Testosterone in Women: The Overlooked Hormone Behind Energy, Mood, and Longevity

When we think of testosterone, most people picture muscle-bound men. But testosterone plays a powerful role in women’s health—affecting everything from brain function and metabolism to mood and sexual wellness. As we explore female estrogen in broader hormonal balance, it’s time we give testosterone the attention it deserves.

What Is Testosterone’s Role in Women?

Testosterone is classified as an androgen, or “male hormone,” but women produce it too—primarily in the ovaries and adrenal glands. In fact, women have three to four times more testosterone than estrogen throughout their reproductive years.

Its functions include:

• Supporting lean muscle mass and bone density

• Regulating libido and sexual satisfaction

• Promoting mental clarity, motivation, and mood

• Enhancing exercise tolerance and recovery

• Stabilizing metabolism and body composition

Symptoms of Low Testosterone in Women

Testosterone deficiency is underdiagnosed in women. While lab cutoffs vary, many women experience symptoms even when their levels are considered “within normal range.” Common symptoms include:

• Persistent fatigue or loss of vitality

• Reduced mental clarity and memory

• Decreased muscle tone and increased fat gain

• Poor exercise tolerance and longer recovery times

• Low libido, vaginal dryness, or diminished sexual satisfaction

• Irritability, depression, or anxiety

• Chronic pain, especially musculoskeletal

• Insomnia or non-restorative sleep

This cluster of symptoms may be referred to as Female Androgen Insufficiency Syndrome (FAIS), a clinical diagnosis proposed for women with low testosterone and related functional decline.

The Benefits of Testosterone Therapy in Women

When administered appropriately and safely, testosterone therapy may significantly improve:

• Lean muscle mass and physical strength

• Energy levels and endurance

• Cognitive function and memory

• Mood stability and resilience to stress

• Sense of well-being and life satisfaction

• Lipid profiles and cardiovascular markers

• Sexual desire and function

Importantly, these improvements are often most notable in women during perimenopause, post-menopause, or those with surgical menopause.

What Does the Science Say? Key Studies on Testosterone and Women’s Health

Testosterone and Alzheimer’s Disease

Vest, R.S. & Pike, C.J. (2013). Gender, sex steroid hormones, and Alzheimer’s disease. Hormones and Behavior, 63(2), 301–307.

This study explored how declining androgens may increase vulnerability to neurodegenerative processes in women. It found that testosterone plays a neuroprotective role, potentially reducing beta-amyloid accumulation and preserving neuronal function.

Testosterone and Mental Health

Ciocca, G., et al. (2016). Is testosterone a food for the brain? Journal of Psychosexual Health, 1(2), 137–144.

This review highlights testosterone’s impact on dopamine and serotonin, improving cognition, reducing anxiety, and enhancing mood—particularly in women with depression or low motivation.

Testosterone, Vascular Health & Bone Density

Vegunta, S. et al. (2020). Androgen therapy in women. Journal of Women’s Health, 29(1), 57–64.

This article confirms that testosterone can support bone mineral density, improve vascular elasticity, and may lower triglycerides in certain populations, helping address sarcopenia and cardiovascular aging.

Testosterone and Breast Cancer Prevention

Glaser, R., et al. (2015). Testosterone and breast cancer prevention. Maturitas, 82(3), 291–295.

Contrary to long-held fears, this paper presents evidence that testosterone may reduce breast cancer risk, especially when delivered transdermally and in physiological doses. It may exert anti-proliferative effects on breast tissue and counteract the mitogenic effects of unopposed estrogen.

What About the Official Guidelines?

In 2020, the Global Position Statement on Testosterone Use in Women—co-authored by representatives from 11 international menopause and endocrine societies—declared:

“Testosterone is the only evidence-based treatment for hypoactive sexual desire disorder (HSDD) in women.”

(Davis, S. R., et al. (2020). Global Consensus Position Statement on the use of testosterone therapy for women. The Journal of Clinical Endocrinology & Metabolism, 105(3), 556–564.)

While its use for libido is officially recognized, the statement also emphasized that additional benefits—including mood, muscle mass, cognition, and bone health—are supported by emerging data, even if regulatory agencies have not yet approved broader indications.

Topical vs. Pellet Testosterone: What Does the Research Say?

While testosterone pellets are often promoted in certain wellness circles, topical testosterone (creams or gels) offers several distinct advantages backed by clinical research. When dosed appropriately, topical therapy can be just as effective—without the long-term commitment or risk of supraphysiologic levels.

Clinical Benefits of Topical Testosterone Therapy in Women

Mood, Cognition & Libido
A UK cohort study of 510 women using transdermal testosterone showed substantial improvements:

• 47% reported improved mood

• 39% saw cognitive enhancement

• 52% experienced increased libido
  Symptom scores improved across the board within just four months of use.

Sexual Function in Surgical Menopause
Randomized controlled trials of testosterone creams and patches in women with surgical menopause (i.e., ovaries removed) found significant improvements in sexual motivation, desire, and satisfaction.

Body Composition, Strength & Bone Health
When combined with estrogen, transdermal testosterone has been shown to:

• Increase lean muscle mass and strength

• Support bone mineral density

• Improve lipid profiles and body composition

Mechanism & Safety
Transdermal testosterone achieves physiologic serum levels with daily use. Unlike pellets, which release hormone continuously for months, topical testosterone allows for:

• Precise titration based on symptoms and labs

• Lower risk of overtreatment

• Quick discontinuation if side effects arise

And while mild side effects like acne or hair growth can occur, they are typically dose-related and reversible.

Why Many Functional Medicine Experts Prefer Topical

Topical testosterone offers flexibility, control, and a strong safety profile when monitored properly. For many women, especially those just starting therapy or aiming for subtle hormonal recalibration, transdermal delivery is the most elegant and adjustable approach.

**Important Note: To avoid unintentional transfer to others, always apply creams to clean, covered skin areas such as the inner thigh, and wash hands thoroughly after application.

Takeaway: It’s Time to Reframe Testosterone in Women’s Health

For women struggling with fatigue, brain fog, low libido, or unexplained weight gain, testosterone may be part of the answer—not the enemy. While estrogen remains central to female health, testosterone is often the missing link in true hormonal balance.

The key is personalized dosing, careful monitoring, and bioidentical transdermal delivery under expert supervision—ideally within a functional or integrative medicine framework.