Testosterone Is Not Just for Men. Why Women Need It in Midlife
Key Takeaway
Testosterone is a critical hormone for women, influencing energy, muscle mass, bone density, libido, mood, and genitourinary health.
Declining testosterone in midlife can drive symptoms often dismissed as “normal aging,” yet clinical evidence shows these changes are measurable and treatable.¹²
Why didn’t anyone explain this to women?
Testosterone is routinely described as a male hormone.
That framing has consequences.
Because when women experience fatigue, low libido, bone loss, or genitourinary symptoms in midlife, testosterone is rarely assessed, discussed, or considered as part of the solution.
Yet women produce testosterone throughout life, and it plays a vital role in female physiology. Its decline during perimenopause and menopause is not trivial. It affects multiple systems at once.
This is not fringe medicine. It is well described in endocrinology literature.¹³
Testosterone’s role in women’s health
Although women produce far less testosterone than men, it remains biologically active and clinically significant.
Testosterone contributes to:
Energy and physical drive
Muscle strength and lean mass
Bone formation and density
Mood and cognitive resilience
Sexual desire and arousal
Genitourinary tissue integrity
Women have androgen receptors throughout the body, including in muscle, bone, brain, vaginal tissue, and the urinary tract.¹⁴
This means testosterone is not optional. It is foundational.
What happens to testosterone in midlife
Testosterone levels in women begin to decline from the mid-30s and continue to fall through perimenopause and menopause. This decline occurs independently of oestrogen and progesterone changes.¹⁵
By midlife, many women have testosterone levels significantly lower than those seen in early adulthood, even if they are using oestrogen-based hormone therapy.
This helps explain why some symptoms persist despite “doing everything right.”
Genitourinary health and testosterone
One of the most overlooked roles of testosterone in women is its effect on genitourinary tissues.
Clinical studies show that androgen receptors are present in:
Vaginal epithelium
Vulvar tissue
Urethra and bladder neck¹⁶
Low testosterone can contribute to:
Vaginal dryness
Painful intercourse
Reduced tissue elasticity
Urinary urgency or discomfort
These symptoms are often grouped under genitourinary syndrome of menopause, yet testosterone deficiency is rarely assessed as part of management.
Testosterone and libido
Sexual desire is hormonally complex, but testosterone plays a central role.
Low testosterone in women has been associated with:
Reduced sexual desire
Decreased arousal
Lower sexual satisfaction¹⁷
This is not about libido as a lifestyle issue. It is a neuroendocrine signal.
Restoring testosterone to physiological levels has been shown to improve sexual desire and function in appropriately selected women.¹⁷¹⁸
Testosterone and bone health
Bone health in women is often discussed only in terms of oestrogen.
This is incomplete.
Testosterone supports bone density by stimulating osteoblast activity and contributing to bone remodelling.¹⁹
Low testosterone in midlife is associated with:
Accelerated bone loss
Reduced bone strength
Increased fracture risk
Supporting testosterone alongside oestrogen is part of a comprehensive strategy for skeletal health in midlife.
What testosterone supports in women
|
System
|
Role of Testosterone
|
|---|---|
|
Muscle
|
Preserves lean mass and strength
|
|
Bone
|
Stimulates bone formation
|
|
Brain
|
Supports motivation and mood
|
|
Sexual health
|
Drives desire and arousal
|
|
Genitourinary tissue
|
Maintains elasticity and integrity
|
| Energy |
Contributes to physical drive
|
When testosterone deficiency should be considered
|
Symptom Pattern
|
Possible Driver
|
Testing to Consider |
Why it’s Missed
|
|---|---|---|---|
|
Low libido
|
Androgen deficiency
|
Total and free testosterone
|
Focus on oestrogen only
|
|
Fatigue
|
Reduced anabolic signalling
|
Free testosterone, SHBG
|
Fatigue framed as stress
|
|
Bone loss
|
Reduced osteoblast activity
|
Testosterone, DEXA
|
Oestrogen-centred care
|
|
Vaginal discomfort
|
Tissue androgen deficiency
|
Testosterone assessment
|
GSM under-recognised |
Testing for testosterone in women
Testing is straightforward but often overlooked.
Assessment typically includes:
Total testosterone
Free testosterone
Sex hormone binding globulin (SHBG)
Interpretation requires context. Reference ranges are wide, and “normal” does not always mean optimal for function.
This is where clinical experience matters.
Testosterone therapy in women
When deficiency is identified and appropriately treated, low-dose testosterone therapy can be safe and effective.
Clinical consensus statements support the use of physiological-dose testosterone in women for specific indications, particularly hypoactive sexual desire disorder.¹⁸
Common misconceptions persist.
Physiological testosterone replacement does not masculinise women when prescribed correctly. Side effects such as acne or oily skin can occur, but they are typically dose-related and manageable.
This is not about excess. It is about restoration.
What about herbal support?
Some herbal compounds may modestly influence androgen signalling or sexual function, but evidence remains limited and inconsistent.
Herbal strategies may support overall endocrine health, but they do not replace proper assessment or targeted therapy when deficiency is present.
Strategy matters more than supplementation.
A clinical perspective worth hearing
Urologist Dr Rachel Rubin has spoken extensively about the omission of testosterone in women’s health, particularly in relation to sexual and genitourinary symptoms.
Her conversation on The Drive with Dr Peter Attia highlights how often testosterone is overlooked despite its clear physiological relevance.
The bottom line
Testosterone is not a male hormone that women occasionally need.
It is a human hormone that women require for strength, vitality, and quality of life.
Declining testosterone in midlife is common. Ignoring it is not benign.
With the right testing and clinical strategy, many women can address symptoms that were never “just aging” in the first place.
Where to start
If this resonates, the next step is not guessing.
Start with strategy and assessment so decisions are informed, individualised, and safe.
For a deeper look at the systemic shifts of midlife, read the full Midlife Health Redesign.
References
Davis SR et al. Testosterone in women. Endocrine Reviews.
https://pubmed.ncbi.nlm.nih.gov/25169151/Davis SR, Wahlin Jacobsen S. Testosterone and women’s health. Lancet Diabetes Endocrinol.
https://pubmed.ncbi.nlm.nih.gov/30266074/Handelsman DJ. Androgen physiology in women. Endocrine Reviews.
https://pubmed.ncbi.nlm.nih.gov/26908151/Traish AM et al. Androgen receptors in female tissues. J Sex Med.
https://pubmed.ncbi.nlm.nih.gov/21564425/Labrie F et al. Decline in androgen levels in women. J Endocrinol.
https://pubmed.ncbi.nlm.nih.gov/18230656/Panay N, Fenton A. Genitourinary syndrome of menopause. Climacteric.
https://pubmed.ncbi.nlm.nih.gov/25650925/Wierman ME et al. Androgen therapy in women. Journal of Clinical Endocrinology and Metabolism.
https://pubmed.ncbi.nlm.nih.gov/31374558/Islam RM et al. Safety and efficacy of testosterone therapy in women. Lancet.
https://pubmed.ncbi.nlm.nih.gov/32763215/Khosla S et al. Role of sex steroids in bone health. Endocrine Reviews.
https://pubmed.ncbi.nlm.nih.gov/30272039/
Clinician Bio
Susan Hunter is a Melbourne-based, double degree qualified women’s healthcare strategist with nearly 20 years of clinical experience in midlife metabolic and hormonal health. Her work focuses on precision diagnostics, root-cause treatment, and long-term healthspan optimisation.
View credentials and clinical background on LinkedIn.
