Testosterone in Women: An Underestimated Hormone with Significant Impact

When hormones are discussed, the focus is usually on estrogen and progesterone. In contrast, testosterone in women is often underestimated or misunderstood. However, scientific research has shown for decades that testosterone also plays an important role in the female body.

Particularly during perimenopause and after menopause, declining testosterone levels can be associated with noticeable changes in both physical and psychological well-being. Despite this, testosterone is often not routinely measured in clinical practice or considered in therapeutic decision-making.

What role does testosterone play in the female body?

The female body also produces testosterone, primarily in the ovaries and adrenal glands. Although the amounts are significantly lower than in men, its effects are no less important. Testosterone influences, among other things:

• libido and sexual function
• energy levels, motivation, and drive
• muscle strength and physical performance
• concentration and mental clarity
• mood and self-confidence
• bone and joint health

When testosterone levels decline, this can become noticeable across many of these areas. The symptoms are often non-specific and are not always directly linked to hormonal changes.

Why testosterone in women is often overlooked

A key reason for the uncertainty surrounding testosterone in women lies in a fundamental misunderstanding. Testosterone is frequently perceived as a “male hormone.” In addition, there is often confusion between synthetic anabolic steroids and bioidentical testosterone.

Synthetic substances have an altered chemical structure and may cause side effects if used incorrectly. Bioidentical testosterone, on the other hand, is structurally identical to the hormone naturally produced by the body.

This difference can be explained simply: it is comparable to a real strawberry versus an artificial strawberry flavor. Both may seem similar, but they are not biologically the same. Due to concerns about potential risks, testosterone in women is often not measured or considered in treatment at all.

Testosterone in women during menopause

As we age, hormonal balance changes. During perimenopause, hormone levels begin to fluctuate, and after menopause, they decline significantly.

In addition to estrogen and progesterone, testosterone is also affected. Low testosterone levels may contribute to increased fatigue and difficulties with concentration. These changes often develop gradually and are not always immediately recognized as hormone-related.

Why do testosterone levels decline in women?

The decrease in testosterone levels typically does not occur suddenly, but develops over a longer period of time. Common contributing factors include:

• natural aging processes, particularly from perimenopause onward
• declining ovarian function
• reduced activity of the adrenal glands
• chronic stress and elevated cortisol levels
• hormonal changes following the use of contraceptives
• metabolic changes

An important and often overlooked factor is SHBG (sex hormone-binding globulin). This protein binds testosterone in the bloodstream and influences how much of it is actually biologically active. It is not only the total level that matters, but especially the proportion of free testosterone.

Total testosterone vs. free testosterone – an important distinction

In clinical diagnostics, total testosterone is often the primary value measured. However, this alone has limited significance. A large portion of testosterone in the blood is bound and therefore not available for active use by the body. What is more relevant is the level of free testosterone.

It is possible for laboratory values to fall within the normal range while symptoms are still present, for example when:

• free testosterone levels are too low
• SHBG levels are elevated
• the overall hormonal balance is disrupted

A comprehensive and differentiated hormonal analysis is therefore essential to accurately assess the individual situation.

When testosterone therapy may be appropriate in women

Testosterone therapy is not a universal solution, but in certain cases it can be a meaningful component of an individualized hormone treatment plan. Key prerequisites include:

• careful diagnostic evaluation
• confirmed low testosterone levels
• corresponding clinical symptoms

Studies indicate that individually tailored testosterone therapy may have beneficial effects in selected postmenopausal women, particularly in terms of libido, energy levels, muscle mass, and overall well-being. It is important that the goal is not to reach “male” hormone levels, but rather to restore a physiological range appropriate for women.

Bioidentical testosterone therapy – what matters

In modern hormone medicine, bioidentical testosterone is increasingly used, often in the form of a precisely dosed gel. Bioidentical testosterone has the same molecular structure as the hormone produced by the body, allowing for targeted and individualized application.

The goal is not to mask individual symptoms in the short term, but to restore hormonal balance. With an appropriate therapy, many women report:

• increased energy and drive
• more stable mood
• a return of libido
• changes in body composition, including increased muscle mass

Testosterone therapy should always be considered within the overall hormonal context

An important aspect is often overlooked in discussions: hormones never act in isolation within the body. Testosterone interacts closely with:

• estradiol
• progesterone
• thyroid hormones
• metabolic processes

For this reason, evaluating or treating testosterone in isolation is not medically appropriate. A responsible approach to testosterone therapy always takes the entire hormonal system into account. Only once this broader picture is understood can it be determined whether supplementation is appropriate and in what form.

Testosterone, estrogen, and progesterone – the hormonal interplay

Testosterone is part of a complex hormonal balance. While estrogen is primarily relevant for mucous membranes, skin, circulation, and various metabolic processes, and progesterone plays an important role in the nervous system and overall internal balance, testosterone is more closely associated with energy levels, physical performance, and structural stability.

These three hormones influence one another. If one of them becomes imbalanced, it can affect the entire system. For this reason, it is essential not to focus on individual values alone, but to consider the overall hormonal picture.

Why an individualized hormone analysis is essential

Every woman has a unique hormonal baseline. Factors such as lifestyle, stress levels, metabolism, genetic predisposition, and previous treatments all influence how the body responds to hormonal changes. This is why there is no one-size-fits-all solution.

Effective treatment is always based on an individualized assessment and a careful evaluation of the entire hormonal situation.

How we can support you with this program

If you feel that your body has changed and the underlying causes are unclear, a targeted hormonal analysis can be a valuable first step. At the practice of Dr. Isabella Wilden, every treatment begins with a comprehensive evaluation of your individual situation. This includes:

• a detailed medical history
• a thorough assessment of your symptoms
• targeted laboratory testing
• evaluation of the overall hormonal balance

Based on these findings, an individualized treatment plan is developed. If medically appropriate, this may include bioidentical hormone replacement therapy.

The goal is not only to address individual symptoms, but to restore long-term hormonal balance, thereby sustainably improving energy levels, physical performance, and overall quality of life.

If you would like to better understand the role your hormones may play in your symptoms, a comprehensive analysis can be the first step.