The Hormone Nobody Mentions: How Testosterone Keeps Women Feeling Like Themselves

She has the life she worked for, balancing her career and social life with a calendar full of tennis and dinners with friends. For years, she managed it all and still felt like herself. But somewhere around forty-five, things began to change. Her workouts seemed to do less, her skin began to look thinner, words slipped away mid-sentence, and desire became something she remembered more than felt. Her doctor checked her thyroid and said hormones were a conversation for later. Yet nobody mentioned testosterone, a hormone I believe deserves more attention in women’s midlife care.

Testosterone is part of a woman’s own chemistry, made in her ovaries and adrenal glands in small amounts that matter a great deal. It acts on muscle, bone, skin, and the brain, and it plays a large part in desire. It fades early: large studies using today’s most accurate blood tests show it falling gradually from a woman’s twenties, about a quarter lower by her late thirties and roughly half by sixty, so by the time her periods start to space out much of it is gone. After menopause her estrogen and progesterone are essentially flat as well.

I think of a beautiful grapevine that is still standing but no longer fed, its grapes slowly withering. Is that what we want for every woman in this country?

Bone shows why timing matters. Osteoporosis in women follows mainly from the loss of estrogen, yet the usual approach is to wait for a worrying bone scan and then prescribe a drug such as Fosamax, which alters the way bone rebuilds itself and, with long-term use, carries rare but serious complications. Replacing hormones early, before the loss, helps keep bone and muscle where they were and lets a woman stay in the health of her thirties and forties for as long as possible.

I usually start with testosterone and add estrogen later. Estrogen matters, especially for bone, but it takes more fine-tuning and can bring back bleeding, which no woman welcomes. Testosterone produces a change women notice quickly, and what they describe is vitality. More than one patient has asked me some version of “What have I been doing the last five years without this?” You never know what you are missing until you get it back. The dose is tiny, a tenth or less of a man’s, and the goal is to restore the levels she had in her healthier years, with blood work to keep it there.

In fairness, the research is still catching up. A 2019 international consensus statement found that the strongest evidence for testosterone therapy was for women experiencing distressingly low intimate desire after menopause, and called for more study on bone, muscle, and memory. The FDA has revised several major warnings on menopausal hormone therapy, but there is still no approved testosterone product specifically for women. In my opinion, the potential benefits for appropriately selected patients deserve serious consideration. Women should not have to wait until these changes become overwhelming to seek help. If symptoms are affecting your quality of life, now is the time to discuss your hormones with a physician and explore whether treatment is right for you.