What will testosterone do to you? Testosterone in Women, and Mid-Life Care

Let me ask you something.

When you picture hormone therapy for women in midlife, what comes to mind? Probably estrogen patches. Maybe progesterone. The classic duo that gets all the attention, all the research headlines, all the conversation at your annual appointment.

But what if I told you there's a third hormone — one your body has been making since adolescence, one that quietly shapes your energy, your mood, your drive, your sexual health, your muscle strength, and even your sense of self — that almost nobody talks about?

Testosterone. In women.

Stay with me here, because this might be the most important thing you read about your hormones in a long time.

You Were Never Supposed to Know About This

That sounds dramatic, but it's not far from the truth. For decades, testosterone has been classified in the cultural imagination as a "male hormone." It's what makes men aggressive, competitive, muscular. It's the stuff of locker rooms and sports scandals.

Except that framing is wrong — and it's left an enormous gap in women's healthcare.

Women produce testosterone too. We've always produced it. It comes primarily from the ovaries and the adrenal glands, and it plays a meaningful role in how we feel throughout our entire lives. The problem is that levels begin declining in our 30s — well before menopause — and continue dropping through perimenopause and beyond. By the time many women are navigating the hormonal chaos of midlife, they've quietly lost a significant portion of the testosterone they had in their 20s, and no one has ever told them that might matter.

Dr. Kelly Casperson, a urologist and one of the most passionate voices in women's sexual and hormonal health, has made this her mission (you have probably noticed that I really admire Dr Casperson and have her books and podcasts in my newsletters, social posts, etc). Through her podcast You Are Not Broken and her book of the same name, she's been helping women understand that the symptoms they've been brushing off — the flat affect, the low libido, the fatigue that coffee can't fix — are not just "part of getting older." They're physiological. They're real. And they're often addressable.

"Women deserve to understand what's happening in their bodies," Dr. Casperson has said. "We deserve the same access to evidence-based care that men get."

She's right. And it starts with a conversation most of us have never been invited into.

So What Does Low Testosterone Actually Feel Like in Women?

This is where it gets personal — and where so many women have a quiet moment of recognition.

Because the symptoms of low testosterone in women don't usually announce themselves loudly. They creep in. They overlap with burnout, with depression, with the general overwhelm of midlife. They're easy to dismiss. They're even easier to blame on yourself.

Here's what women with low testosterone often describe:

Fatigue that sleep doesn't fix. Not just tiredness — a kind of deep flatness, an absence of the spark that used to get you going in the morning.

Loss of motivation and drive. Things that used to excite you feel muted. Ambitions feel heavier. You wonder if you've just become someone who doesn't care as much.

Decreased libido. Not just less interest in sex, but often a loss of the mental and physical engagement that used to come naturally. This one is frequently dismissed as normal aging or relationship issues — when it's often hormonal.

Difficulty building or maintaining muscle. You're exercising just as hard, maybe harder, but your body isn't responding the way it used to.

Brain fog and difficulty concentrating. That sense of reaching for a word and not finding it. Of feeling like you're operating behind glass.

Mood changes, anxiety, and a sense of emotional flatness. Not quite depression, but not quite yourself either.

Sound familiar? You're not imagining it. And you're far from alone.

What the Science Actually Says

Here's where I want to slow down for a moment, because this matters.

The research on testosterone in women is genuinely promising — and genuinely complicated. We don't yet have the decades of large-scale clinical trials that we have for estrogen. What we do have is a growing body of evidence, a lot of clinical experience from physicians who specialize in this area, and an emerging consensus that testosterone therapy, when used thoughtfully and appropriately, can meaningfully improve quality of life for women in midlife.

Dr. Rachel Rubin, a urologist and sexual medicine specialist based in Washington, D.C., has been at the forefront of pushing this research and this conversation forward. She's spoken widely about the fact that testosterone is the only hormone for which there is currently no FDA-approved formulation for women in the United States — not because the evidence isn't there, but because of decades of regulatory and cultural neglect.

"We have an obligation to our patients," Dr. Rubin has said, "to offer them evidence-based options and to be honest about what we know and what we don't know."

