Testosterone Isn’t Just a “Male Hormone” — Why Low T Matters for Both Men AND Women

Testosterone is often talked about as a “male hormone,” but that distinction doesn’t represent the whole picture. Testosterone plays an important role in sexual desire, mood, energy, muscle, bone health, and overall vitality in both men and women. Women naturally produce testosterone too, and levels can change with age, menopause, surgical menopause, certain medications, stress, illness, and other hormonal shifts. (Harvard Health)

For perimenopausal and menopausal women, testosterone is one of the most overlooked hormones in the conversation. Progesterone, and especially estrogen, usually get the spotlight, but many women also notice changes in libido, sexual response, motivation, strength, body composition (like midline weight gain), and confidence during this life stage. That does not mean testosterone is always the answer—but it does mean it deserves a thoughtful, evidence-based discussion.

Testosterone in Women: What the Evidence Actually Supports

The strongest evidence for testosterone therapy in women is for hypoactive sexual desire disorder (HSDD)—persistent, distressing low desire not better explained by other factors. The 2019 Global Consensus Position Statement concluded that the only clearly evidence-based indication for testosterone therapy in women is HSDD in postmenopausal women. (Global Consensus Statement)

That distinction matters. Testosterone is often marketed as a cure-all for fatigue, brain fog, weight gain, and aging. Current evidence does not support broad use for all menopausal symptoms or general “anti-aging.” The International Society for the Study of Women’s Sexual Health also emphasizes careful patient selection, dosing, and monitoring. And while this topic may be difficult to discuss with your doctor, it’s very important to bring it up.

Why Women Are Often Missed

Many women are told their symptoms are “just stress,” “just aging,” or “just menopause.” But libido changes, low motivation, reduced muscle mass, mood shifts, and changes in body composition are often multifactorial—and hormones can be one piece (and sometimes a big one) of that puzzle.

A proper evaluation should never stop at estrogen alone! If that is the only lab your doctor is ordering, demand more!

What Labs Should Be Considered?

If testosterone is part of the conversation, labs should be thoughtful and comprehensive, not one quick checkbox.

Commonly used labs include:

·         Total Testosterone

·         Free Testosterone (often calculated, not directly measured)

·         Sex Hormone Binding Globulin (SHBG)

·         DHEA-S (Dehydroepiandrosterone sulfate)

·         Estradiol (E2)

·         Progesterone (if cycling or on therapy)

Why DHEA-S Matters

DHEA-S is an adrenal hormone that acts as a precursor to testosterone and estrogen. Low DHEA-S may contribute to low androgen levels, particularly in women, and can point toward adrenal involvement—not just ovarian hormone changes.

But labs are not the whole story. Here’s where many people get frustrated:

·         A “normal” testosterone level does not rule out symptoms

·         There is no universally agreed-upon optimal range for women

·         Lab reference ranges are often broad and based on population averages—not symptom resolution

This is why clinical context matters just as much as numbers. A thorough workup should also consider:

·         Thyroid panel (TSH, free T3, free T4, antibodies)

·         Iron/ferritin

·         Vitamin D

·         Insulin resistance/metabolic markers

·         Sleep, stress, medications (like SSRIs, birth control, etc.)

A Real-World Problem: When Care Falls Short

This is unfortunately common:

A patient presents with symptoms. Testosterone isn’t tested initially. When it finally is, treatment is offered—but:

·         Only one form is presented (often compounded cream)

·         The patient has side effects or poor absorption

·         Levels don’t improve

·         The patient asks for alternatives

·         They are told other options are unavailable or “dangerous”

That last part is where things break down.

Let’s be clear:

Not all non-compounded options are “dangerous.”

There are multiple delivery methods used in clinical practice, including:

·         Transdermal gels (used at lower doses for women)

·         Patches (limited availability in the U.S.)

·         Injections (used cautiously and less commonly in women)

·         Compounded formulations

Each has pros and cons:

·         Creams can have variable absorption

·         Gels can be more consistent but require careful dosing

·         Injections can cause peaks and troughs if not managed properly

The issue isn’t that one is universally “safe” and another “dangerous.”

The issue is appropriate dosing, monitoring, and patient-specific decision-making.

The U.S. Food and Drug Administration notes that no testosterone product is currently approved specifically for women in the U.S., which means clinicians must use off-label strategies carefully and responsibly.

