Testosterone gets marketed as a guy thing: gym bros, truck commercials, and a lot of shouting. Meanwhile, women make it their whole lives, have receptors for it nearly everywhere in their bodies, and lose it slowly with age, the same way men do. Almost nobody tells them.
We’d like to change that. Here’s what testosterone does in a woman’s body, what we know, what we don’t yet, and how we use it.
Your ovaries and adrenal glands make testosterone every day. In fact, measured by weight in your blood, most women have more testosterone circulating than estradiol for most of their lives, and after menopause it isn’t even close. Testosterone isn’t a borrowed male hormone. It’s one of yours.
It also doesn’t fall off a cliff at menopause. It declines gradually, starting in your twenties. By your forties, levels are roughly half what they were at twenty-one. If your ovaries are removed, the drop is sudden. Birth control pills can lower the amount your body can actually use, too.
Estrogen’s decline at menopause gets the headlines. This is the androgen decline nobody talks about.
Fair warning: every one of these can have other causes, and a blood test alone can’t tell us whether testosterone is the answer. That’s why we start with a conversation, not a lab slip.
We start with your story: symptoms, cycle or menopause status, medications, sleep, and what you’re hoping changes. Then labs, including total testosterone and the protein that binds it (SHBG). Labs give us a safe starting point and rule out other problems. They don’t decide for you whether you’ll benefit.
We start with testosterone applied to the skin, dosed for women. It’s adjustable, easy to stop, and makes it easy to keep levels in the normal female range. Pellets or injections may be an option later for some women. Pellets can’t be adjusted once they’re in, so they come after we know how your body responds, not before.
We recheck your levels about six weeks after you start, then adjust. The goal is normal female levels, not more.
Testosterone isn’t a single-purpose hormone. Androgen receptors, the docking stations testosterone acts on, show up in nearly every major tissue in a woman’s body. Here’s what the hormone does when it gets there.
That’s the biology, and it’s not in dispute. What hasn’t happened is the research translating it into treatment outcomes for women, because the funding and attention have gone almost entirely to men.
Until a 1993 federal law required it, women weren’t routinely included in NIH-funded clinical trials. Medicine spent decades studying men and assuming the results applied to everyone. Women’s hormones were treated as a complication to control for, not a subject worth studying.
Men have a whole shelf of FDA-approved testosterone products. Women have zero. In 2004 the FDA declined a testosterone patch for women, asking for more long-term safety data. Europe approved the same patch two years later. The data the FDA wanted was never generated, and American women were left with off-label prescribing.
In 2002, early results from the Women’s Health Initiative sent hormone prescribing and hormone research into a nosedive. Later analyses painted a much more nuanced picture, especially for women closer to menopause, but the fear outlasted the facts by about twenty years.
A lot of the caution around women’s hormones has been framed as protecting women, with far less attention to the cost of leaving them untreated. We take risks seriously; that’s what the risks section below is for. We also think “we haven’t studied it” is not the same as “it doesn’t work.” We lean on the best evidence available, make decisions with you, and want to be part of building the evidence women deserve.
We recheck labs about six weeks after you start. Most women who respond notice changes in desire within 6 to 12 weeks, and we reassess at about six months. Other effects, like strength or energy, are less predictable and may take longer. If it isn’t helping, we stop it.
Results vary. Your plan and expectations will be based on your own evaluation.
We’re a cash-pay clinic, so there are no surprise insurance bills.
Ongoing hormone care, including testosterone, labs, and follow-up, starts at $200/month. Our menopause membership bundles hormone care with everything else, for women who want it all under one roof.
Your care is led by Dr. Jake Shank, a board-certified physician and Menopause Society Certified Practitioner. We take women’s androgen health seriously, which means talking about the benefits medicine has ignored and the risks marketers leave out, in the same conversation.
Not at female doses. Masculinizing effects come from levels well above the normal female range, which is exactly what our dosing and lab checks are designed to prevent.
By weight in the bloodstream, yes, for most women most of the time, and especially after menopause. Estrogen is far more potent per molecule, so they’re not interchangeable. But “testosterone is the male hormone” has never been accurate.
Yes. Testosterone starts declining in your twenties, and it’s an option we discuss with women at any stage. Most of the research is in postmenopausal women, and we’ll be upfront about that.
Not in the US. No product has been approved for women here, so all testosterone prescribing for women is off-label. That says more about the research funding than about the hormone.
Please don’t. Men’s products are dosed for men, roughly ten times what a woman needs, and eyeballing it is how women end up with side effects. We’ll get you a dose built for you.
Book a consultation and bring your questions, even the awkward ones. Especially the awkward ones.
