When you think of testosterone, you probably think of manly traits. Strong muscles. Deep voices. Beards. Those all make sense because testosterone is the hormone that makes men masculine.  

But men aren’t the only ones with testosterone—women's bodies produce testosterone too. It may sound counterintuitive, but testosterone is absolutely vital for peak physical and emotional wellness in women.

Why testosterone matters for women

Would it surprise you to know that testosterone is the most abundant hormone in women? It’s true. During our reproductive years, women actually make more testosterone on a day-to-day basis than estradiol, the most active form of estrogen.

In the female body, much of the testosterone is produced in the ovaries. Some of the circulating testosterone also comes from another androgen that’s made in the ovaries and adrenal gland and then converted into testosterone.

Testosterone plays an essential role in a woman’s body, interacting with estrogen and progesterone to regulate bodily functions. When your testosterone is low, your symptoms present in similar ways as they do in men.

Symptoms of testosterone deficiency in women

As we age, both testosterone and estrogen levels start to drop. While estrogen is stored for a rainy day in a woman’s fat cells, testosterone is not. And even if you’re on hormone therapy that replaces estrogen and progesterone, replenishing those hormones won't necessarily help raise your testosterone levels back up to an optimal level.  

For women, typically, testosterone starts to decline in our mid-to-late 30s. So that means when we hit perimenopause and start developing symptoms of low estrogen, like hot flashes, we’re already testosterone deficient. As a result, any of the following signs and symptoms may crop up.

• Muscle fatigue and decreased exercise endurance

• Weight gain, especially excess belly fat

• Decreased bone density

• Irritability, anxiety, or depression

• Brain fog and forgetfulness

• Lower libido and diminished sexual satisfaction

• Apathy and decreased confidence

That last symptom, apathy, is lesser known and may have surprised you. While the other symptoms may also be partly attributed to the simultaneous estrogen deficiency, apathy is mostly testosterone driven.

Angela DeRosa, DO, MBA, CPE, Medical Director at Belmar Pharma Solutions, described this apathy in detail during a podcast for the European Menopause and Andropause Society and in a Belmar Pharma Solutions clinician webinar. Here’s how apathy resulting from low testosterone can affect a woman’s outlook:  

You just don’t feel anything anymore. Life feels lackluster, and you think, “Wow, is this all there is?” You can have a wonderful family, a good husband, and a nice life, but still feel kinda blah. It impacts your relationships and becomes a sad state of living, but you just stoically move through it.

And when a woman tells her doctor about these feelings, there’s a risk of misdiagnosis. If hormonal imbalances aren’t evaluated or even brought up, the provider may prescribe an antidepressant instead of the hormone replacement that could address a root cause of the problem.  

What medical treatments may contribute to low testosterone in women?

Aging and menopause aren’t the only culprits behind plummeting testosterone. Sometimes low testosterone results from clinical interventions like oral contraceptives or surgical removal of the ovaries and/or uterus.  

Surgical menopause

When the ovaries are removed, the main source of estrogen, progesterone, and testosterone is gone. This throws a woman into surgical menopause.  

Just a hysterectomy, even when the ovaries are not removed, can disrupt ovarian function and hormonal balance. During a hysterectomy procedure, measures are taken to control blood loss during surgery. Some arteries that feed the uterus (and ovaries) may also be removed during the surgery, potentially disrupting blood flow to the ovaries afterward. Hormone deficiency symptoms may develop right away as the ovaries adapt, but sometimes the process may negatively affect ovarian function over time.

Birth control pills

The traditional pill provides a constant low-level estrogen and progesterone. This presence of hormones tricks the pituitary gland into suppressing the ovarian production of all three hormones—estrogen, progesterone, and testosterone. The pill provides supplemental estrogen and progesterone, but not testosterone. So, guess what happens? Women taking traditional oral birth control can have low testosterone symptoms like weight gain, brain fog, moodiness, fatigue, etc.

Benefits of testosterone therapy for women

Because testosterone is such a critical hormone for women, addressing a deficiency with bioidentical hormone therapy (BHRT) may benefit a woman’s health in so many ways.  

Testosterone helps build and strengthen a woman’s muscles

Low testosterone may show up as post-exercise fatigue and muscle soreness, and it may take longer to recover after workouts. Testosterone therapy may help with muscle strength, lean body mass, and tone. It also supports better stamina and recovery after workouts.  

Testosterone can affect fat distribution and weight in women

Testosterone affects metabolism and body composition in women. In menopause, women tend to accumulate visceral fat in the belly area. Visceral fat coats the organs and contributes to diabetes and heart disease. Testosterone therapy has been linked to reduced abdominal fat accumulation in postmenopausal women.

Testosterone helps strengthen women’s bones

Bone mineral density in older women is better in those with higher testosterone levels, as shown by a study of women ages 40-60. That’s because testosterone supports bone-building cells called osteoblasts and suppresses osteoclasts, cells that break down bones.

Testosterone may boost women’s mood and improve cognitive function

Testosterone functions as what DeRosa calls, “Mother Nature’s serotonin.” As a brain chemical, serotonin is known to positively influence mood. In one study where more than 500 menopausal women used transdermal testosterone, both mood and cognition improved significantly.

Testosterone may enhance women’s sexual desire and pleasure

There’s a lot of evidence that testosterone enhances sexual function in postmenopausal women. A meta-analysis of three dozen studies found that testosterone therapy can enhance sexual desire, pleasure, orgasm, and frequency of sexual events.

How women can seek testosterone therapy

In the United States, there are more than 30 FDA-approved testosterone therapies for men, while there are exactly zero that are FDA approved for women. That’s why many hormone-savvy practitioners prescribe compounded bioidentical hormone replacement therapy for their female patients who could benefit from testosterone or DHEA, which is a precursor hormone that may help raise testosterone levels.  

The chemical structure of a bioidentical hormone matches what is naturally produced in the body. Your doctor prescribes the dosage and form—like creams, gels, or pellets—that can work best for your individual needs. Then pharmacists craft the unique, compounded hormone formulation and send it to you.  

If you’re experiencing the low testosterone symptoms above, consider talking with your provider about whether compounded BHRT may be an option.