In 2019, a global consensus panel drawn from several major international menopause and endocrine societies signed the same document.
It stated testosterone therapy is both evidence-backed and effective for postmenopausal women with low sexual desire, while recommending dosing protocols should target premenopausal physiological concentrations.
This happened seven years ago.
How far have we come since then?
I’ll tell you…
Talk to the last three women you know who complained about fatigue, collapsing libido, or brain fog to their physician.
And ask if the subject of testosterone ever came up once.
That gap between what the literature clearly says and what happens in the exam room is the entire subject of this article.
Just another instance of most women being gaslit into believing their hormonal health is perfectly intact while their lives are falling apart.
Fatigue, low libido, brain fog, muscle loss, creeping body fat… all of these things are slowly eroding the version of themselves they used to be.
But it doesn’t have to be this way.
And it starts with recognition you can — and should — employ therapeutic testosterone for women who are suffering from a suboptimal hormonal terrain.
Because contrary to what you may have heard, this “male hormone” circulates in women at concentrations several times higher than estradiol across the reproductive years.
Once you start optimizing for testosterone, everything else starts to change for the better.
Quick Takeaways
- Testosterone is essential for women’s health and declines with age, although stress and hormonal contraceptive use are contributing factors as well
- Low-dose testosterone therapy is backed by global consensus guidelines for Hypoactive Sexual Desire Disorder (HSDD), and its clinical use case extends well beyond restoring a low libido.
- The dosing for women is a fraction of what is used for male dosing; the delivery method and cycle timing matter just as much as the dose.
- Most conventional physicians are heavily undertrained in female androgen optimization and will dismiss this subject entirely.
The Hormone Women Are Systematically Denied
The medical establishment has done women a profound disservice.
For decades, low testosterone was framed exclusively as a male concern.
This left millions of women with an androgen deficiency and without any answers.
Women produce testosterone in the ovaries and adrenal glands, where it supports:
- Muscle maintenance
- Bone density
- Cognitive sharpness
- Metabolic regulation
- Cardiovascular function
- Sexual response
24-hour mean plasma testosterone levels decline with age in normally cycling premenopausal women, meaning roughly half the amount of hormone found within a woman in her early twenties is gone by her forties.
However, bioavailable testosterone declines linearly across a wide age span in both sexes, telling us that the hormonal erosion starts long before menopause gets blamed for it.
Then there’s another contributing factor almost nobody mentions to a 22-year-old woman.
Combined oral contraception raises SHBG substantially and drives both total and free testosterone down.
My wife Monica has spoken openly about being put on birth control at 18 years old, with zero education about what it was doing to her.
Like I said in the introduction…
The Global Consensus Position Statement formally recognized testosterone therapy as evidence-based for postmenopausal women with HSDD.
And the clinical practice guideline from the International Society for the Study of Women’s Sexual Health laid out how to actually prescribe it.
But even though the documentation exists, most gynecologists refuse to have the important conversations with their patients.
What the Research Actually Shows
The landmark randomized trial from Shifren and colleagues in the New England Journal of Medicine found transdermal testosterone treatment improved sexual function and psychological well-being in women with impaired sexual function after oophorectomy (surgical removal of the ovaries).
A later systematic review and meta-analysis of randomized trial data confirmed significant benefits of therapeutic testosterone for sexual function in postmenopausal women.
That same meta-analysis, and the consensus statement built on it, found the evidence base for the NON-sexual endpoints to be insufficient.
In plain English: The reported health benefits of testosterone on bone, cognition, mood, and body composition have not been proven in trials the same way libido has.
While this sounds discouraging at first, here is what I will tell you…
The trials that would thoroughly answer those questions have never been funded because no pharmaceutical company holds an FDA-approved testosterone product for women in the United States.
Nor is there any revenue waiting at the end of that research.
Absence of a trial is not evidence of danger.
Furthermore, there was one study in hysterectomized women that did measure a dose-response relationships across sexual function, body composition, muscle performance, and physical function.
