Testosterone is not a male hormone. Women produce it continuously from the ovaries and adrenal glands throughout their lives, in smaller amounts than men but in quantities that are physiologically significant. At its peak in the mid-twenties, a woman's testosterone level is roughly a tenth of a man's peak, but the tissues that respond to it are equally sensitive. Muscle cells, bone, brain, and sexual organs all carry testosterone receptors in women, and all are affected when levels decline.
When Female Testosterone Declines
Unlike the relatively abrupt oestrogen fall at menopause, testosterone in women declines more gradually across the forties and into the fifties, with a particularly sharp drop in women who undergo surgical menopause via oophorectomy. By the mid-fifties, many women have testosterone levels less than a quarter of their twenties peak. The symptoms include loss of muscle despite training, persistent fatigue that does not respond to sleep, reduced libido, cognitive sluggishness, and a generalised flattening of motivation and wellbeing that is frequently attributed to depression.
The Evidence for Testosterone Therapy in Women
A 2019 systematic review and meta-analysis published in The Lancet Diabetes and Endocrinology, covering 46 randomised controlled trials, concluded that testosterone therapy in women significantly improves sexual function, wellbeing, and musculoskeletal health. The Global Consensus Position Statement on testosterone therapy for women, published the same year and signed by multiple international endocrine societies, supports its use for women with low testosterone and relevant symptoms after appropriate assessment.
Sources
- Islam, R.M., et al. (2019). Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. The Lancet Diabetes and Endocrinology, 7(10), 754-766.
- Davis, S.R., et al. (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Journal of Clinical Endocrinology and Metabolism, 104(10), 4660-4666.
- Davison, S.L., et al. (2005). Androgen levels in adult females: changes with age, menopause, and oophorectomy. Journal of Clinical Endocrinology and Metabolism, 90(7), 3847-3853.