By Michelle Clay, FNP
“Do you think I need testosterone?”
It’s a question I hear frequently from women, especially when they’re struggling with low libido, decreased energy, loss of motivation, or changes in strength and muscle mass.
Sometimes testosterone therapy can help.
But testosterone isn’t a magic hormone—and more is definitely not better.
Women Need Testosterone Too
We often think of testosterone as a male hormone, but women naturally produce testosterone too.
It plays an important role in sexual function, and it also contributes to muscle and bone health and overall well-being.
Testosterone levels change throughout a woman’s life, so there are situations where testosterone therapy may be worth considering.
But I don't prescribe testosterone simply because someone has a symptom that could be related to low testosterone.
Testosterone Has the Best Evidence for Low Sexual Desire
This is something I think women deserve to understand.
The strongest evidence for testosterone therapy in women is for postmenopausal women with Hypoactive Sexual Desire Disorder (HSDD) after other possible contributors to low sexual desire have been evaluated.
That doesn't mean testosterone can't affect other things a woman notices.
Some women report improvements in energy, motivation, strength, or overall well-being while using testosterone. But we don't have the same quality of evidence for using testosterone specifically to treat those symptoms.
Feeling tired doesn't automatically mean you need testosterone.
I Don't Treat a Testosterone Number
Lab testing is useful, but I don't believe a woman should be prescribed testosterone simply because her level falls below someone's idea of “optimal.”
I look at her symptoms, health history, medications, menopausal status, other hormone levels, and what else could explain what she's experiencing.
I also like to look at total testosterone, free testosterone, and SHBG rather than relying on total testosterone alone.
The lab work is one piece of the puzzle.
What Testosterone Can't Do
Testosterone isn't going to fix every symptom of menopause.
It isn't a weight-loss medication.
It isn't a substitute for strength training, adequate protein, good sleep, or addressing metabolic health.
And it isn't necessarily going to fix low libido if the real problem is painful intercourse, medication side effects, relationship issues, chronic stress, or something else entirely.
That's why figuring out what we're actually trying to treat matters.
More Testosterone Isn't Better
When testosterone therapy is appropriate, I prefer to start low and adjust gradually based on symptoms, labs, and response.
Too much testosterone can cause side effects such as acne, oily skin, unwanted facial or body hair, scalp hair changes, and other androgenic effects.
That's one reason testosterone therapy should be monitored rather than treated as something you start and forget about.
The goal isn't to create the highest testosterone level possible.
The goal is to use the lowest effective dose that helps the problem we're trying to address.
So, Should You Take Testosterone?
Maybe.
For the right woman with the right indication, testosterone can be an incredibly useful part of hormone therapy.
For another woman experiencing similar symptoms, it may not be the answer at all.
And that's really the point I've tried to make throughout this month's series:
Don't treat the hormone. Treat the woman.
Wondering If Your Hormones Could Be Part of the Picture?
If you've noticed changes in your libido, energy, mood, sleep, weight, or overall sense of well-being, my FREE Hormone Imbalance Assessment can help you identify patterns in your symptoms.
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About the Author
Michelle Clay, APRN, FNP-C
Michelle Clay is a Family Nurse Practitioner and founder of Balanced Health, a Kentucky-based telehealth practice specializing in women's hormone health, thyroid optimization, insulin resistance, and weight-loss resistance.