And to add on to this: The collected clinical experience gathered by decades of practitioners all points in one direction.
I’ll let you take a wild guess at what that direction looks like.
Dosing: What Low-Dose Testosterone Actually Means for Women
This is where women get hurt by practitioners who do not understand female androgen physiology and treat women like smaller-sized men.
| Delivery Method | Typical Female Dose | Notes |
|---|---|---|
| Compounded transdermal cream | 0.5 mg to 2 mg daily | The standard in the protocol I teach, and the most precisely titratable |
| Transdermal gel (male product, fractional dose) | Roughly one tenth of a male dose | Absorption varies widely, so lab confirmation is mandatory |
| Very low-dose injections | Individualized, expert oversight required | Monica knows women who do excellently on extremely low-dose injections |
| Subcutaneous pellets | 50 mg to 100 mg every 3 to 5 months | Cannot be adjusted or removed once implanted |
| Oral testosterone | Not recommended | Adversely affects lipid profiles, unlike non-oral routes |
Target your labs to the mid-to-upper end of the premenopausal physiological range FOR WOMEN, and know that published testosterone reference ranges for normally cycling healthy premenopausal women are the benchmark you want to be aiming for.
Also, over-dosing is the most common mistake I see with women on testosterone therapy and this happens most often with pellets.
A delivery mechanism in which the dose cannot be walked back once it is under the skin.
The Part Almost Every Protocol Gets Wrong
In The TOT Bible, Monica and I centered our approach female hormone optimization around four principles: bioidentical, biorhythmic, balanced, and bioavailable.
Biorhythmic means this: A woman’s own testosterone peaks around days 14 to 16 of her cycle, estradiol peaks around day 12, and progesterone peaks around day 21.
Dosing a fixed amount per day into a biological system built on a rhythm ignores the entire design of female physiology.
It also means your labs are close to meaningless without a cycle day attached to them:
- Test estradiol on day 12
- Test testosterone on day 14
- Test progesterone on day 21
Insist on high-sensitivity LC/MS methodology for all of the above because standard immunoassays are unreliable at female testosterone concentrations
Balanced means testosterone is one leg of a triad alongside estradiol and progesterone.
Bioavailable means compounded bioidentical hormones delivered through the skin, a superior administration method to synthetic analogues swallowed as a pill.
The Benefits Beyond Libido
The conversation around testosterone and women almost always defaults to libido, but that framing is selling the therapy short.
Androgen receptors are distributed throughout virtually every tissue in the female body — brain, bone, muscle, cardiovascular tissue, skin, and so much more.
Here’s what practitioners consistently report when women hop on testosterone, and a lot of this is mechanistically validated:
- Cognitive function, due to the presence androgen receptors in the hippocampus and prefrontal cortex
- Bone protection via osteoblast stimulation and reduced resorption
- Muscle preservation, with a lower trajectory toward sarcopenia
- Metabolic health, including insulin sensitivity and visceral fat
- Mood and drive, thanks to testosterone’s influence on dopaminergic signaling
Treat that list as clinical observations instead of settled trial evidence.
My wife Monica has spent several years saying that testosterone is one of the most overlooked hormones for women’s mood, muscle, libido, and longevity.
Furthermore, imbalanced testosterone levels can sit underneath depression in women the same way it does in men.
Her Women’s Peptide Cheat Sheet and her Modern Woman’s Peptide Course exist because testosterone therapy was initially designed for men, but then handed to women without any adjustments.
Myth vs. Reality
| Myth | Reality |
|---|---|
| Testosterone will give women facial hair and a deep voice | Virilization is a supraphysiological-dose problem, and it is rare and largely reversible at physiological doses caught early |
| No FDA approval means it must be dangerous | The absence reflects market economics, and testosterone has been used clinically in women for decades |
| Women do not need testosterone after menopause | Declining androgens after menopause work against bone, muscle, cognition, and metabolic health |
| Estrogen is the only hormone women need | Estradiol, progesterone, and testosterone are a triad, and optimizing one leg leaves the system incomplete |
| Pellets are the convenient option | Convenience is the problem, because a supraphysiologic pellet cannot be removed |
Risks, Safety, and Contraindications
Nothing in this article is medical advice or a suggestion to over-ride the judgment a physician who actually understands female endocrinology.
