Testosterone for Women
Hormones & Treatment
Testosterone for Women
The hormone hiding in plain sight — and why it matters more than you think.
Testosterone replacement for women has historically been a taboo subject in mainstream medicine. And the reason comes down to something surprisingly simple: we gendered our hormones. We called testosterone the “male” hormone and estrogen the “female” hormone — and in doing so, we ignored the physiology entirely.
Here’s the fact mainstream medicine has been slow to reckon with: women have more testosterone than estrogen in their bloodstream. Much of our circulating estrogen actually begins as testosterone and is converted via an enzymatic reaction. Testosterone isn’t foreign to the female body — it’s foundational to it.
What happens to testosterone over time?
A woman’s natural testosterone production peaks in her mid-20s, then begins a gradual decline. By the time perimenopause arrives, levels may be extremely low. This matters because testosterone plays a role in far more than libido — it affects energy, cognition, muscle tone, pelvic floor strength, and overall vitality.
Low testosterone in women can contribute to:
Is testosterone supplementation safe for women?
Yes — when monitored appropriately. Once a low testosterone level is confirmed with bloodwork, treatment typically begins with a daily topical testosterone gel. Unfortunately, there is currently no FDA-approved testosterone product for women in the U.S., though products are available in Australia and the UK.
For patients at Magnolia Midlife, I recommend using the FDA-approved male topical product at one-tenth the standard dose. Inconvenient? A little. But it works, and it’s safe when used correctly. Lab levels are rechecked at 6–8 weeks, then again at 3 and 6 months, to confirm proper absorption and ensure levels aren’t rising too high.
Side effects from excess testosterone are possible, but are much more common with hormone pellets than with topical products. If you’ve been offered pellets elsewhere, it’s worth asking about the monitoring protocol.
What about side effects?
When testosterone levels are kept within the appropriate female range, side effects are uncommon. Possible effects of excess testosterone can include excess chin hair, oily skin or acne, and hair loss. Much more rarely — and almost exclusively seen with pellets or incorrect dosing — women may experience deepening of the voice or clitoral enlargement. With correct use of a topical product and proper monitoring, these risks are very low.
One more barrier: it’s still a controlled substance
Testosterone remains a DEA-scheduled drug — a legacy of the sport doping scandals of the 1980s. This creates an additional hurdle between women and the relief they need, including restrictions on how and where it can be prescribed and refilled.
The good news: now that the black box warning has been removed from estrogen products, advocates and prescribing physicians are actively working to have testosterone removed from the DEA’s scheduled drug list. Progress is slow, but it’s moving.
The bottom line
Testosterone is not a male hormone. It is a human hormone — and in women, it’s one that deserves far more clinical attention than it has historically received. If you’re experiencing low energy, brain fog, or changes in libido and haven’t had your testosterone levels checked, that’s a conversation worth having.
At Magnolia Midlife, we look at the full hormonal picture — not just estrogen. Because you deserve care that reflects the actual science.
Book a free meet-and-greet at Magnolia Midlife Women’s Health.
