Testosterone in women: more than libido
Many of us grow up hearing testosterone described as a “male hormone”. In reality, women make testosterone too, and it supports day‑to‑day wellbeing in ways that can be easy to miss.
This article is written from a patient perspective. It explains what testosterone does in the female body, what symptoms may suggest your level is too low or too high, and how testing and treatment are approached in Australia.
What testosterone does in the female body (role)
Testosterone is an androgen (a family of hormones that influence tissues like skin, hair follicles, brain, muscle, and bone). In women, testosterone acts more like a “supporting hormone” than a dominant driver.
Common roles include:
Sexual desire and arousal: supporting interest in sex and sexual responsiveness.
Energy and vitality: contributing to motivation and “get up and go” (alongside thyroid hormones, cortisol, and oestrogen).
Mood and cognition: supporting mood stability, confidence, and mental clarity for some people.
Muscle and strength: helping maintain lean mass and physical capacity.
Bone health: working alongside oestrogen to support bone density.
Testosterone is also a precursor hormone. Your body can convert it into:
Estradiol (an oestrogen) via aromatase.
Dihydrotestosterone (DHT) (a more potent androgen) via 5‑alpha reductase.
Where testosterone comes from in women
Women produce testosterone from several sources:
Ovaries and adrenal glands (direct production).
Peripheral tissues (such as fat and skin) that convert other androgens (for example, androstenedione) into testosterone.
Because production is distributed, testosterone levels and symptoms can be influenced by:
ovarian function (including menopause)
adrenal health and stress physiology
body composition and insulin sensitivity
medications (including some forms of hormonal contraception)
Why blood results can be confusing (SHBG, free testosterone)
In your bloodstream, most testosterone travels bound to proteins:
Sex Hormone Binding Globulin (SHBG)
Albumin
Only a small fraction is “free” (unbound) and able to enter cells easily. This matters because two people can have the same total testosterone but very different free or bioavailable testosterone depending on SHBG.
Things that can raise or lower SHBG include thyroid status, oestrogen levels, liver health, and some medications.
When testosterone may feel “too low” (symptoms)
Testosterone symptoms are not specific. Many can overlap with thyroid issues, iron deficiency, sleep deprivation, chronic stress, depression, perimenopause/menopause, and relationship or life factors.
That said, the symptom with the strongest evidence for testosterone treatment in women is:
Hypoactive Sexual Desire Disorder (HSDD): a persistent lack of sexual desire that causes distress and is not better explained by another medical condition, medication, relationship difficulty, or mental health concern.
Other symptoms that may sometimes be reported alongside low androgen levels (but are less specific) include:
reduced sexual pleasure or arousal
fatigue or low stamina
reduced strength or slower recovery from exercise
low mood, reduced motivation, or “flatness”
reduced sense of wellbeing
Common “look‑alikes” worth checking
Because symptoms overlap, clinicians often also consider:
iron studies and B12
thyroid function
sleep quality and obstructive sleep apnoea risk
mood and anxiety
medication side effects
perimenopause/menopause status and oestrogen/progesterone balance
When testosterone may be “too high” (symptoms)
When testosterone (or DHT) is higher than expected for your stage of life, symptoms tend to show up in tissues like skin and hair follicles.
Possible signs include:
acne or oily skin
increased facial or body hair growth (hirsutism)
scalp hair thinning
irregular periods (in premenopausal women)
A common underlying cause is polycystic ovary syndrome (PCOS). PCOS is a pattern of symptoms and signs that can include irregular cycles, features of higher androgens, and metabolic changes such as insulin resistance.
Testosterone changes across life stages
Testosterone does not usually “crash” overnight. In many women it declines gradually from early adulthood.
Around midlife, symptoms can become more noticeable because testosterone is changing in the context of other shifts, including:
fluctuating and then falling oestrogen during perimenopause
changes in SHBG
changes in sleep, stress load, and body composition
How testosterone is assessed in practice (Australia)
If you are experiencing symptoms that could fit low or high testosterone, a clinician will usually start with:
a careful symptom history (including sexual health, mood, sleep, and relationship context)
medication review
targeted blood tests
Testing considerations
Testosterone in women is present at low concentrations, so assay quality matters.
Results are interpreted using female reference ranges and in the context of symptoms.
Clinicians often consider total testosterone, SHBG, and calculated free testosterone rather than relying on a single number.
Testing is not a substitute for a full assessment. Your symptoms and context matter as much as your lab values.
Treatment
In Australia, testosterone treatment for women is usually considered only when:
symptoms are clearly consistent with HSDD, and
other common contributors have been assessed and addressed, and
treatment is prescribed and monitored by a clinician experienced in women’s hormonal health.
Forms of testosterone
Testosterone for women is commonly prescribed in low‑dose transdermal preparations (applied to the skin) because small, steady dosing is important.
Key safety principles
Physiological dosing: women typically require a small fraction of male doses.
Avoiding excess: the goal is symptom improvement without pushing levels above the typical female range.
Monitoring: follow‑up includes symptom review and blood tests (and sometimes monitoring of lipids, liver function, and full blood count depending on individual context and local practice).
Side effects to watch for
If the dose is too high, side effects may include:
acne
increased body or facial hair
scalp hair thinning
voice changes (rare, but important to report early)
mood changes
If you notice side effects, contact your prescribing clinician promptly. Early dose adjustment is often important.
Bringing it together
Testosterone can be an important piece of the hormonal puzzle for women, but it is rarely the only piece. The most useful approach is usually:
start with your symptoms and life context
rule out common “look‑alikes”
use targeted blood testing to support (not replace) clinical assessment
if appropriate, treat conservatively and monitor carefully
If you are concerned about your symptoms or blood results, speak with your GP or a clinician experienced in women’s hormonal health.
References
Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660–4666.
Islam RM, Bell RJ, Green S, et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754–766.
Rosner W, Auchus RJ, Azziz R, Sluss PM, Raff H. Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. J Clin Endocrinol Metab. 2007;92(2):405–413.
Teede HJ, Misso ML, Costello MF, et al. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602–1618.
Disclaimer (educational information only): This article provides general educational information and is not a substitute for personalised medical advice, diagnosis, or treatment. Hormone therapy is not suitable for everyone and requires assessment and monitoring by a qualified health professional. If you have symptoms or concerns, please speak with your GP or another qualified clinician. In a medical emergency, call 000.