Testosterone therapy for women is not risk-free and no serious practitioner or advocate would ever pretend otherwise.
Potential side effects at physiological doses include acne or oily skin, which is the most common one.
It’s also why Monica does not personally use transdermal delivery… for some women, it also comes with increased body hair at higher doses and changes in clitoral sensitivity.
Voice change is a rare and supraphysiologic-dose phenomenon.
It also happens to be the one side effect that may not fully reverse itself, which makes for a very strong argument AGAINST chasing male-centric numbers and ranges.
Contraindications include:
- Active or prior hormone-sensitive cancer
- Pregnancy and breastfeeding
- Uncontrolled polycythemia
- Undiagnosed abnormal uterine bleeding
Either way, make sure you’re running baseline labs and repeating them every 3 to 6 months initially (total and free testosterone, SHBG, hematocrit, lipids, and more on the correct corresponding cycle days if you are still cycling).
One final and honest disclosure worth making: The same global consensus that endorses testosterone for HSDD also cautions against compounded products dosed beyond physiological female ranges.
I agree with the second half of that entirely, which is why the protocol I teach involves the use of compounded testosterone in a cycle-timed and physiologically dosed manner where blood work is monitored regularly with LC/MS labs.
Finding the Right Support
The conventional OB-GYN system is built to manage disease states and bill insurance codes.
If your doctor calls your testosterone levels normal without running other labs (including free testosterone, SHBG, and DHEA-S), they are not equipped to have this conversation.
Here’s what to look for in a provider:
- Experience with compounded bioidentical hormone therapy, preferring it over the use of synthetic analogues
- Comfort with the use off-label testosterone use in women, something that is well documented internationally
- A comprehensive hormone panel before and during therapy, with cycle days attached to each hormone
- Willingness to individualize dosing against what is being shown by symptoms AND biomarkers
Bring the Global Consensus Position Statement to the appointment if you have to… and if your provider waves it off, find a different provider.
Monica’s guidance here has not changed in a decade:
Get a baseline panel as early in life as you can, ideally in your twenties, because that number tells you what optimal looks like for YOU.
Stop basing your medical decisions off of population averages.
Testosterone For Women: The Bottom Line
Testosterone is a foundational pillar of female health that the sick-care system has systematically minimized.
There’s a growing body of consensus backing its therapeutic use in women, and any leftover trials we have yet to perform that would easily settle the remaining questions are simply not being funded.
What stands between most women and their optimal hormonal health is a medical system that prioritizes managing symptoms over restoring function.
Your hormones are your birthright, and refusing to accept slow decline as inevitable is one of the most powerful acts of self-sovereignty available to you.
If you want to go deeper, start with my breakdown of the benefits of testosterone for women.
Next, read how it connects to HRT and sleep quality and which peptides for women are worth using a properly built hormone protocol.
Then, find an optimization-minded physician and go get your baseline blood labs done.
Isn’t It Time You Became Fully Optimized To Live Leaner, Longer And Stronger?
Join my #1 online membership group, Fully Optimized Health to receive guidance from me and an elite group of more than 800 male and female biohackers (who all started out just like you).
And don’t forget to check out our other premium educational content dedicated to helping you fully optimize your health:
Quantum Peptides – the A-to-Z system for anyone (newbies & pros alike) desiring to master peptide use for the first time and forever.
Quantum Testosterone – the A-to-Z system for Men & Women to learn to optimize their hormones for explosive energy, lean muscle, and timeless vitality.
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See you on the inside!
[Disclaimer: This article is for educational purposes only. Always consult with a qualified healthcare provider before starting any peptide protocol.]
