Testosterone in Women: The Hormone Nobody Mentions and Why That Needs to Change

You finally got your oestrogen sorted. Maybe progesterone too. Your hot flushes have improved. Sleep is better. And yet something is still not quite right. You are still flat. Still unmotivated. Your drive, your ambition, your sense of yourself as a person who gets things done, it is just not there.

Here is what nobody told you: oestrogen and progesterone are not the whole story.

The third hormone is testosterone. In most conversations about women's hormonal health, it is the one women have never been told they have, let alone that they might need.

Yes, women make testosterone

This surprises more people than it should. Testosterone is produced in a woman's ovaries and adrenal glands (the small glands that sit above the kidneys and produce several hormones involved in stress response and metabolism). It is the most abundant sex hormone in women across most of adult life. More abundant than oestrogen, in terms of total circulating levels.

That is not a typo. The difference is that men have roughly ten times more testosterone than women, and their testosterone does more of the heavy lifting in terms of muscle mass and reproductive function. But in women, testosterone plays a quiet and essential role in several areas that most standard hormone conversations never touch.

What testosterone actually does in women

Energy and motivation. This is the one women most consistently describe when testosterone is low. Not just tiredness, but a specific flatness. A loss of the get-up-and-go that used to feel automatic. Women often describe it as feeling like they are going through the motions rather than actually living their life.

Libido. Testosterone has a well-established role in sexual desire in women. Low testosterone is associated with low libido (sex drive) in women in their 40s and beyond, and is often undertreated. This is not a relationship problem or a mindset issue. It is, in many cases, a hormone question that deserves a clinical conversation.

Muscle mass. Testosterone helps your body build and maintain muscle tissue. When levels decrease, maintaining muscle becomes harder, even with regular exercise and good nutrition. This matters not just for body composition, but for metabolic health, bone strength, and long-term function.

Bone density. Alongside oestrogen, testosterone supports bone strength. Both hormones decrease during perimenopause, and both matter for fracture risk as women age.

Mood and cognitive function. Many women report brain fog, low mood, and reduced mental sharpness as part of low testosterone, separate from oestrogen-related symptoms. It is not always easy to disentangle these hormonally, but the overlap is real and worth taking seriously.

What happens to testosterone in perimenopause

Testosterone does not drop suddenly at menopause the way oestrogen does. It decreases more gradually through a woman's 30s and 40s, so the effects can be subtle and slow enough that most women attribute them to stress, ageing, or just being busy.

By her mid-to-late 40s, a woman may have half the testosterone she had at 20. The ovaries continue to produce some testosterone after menopause, but total levels are substantially lower than in younger years. Women who have had their ovaries removed surgically experience a faster and more complete decrease.

The pattern seen in practice is this: women come in having already addressed oestrogen, feeling better in some ways, and still wondering why they do not feel like themselves. Often, that missing piece is testosterone.

Related reading: If you are weighing up HRT in general, the full plain-English guide covers the types, routes, and safety evidence. HRT Explained: A Pharmacist's Guide to What It Is, How It Works, and Who It Is For.

What the NICE guidance actually says

NICE (the National Institute for Health and Care Excellence, the UK body that sets clinical guidelines) recommends testosterone supplementation for women with low libido that has not improved with oestrogen and progesterone HRT alone. That is an important recommendation, and one that many women have never heard from their GP (general practitioner).

The reason it does not always come up is partly prescribing familiarity and partly the fact that there is no licensed testosterone product in the UK specifically for women. Most women are prescribed testosterone off-licence (meaning a licensed medicine is used in a way or dose not specifically listed in its product licence, which is common practice in medicine, particularly in hormonal health). Testosterone gel, originally licensed for men at higher doses, is commonly used off-label at a much lower dose for women. This is legal, clinically supported, and consistent with NICE guidance. It just requires a clinician who is familiar with it.

Why testing is more complicated than it looks

If you ask your GP to test your testosterone, they will likely run a total testosterone test. The problem is that total testosterone is not a particularly useful measure of what is actually available to your cells.

A significant portion of testosterone circulates bound to SHBG (sex hormone-binding globulin, the protein that binds and inactivates testosterone, stopping it from having any effect). Only the testosterone that is free, or loosely bound, can actually be used by your body.

Free testosterone is a more useful measure, but it is not routinely tested on a standard NHS (National Health Service) panel. As a result, many women are told their testosterone is normal when the more clinically relevant number has not been checked. Testosterone also varies across the menstrual cycle and at different times of day, which makes a single snapshot test even less straightforward to interpret without the right clinical context. This does not mean testing is pointless. It means testing needs to be interpreted properly, with the full clinical context and a clinician who knows what they are looking at.

Symptoms that might suggest low testosterone in women

No single symptom confirms low testosterone, and these overlap with other hormonal changes. But if several feel familiar, it is worth asking the question:

• Significant decrease in sex drive, especially where this represents a change from your baseline
• Persistent fatigue that does not improve with rest
• Noticeable loss of motivation, drive, or ambition, different from low mood in the classic sense
• Difficulty building or maintaining muscle despite training
• Brain fog, reduced mental sharpness, or reduced confidence in cognitive function
• Low mood or emotional flatness that has not fully resolved on oestrogen alone

Support for energy, muscle, and metabolic health

While testosterone is a clinical conversation in its own right, the foundations of energy, muscle maintenance, and metabolic health matter alongside it. Creatine and a women's multivitamin support the muscle and energy side, and these guides cover the nutrition and lifestyle picture:

Creatine increases physical performance with regular training; food supplements, not a substitute for medical advice.

Why so many women are still waiting

The information gap around testosterone in women is real, and it has been real for a long time. Part of it is a research gap: most hormonal studies, historically, focused on men, and the translation to women's hormonal health came later. Part of it is the absence of a licensed product specifically for women in the UK, which makes prescribers less confident.

Dr Louise Newson, a leading UK menopause specialist, has been vocal about the underuse of testosterone in women's HRT for years. The British Menopause Society supports its use. NICE recommends it in specific circumstances. And yet many women complete their HRT journey with oestrogen and progesterone, still not feeling fully well, with testosterone never once mentioned.

At Debora Tentis Clinic, this is part of every hormonal health conversation. Not because testosterone is a magic solution, but because a complete hormonal assessment for a woman in perimenopause or menopause should include all three hormones, not two.

Keep reading: If brain fog and low mood are part of your own pattern, the second half of the cycle and progesterone are worth understanding too. PMS: The Hormonal Causes and What Actually Helps.

What to do if you think this might be relevant to you

Start with your GP. Ask specifically about testosterone, not just HRT in general. If they are not familiar with prescribing it for women, ask for a referral to a menopause specialist or a women's health pharmacist with prescribing expertise in this area.

If you are already on HRT and still not feeling well, go back. "Not quite right" is a clinically relevant symptom, and low testosterone is one of the reasons it happens. You are not overreacting, and you do not have to just get used to it.

Shop the products in this post

These are the clinic guides and resources that support the energy, muscle, and metabolic side of the testosterone conversation:

Browse the full range at deboratentis.com. For a complete hormonal health conversation that includes all three hormones, book a Health and Wellness Consultation at Debora Tentis Clinic (£60).

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Debora Tentis is a Women's Health Pharmacist and Independent Prescriber Trainee at Debora Tentis Clinic, Milton Keynes. This post is for educational purposes only and does not constitute medical advice.