That honesty is exactly what good care looks like. It means acknowledging that testosterone therapy for women is typically used "off-label" in the U.S. — meaning it's prescribed using formulations approved for men, adjusted to female-appropriate doses. It means understanding that dosing matters enormously, and that a provider who knows what they're doing will start low and adjust carefully. And it means knowing that in the research we do have, testosterone therapy in women has shown benefits for sexual function, mood, energy, and bone density — with a favorable safety profile when used at physiological doses.

This isn't a fringe idea. The International Society for the Study of Women's Sexual Health (ISSWSH) and the Menopause Society both recognize testosterone as a valid therapeutic option for women with symptoms of deficiency. The evidence is there. What's been missing is the willingness to bring it into mainstream practice.

The Conversation Your Doctor May Not Have Started

Here's the hard truth: many women don't hear about testosterone as part of their hormone care because many clinicians simply weren't trained on it. Medical education on menopause and perimenopause has historically been thin — a reality that physicians like Dr. Rubin and Dr. Casperson have been vocally and persistently working to change.

What this means for you is that you may need to be the one who brings it up. And that's okay. You deserve a provider who will take the conversation seriously.

If you're experiencing symptoms like the ones described above, here are some things worth asking about:

A complete hormone panel. Not just estrogen — testosterone (both total and free), DHEA-S, and ideally a full picture of where you are in the perimenopause or menopause transition.

Individualized interpretation. Lab ranges for testosterone in women are notoriously wide and often outdated. What matters isn't just whether your number falls within a "normal" range — it's how you feel, and whether your levels have declined significantly from where you used to be.

A provider who listens. This is perhaps the most important thing. You want someone who treats your symptoms as data, not inconveniences. Someone who asks follow-up questions. Someone who sees hormone care as an ongoing relationship, not a single prescription.

A Note on "Too Much Testosterone"

It's worth addressing this directly, because it comes up.

Yes, testosterone at too-high doses can cause side effects in women — acne, oily skin, hair changes, and in severe cases, virilization (voice changes, clitoral enlargement). These are real, and they're why careful, monitored dosing matters.

But here's the key word: physiological.

The goal of testosterone therapy in women is to restore levels to the range your body naturally maintained — not to elevate them above that. When therapy is done correctly, with appropriate dosing and regular monitoring, the risk of these side effects is low. And many women find that even conservative dosing makes a meaningful difference in how they feel.

The fear of "too much" testosterone should never be a reason to avoid the conversation altogether. It should be a reason to have the conversation with someone who knows what they're doing.

This Is Part of Caring for Your Whole Self

I want to come back to something personal for a moment.

So many of the women I talk to describe a version of the same experience: feeling like they've lost themselves somewhere in their 40s or 50s. Like the person they used to be — energetic, curious, present, embodied — has been slowly replaced by someone quieter and more tired. They've often tried everything: better sleep habits, therapy, new supplements, more exercise. Some of it helps. None of it quite gets them back.

Hormones aren't the only answer to that feeling. But for many women, they're a piece of the puzzle that nobody handed them. And when that piece clicks into place — when a woman who has been exhausted and flat for years starts feeling like herself again — it's not a small thing. It's profound.

You deserve that conversation. You deserve a clinician who takes your symptoms seriously, explains your options honestly, and partners with you in your care. You deserve to know that testosterone exists, that it matters, and that it might matter for you.

Keep Learning

If this resonates with you, I want to encourage you to keep going.

Listen to Dr. Kelly Casperson's podcast, You Are Not Broken. She has episodes specifically on testosterone in women that are warm, smart, and deeply practical. She has a gift for making complex science feel like a conversation with a trusted friend.

Follow Dr. Rachel Rubin's work. She publishes and speaks widely on women's sexual health and hormone therapy, and her no-nonsense approach to evidence-based care is exactly what this field needs.

And come back here. I'll be continuing this conversation — on the science, on finding good care, on navigating the cultural noise around women's hormones — because it matters too much to say only once.

If you have questions about your own hormone health, or if you'd like to explore whether testosterone therapy might be right for you, [reach out / book a consultation / etc.]. This is exactly the kind of conversation I'm here for.

The information in this post is for educational purposes and does not constitute medical advice.

Please work with a qualified healthcare provider who can evaluate your individual health history and needs. Thank you

for being here! Maggie Powers, NP Luna Hormone Health