Wait, Women Need Testosterone Too?

When I told my husband I was thinking about starting testosterone, he looked at me and said:

“I’d rather have a wife who doesn’t want as much sex as she used to than a wife with a beard.”

I laughed because, honestly, that is pretty much the entire cultural conversation around testosterone for women in one sentence.

Testosterone is still treated like the male hormone.

The hormone that makes men hairy, aggressive and horny.

The one you take if you want to bench-press a refrigerator and yell at people in traffic.

Meanwhile, women have been making testosterone our entire lives.

We just make less of it than men do.

And somewhere around our 30s, the amount our bodies produce begins to decline.

That is the part that tends to get left out.

Your hormones have never been exactly chill

There is another piece of this conversation that gets overlooked: women don't have one static hormonal state.

During our reproductive years, estrogen and progesterone rise and fall throughout the menstrual cycle. Testosterone moves, too, although its fluctuations are generally smaller than those of estrogen and progesterone.

So your body is essentially running a monthly endocrine production with a rotating cast of hormones, and we're somehow surprised when energy, mood, appetite, sleep, sex drive and physical performance don't feel exactly the same every week.

Then there's the longer timeline.

Testosterone is produced by the ovaries and adrenal glands. Levels generally decline as women age, with production beginning to decrease earlier in adulthood.

It isn't some dramatic cliff where you wake up on your 31st birthday and suddenly need a hormone prescription.

It can be much more subtle than that.

But over time, the amount your body produces can become meaningfully lower.

So, in short, women are navigating decades of monthly hormonal fluctuations while another important hormone is gradually trending downward in the background.

And then we act surprised when she says:

“I don't really feel like myself lately.”

That deserves a better conversation.

Testosterone is about libido.
But libido is not the whole story.

Sexual desire is where the evidence for testosterone in women is strongest, particularly for women with hypoactive sexual desire disorder.

Testosterone plays an important role in sexual desire, arousal and sexual function, which is why it has become such an important part of the conversation around female sexual health.

But testosterone receptors aren't hanging out exclusively in your sex organs waiting for a date night.

Testosterone is involved throughout the body.

It plays a role in maintaining muscle and bone, and researchers continue to study its relationship with energy, mood, cognition and body composition.

Some women report feeling more energetic, stronger or mentally sharper when their hormone levels are appropriately supported. The research behind those broader benefits, however, isn't nearly as definitive as it is for sexual desire.

That distinction matters.

We don't need to pretend testosterone is a magic hormone that fixes everything.

We can simply acknowledge that it is an important hormone with a much bigger job description than most women were ever taught.

The muscle conversation is really a longevity conversation

This is one of the reasons I think the testosterone conversation deserves to move beyond sex.

Muscle becomes increasingly important as we age.

Maintaining strength, lean mass and physical function isn't just about looking good in jeans. It's part of staying capable, independent and resilient as we get older.

Testosterone is one of several hormones involved in muscle and bone health.

That does not mean testosterone replaces lifting weights, eating enough protein, sleeping well or taking care of your body.

It means hormones are part of the larger biological picture.

And if we're going to talk seriously about women's health, we should probably talk about the whole picture.

And no, testosterone doesn't automatically give you a beard

This is where my husband's comment actually has a tiny kernel of truth.

Testosterone is powerful.

Too much testosterone can cause unwanted effects, including acne, increased facial or body hair, scalp hair thinning and, at higher levels, voice changes or clitoral enlargement.

Which is precisely why more testosterone is not necessarily better testosterone.

For women, the goal isn't to turn the dial as high as possible.

It's to use an individualized dose when appropriate, with appropriate clinical oversight and monitoring.

The beard is not the goal.

Feeling like yourself is.

So will MADRES offer testosterone?

We hope to offer testosterone in the near future and once available, clinicians may prescribe testosterone for women in certain circumstances, and compounded topical formulations may be used when an individualized formulation is appropriate.

That's where compounded testosterone can have a place.

A topical cream can allow a clinician to prescribe a specific formulation and dose and adjust treatment based on the individual woman, her symptoms, relevant lab work and response to treatment.

At MADRES, we believe women's hormones deserve that kind of individualized approach & we are excited to offer this soon,.

Because there is no universal “female hormone dose.”

There is your biology.

Your symptoms.

Your medical history.

Your labs.

And how you respond to treatment.

That's a much more interesting conversation than simply asking whether testosterone is “for women.”

Maybe it's time we stopped treating testosterone like a dirty word

Women have spent decades being told that exhaustion is normal.

That losing muscle is just aging.

That a disappearing sex drive is something we should quietly accept.

That brain fog is what happens when you have kids, a career, a mortgage and 47 tabs open in your brain.

Some of those things are life.

Some are hormones.

And sometimes it's both.

Testosterone is not a miracle cure.

It isn't right for every woman.

And taking more of it isn't automatically better.

But it is a naturally occurring hormone in women. It changes throughout a woman's life. And it deserves far more attention than the occasional conversation about libido or the fear of growing a beard.

Getting older doesn't mean you have to automatically accept feeling unlike yourself as the price of admission.

And maybe the next time someone says testosterone is a “men's hormone,” we can give them a slightly more accurate answer:

No. It's a human hormone.

Women just spent way too long being left out of the conversation.