which is why some women notice a change in libido and energy after that surgery.
Low or high: what the signs look like
Testosterone problems pull in two directions, and they look quite different.
| Low testosterone | High testosterone | |
|---|---|---|
| Common signs | Low sex drive, ongoing tiredness, low mood, less muscle strength | Acne, unwanted facial or body hair, scalp thinning, irregular periods |
| Usual cause | Gradual age decline, or both ovaries removed | PCOS, often with insulin resistance |
| Worth ruling out first | Thyroid problems, iron deficiency, depression, poor sleep, perimenopause | Rarely, an adrenal or ovarian tumor if levels are very high or rise fast |
Low testosterone is hard to pin down because its signs, from fatigue to low mood, are so common and shared with other conditions. A single low reading rarely explains everything, so a good doctor rules out the usual causes and the shifts of perimenopause first.
High testosterone is more visible, and its usual driver, PCOS, often travels with insulin resistance. That is why PCOS is treated as a metabolic condition as much as a hormonal one.
Testing and treatment
Testosterone is measured by blood test, ideally in the morning when levels are highest. It is read alongside SHBG, a protein that binds testosterone, because the amount that is free and active matters more than the total.
There is no testosterone product formally approved for women in most countries. When low libido after menopause is the main problem and other causes are ruled out, some doctors prescribe a low, fractionated dose of a male transdermal product off-label, at roughly a tenth of a male dose, with blood monitoring to keep you in the female range. It is not a routine or first-line treatment. The evidence supports one use in particular: guidelines name low sexual desire that causes distress after menopause as the sole evidence-based indication, using a transdermal route at physiologic doses, and note that testosterone did not improve bone density, body composition or cognition (Journal of Women's Health, 2021).
When to see a doctor
See your doctor if you have:
- A lasting drop in libido that bothers you
- Signs of high testosterone such as new acne, unwanted hair growth or irregular periods
Testosterone reads best in context, so bring the full picture rather than a single lab number.
Frequently asked questions
Do women have testosterone?
Yes. Women produce testosterone in the ovaries and adrenal glands, just at much lower levels than men. It supports libido, mood, energy, and bone and muscle strength, so it matters for women's health even at low concentrations.
What are the symptoms of low testosterone in women?
The most common signs are low sex drive, persistent tiredness, low mood and reduced muscle strength. These symptoms overlap with many other causes, including thyroid problems, iron deficiency and menopause, so testosterone is rarely the whole story.
What causes high testosterone in women?
The most common cause is polycystic ovary syndrome (PCOS). High testosterone can show up as acne, unwanted facial or body hair, scalp hair thinning and irregular periods. Rarer causes include adrenal or ovarian conditions worth investigating with a doctor.
Can women take testosterone treatment?
There is no testosterone product formally approved for women in most countries. Some doctors prescribe a low, fractionated dose of a male transdermal product off-label for low libido after menopause, guided by blood monitoring. It is not a routine treatment and needs medical supervision.
References
- ISSWSH clinical practice guideline for the use of systemic testosterone for hypoactive sexual desire disorder in women · Journal of Women's Health, 2021
- Testosterone: what it is, function, levels and imbalances · Cleveland Clinic
- Low testosterone in women: causes, symptoms and treatment · Cleveland Clinic