It’s hard to ignore that this gap reflects a longstanding issue: women’s health—especially in areas like sexual function, hormonal balance, and menopause—has historically been under-researched and under-prioritized. For decades, symptoms that significantly impact quality of life were minimized, normalized, or simply not studied at the same depth as comparable conditions in men. The encouraging shift is that this is starting to change. Conversations around perimenopause and menopause are becoming more open, more evidence-driven, and less stigmatized. As these topics move out of the shadows, there is growing momentum for better research, clearer guidelines, and therapies designed specifically for women—not adapted as an afterthought.

Natural Support: Where Do Supplements Like DHEA Fit In?

This is where a lot of patients start—and where clarity is really needed.

Dehydroepiandrosterone (DHEA) is a hormone produced by the adrenal glands and serves as a precursor to both testosterone and estrogen. It is available over-the-counter in the U.S., which makes it appealing—but that doesn’t mean it’s automatically appropriate or risk-free.

What the research shows:

·         DHEA levels naturally decline with age

·         Supplementation can increase androgen levels (including testosterone) in some individuals

·         Effects on libido and well-being are variable and not consistently strong across studies

·         Evidence for broad use in healthy women is limited and mixed with current studies

Some studies show modest improvements in sexual function in certain populations (like adrenal insufficiency), but results are not consistent enough to recommend it universally.

Important considerations:

·         DHEA converts differently in different people (into testosterone, estrogen, or both)

·         Dosing is not one-size-fits-all

·         Side effects can include:

·         Acne

·         Oily skin

·         Hair changes

·         Mood shifts

·         It can interact with:

·         Hormone replacement therapy (HRT)

·         Certain medications (including antidepressants and metabolic meds)

Clinical takeaway:

DHEA can be a useful tool in select cases, particularly when DHEA-S is low—but it should be:

·         Based on lab values

·         Used at appropriate doses (often much lower than OTC labels suggest)

·         Monitored over time with your provider

It is not simply a “natural testosterone booster” you should take blindly.

Advocating for Yourself

If you feel like something is being missed, you are NOT wrong to ask questions.

Here are reasonable, evidence-based things to advocate for:

·         “Can we look at a full hormone panel, including testosterone and DHEA-S?”

·         “How are you interpreting my labs in the context of my symptoms?”

·         “If this form isn’t working for me, what are my alternatives?”

·         “Are there non-prescription options like DHEA that make sense for me—or not?”

·         “How will we monitor levels and side effects over time?”

You are not asking for something inappropriate. You are asking for complete care.

Low Testosterone in Men

Men can also experience clinically significant low testosterone, but diagnosis requires both symptoms and consistently low lab values. The Endocrine Society recommends confirming low testosterone with repeat morning testing. The American Urological Association uses a total testosterone below ~300 ng/dL as a reasonable cutoff in context.

Symptoms may include:

·         Low libido

·         Erectile dysfunction

·         Fatigue

·         Loss of muscle mass

·         Increased body fat

·         Low mood

Testosterone therapy may help men, particularly those with affected sexual function and body composition. However, it is not recommended simply for aging or energy enhancement without clear deficiency. (Mayo Clinic)

What About Heart Risk?

Testosterone safety has been debated for years. The TRAVERSE Trial found testosterone therapy was not associated with increased major cardiovascular events in men with hypogonadism and elevated cardiovascular risk.

That does not mean risk is zero. The FDA continues to require labeling updates, including potential blood pressure effects.

The Bottom Line

Testosterone is NOT just a men’s hormone—and it’s not a magic fix either.

For women, especially in perimenopause and menopause, it is often under-evaluated and under-discussed, particularly when it comes to sexual health and overall vitality.

For men, it is often over-marketed but under-diagnosed correctly.

And when it comes to “natural” options like DHEA, the same rule applies:

·         Just because it’s available over the counter doesn’t mean it’s simple—or appropriate for everyone.

·         The goal is not “more hormones.”

·         The goal is better, more complete, evidence-based care.

And that starts with asking better questions—and working with providers willing to answer them. If you have questions about who to turn to for these issues, how to talk to your doctors, or wonder which supplements may be helpful, our providers are always here to help. Read up on our wide variety of healthcare professionals at www.naturalcarewoodbury.com.