Say the word “testosterone,” and most people think of men’s health. Even in conversations about women’s health, it’s often associated with symptoms like body hair and acne, which can elicit fear or hesitation. But both of those views miss the bigger picture: Testosterone — alongside estrogen, progesterone, DHEA, and other hormones — is an essential part of a woman’s health and hormone balance.
“We’re always talking about estrogen and progesterone when it comes to women’s hormones, and a lot of people don’t know that women make testosterone as well,” says Karen Kaufman, MD, medical director for MIORA at Life Time in Colorado and functional medical physician at Kaufman Health and Hormone Center in Louisville, Colo.
“Patients often have a hard time believing this when I tell them, but women make more circulating testosterone than estrogen when measured by mass. And even though the number might be small compared to [what] men [make], it’s still a very significant makeup of female hormone balance.”
To better understand testosterone’s role in women’s health, we asked Kaufman to explain what this hormone does, how imbalances may show up, and why a thoughtful, whole-body approach is key to hormonal vitality.
The Role of Testosterone
Testosterone is not a single-purpose hormone. It’s a quiet contributor to a woman’s daily energy and long-term health, working with other hormones to support bone and muscle health, mood stability, cognition, sexual desire and function, and more.
“Testosterone is not a one-hit wonder,” says Kaufman. “It supports so many functions in the body and works best when the rest of your health foundation is in place. You can think of estrogen, progesterone, DHEA, and testosterone as a symphony [in which] each hormone plays a distinct part.”
- Estrogen is a growth and signaling molecule with hundreds of functions throughout the body. Testosterone works alongside estrogen to help keep bones strong and dense.
- Progesterone balances and modulates estrogen and is central for reproduction.
- DHEA is the raw material or building block for sex hormones.
- Testosterone drives motivation, lean muscle, mood, and libido, and can be converted into a small amount of estrogen through a natural enzymatic process to support the menstrual cycle and overall hormonal rhythm.
In partnership with the other sex hormones, testosterone influences other key day-to-day functions, including the following:
- Building and retaining lean muscle: Testosterone helps support muscle-protein synthesis.
- Driving energy and motivation: Testosterone supports cellular health to help regulate metabolism and maintain physical stamina.
- Sexual function: Testosterone helps stimulate dopamine release in the brain and supports healthy blood flow to reproductive tissues.
- Mood stability and focus: Testosterone is active in areas of the brain like the amygdala and hippocampus, which support nervous system function.
- Hormonal balance: A small amount of testosterone is made in the ovaries and is converted to estrogen to support the menstrual cycle and overall hormonal rhythm.
Signs of Testosterone Imbalance
Testosterone levels for women typically peak in their 20s, then naturally decline gradually through the 30s, 40s, and beyond. Signs of low or suboptimal testosterone can include difficulty maintaining lean muscle, reduced libido, brain fog, low energy and motivation, and mood changes. However, these symptoms can have many possible root causes and warrant a deeper look at your overall health, according to Kaufman.
“As women approach perimenopause and menopause, hormone levels can become more erratic, and that is typically when I see patients coming in experiencing issues with testosterone,” says Kaufman. “In my clinical experience, they’ll say, ‘I’m working out as hard as ever, and I cannot maintain my lean muscle.’ Or ‘I used to have a sex drive, but I don’t anymore.’ There could be several reasons for these symptoms, but one possibility is that it could be related to testosterone.”
Signs of excess testosterone can include acne or unwanted hair growth in the face, chin, or other areas. “Polyendocrine metabolic ovarian syndrome (or PMOS, formerly PCOS) is a condition in the pre-menopausal years that is often associated with higher testosterone,” Kaufman explains. “Both low or high levels of testosterone are an imbalance that can affect your health and hormone function unless addressed.”
Assessing Testosterone Levels
Testing and evaluating lab values from a blood panel can be confusing, as there is no universal “normal” testosterone range value for women. “Ranges are built from population data and can vary by lab,” Kaufman explains. “Population ‘normal’ is not the same as ‘optimal.’ This means a ‘normal’ result may still leave you feeling far from your best. Many women feel better in the mid-to-upper portion of the range.” (Learn more: “Normal vs. Optimal Lab Ranges: Why the Difference Matters.”)
Typical testing for testosterone involves looking at two lab values: total testosterone and free testosterone. Total testosterone measures all the testosterone in your blood while free testosterone measures the active portion that your body can immediately use.
“There are other specialty tests out there, but measuring total and free testosterone are typically the most widely available ways to assess,” says Kaufman. “From those values, we can make an assessment and decide a path forward.”
Kaufman recommends finding a provider experienced in looking at the full picture so they can advise appropriately on healthy hormonal balance, especially given the nuance and spectrum of “normal” versus “optimal” ranges. “For example, a comprehensive blood panel you can receive through MIORA at Life Time checks both total and free testosterone, and the providers are trained to restore health and vitality while looking at your testosterone levels in context of your full bloodwork and symptoms,” says Kaufman.
Testosterone Therapy for Women
Kaufman notes that testosterone therapy for women is not currently FDA-approved, but there are off-label uses that can be prescribed by a provider.
“Patients often get confused about whether they should try testosterone therapy because of this,” she says. “Is it safe? Is it effective? Yes, when administered appropriately — it’s just not FDA approved. The FDA takes about 20 years of catch up with things. There’s just not currently a diagnostic code for prescribing for testosterone deficiency in women like there is for men.”
If you and your provider decide that testosterone therapy may be right for you, there are a few options. “A topical testosterone cream is a great place to start, as dosing is easily adjusted,” Kaufman says. “You can increase it, decrease it, or stop it easily depending on your results. Another option is injection, which can give more of a robust result depending on your levels and needs. Another option is a pellet, which can be inserted by your provider in your gluteus or the flank (back area) of the body. All of these are plant-based, bioidentical options — they’re not synthetic.”
Hormone Replacement Therapy as One Piece of the Puzzle
Kaufman emphasizes that testosterone is one essential instrument in a larger hormonal symphony, and balance comes from the whole system working together. She encourages a holistic approach through checking your labs, focusing on foundational healthy lifestyle habits, and seeking personalized care.
“Hormones are the sprinkles on the cupcake, and the cupcake (representing your overall health) has to be sound,” she says. “Just sprinkling on the hormones through hormone replacement therapy isn’t going to create the change you want by itself. If you haven’t addressed the other questions about nutrition, exercise, lifestyle habits, stress, relationship status, and other relevant health information, it’s more challenging to get a positive result. But if it’s done in the right circumstances and environment, it can make an impact.”
Kaufman notes there are several lifestyle strategies that help promote healthy hormone balance, including levels of testosterone.
“Regular strength and resistance training, adequate sleep and stress management, and consuming adequate protein are all drivers of natural hormone production,” she explains. “Excess alcohol consumption can also disrupt hormone production and lower testosterone, and it’s important to be aware of endocrine-disrupting chemicals in our environment. For example, plastics and other chemicals like parabens and phthalates can alter our body’s hormone signaling and essentially lower testosterone. Even if you’re engaging in testosterone replacement therapy, these lifestyle interventions can be supportive to your entire physiology and hormone balance.”
