The Hormone No One Talks to Women About
When women come to NOVA Wellness concerned about their hormones, the conversation almost always centers on estrogen and progesterone. Sometimes thyroid. Occasionally cortisol.
Testosterone almost never comes up — because nobody has ever brought it up with them.
Most women have spent their entire adult lives understanding testosterone as a male hormone. Something that explains why men build muscle more easily, why they have a higher sex drive, why their voices are deeper. Not something that has anything to do with how a woman in her 40s feels when she wakes up exhausted, can't hold onto muscle no matter how hard she trains, has lost any meaningful interest in intimacy, and sits across from her doctor being told her labs are normal.
Here's what most women — and frankly, many providers — don't fully appreciate: testosterone is not a male hormone. It is a human hormone. Women produce it, depend on it, and lose it. And the timeline of that loss is something worth understanding.
What Testosterone Does in Women
Women produce testosterone in the ovaries and adrenal glands in amounts that are smaller than men but physiologically essential. Testosterone in women is responsible for:
Energy and drive. Not just physical energy — the motivational, get-things-done, show-up-fully kind of energy that defines how engaged a person feels in their own life.
Lean muscle mass and body composition. Testosterone is one of the primary anabolic signals in the body — it tells muscle tissue to grow and maintain itself. Without adequate testosterone, muscle responds less efficiently to training and is lost more easily during periods of caloric deficit.
Bone density. Testosterone contributes to bone mineral density independently of estrogen. Women with low testosterone have higher rates of bone loss, a risk that accelerates significantly after menopause.
Cognitive sharpness. Focus, clarity, word recall, and mental processing speed all have a testosterone component. The brain fog that many women attribute to stress, aging, or perimenopause often has a testosterone dimension that goes unexamined.
Libido and sexual function. Testosterone is the primary driver of sexual desire in women — more directly than estrogen. Low testosterone is one of the most common and most underdiagnosed causes of low libido in women of all ages, and it is rarely measured or addressed in a conventional clinical setting.
Mood stability and emotional resilience. Adequate testosterone appears to support a baseline sense of confidence, emotional steadiness, and capacity to handle stress. Its absence can contribute to a low-grade flatness — not quite depression, but a diminishment of vitality that's hard to name.
When It Starts to Decline — And Why That Matters
This is the part most women find surprising. Testosterone begins declining in women in their late 20s. Not their late 40s. Their late 20s.
By the time a woman reaches her mid-30s, her testosterone level may already be 50 percent of what it was at its peak. By her 40s, the decline is often significant enough to be producing real, noticeable symptoms — symptoms that are frequently attributed to stress, perimenopause, depression, or simply life.
This timing matters because it means that testosterone deficiency in women is not a postmenopausal problem. It is a midlife problem — and often an earlier-than-midlife problem — that affects women who are nowhere near menopause and would never think to consider testosterone as a relevant hormone for how they feel.
The decline accelerates with certain events: surgical menopause (removal of the ovaries eliminates roughly half of a woman's testosterone production immediately), use of oral contraceptives (which raise SHBG and reduce free testosterone significantly), and chronic stress (which suppresses adrenal androgen production over time).
Why It's Almost Never Tested or Treated
The honest answer is that the medical system has been slow to take women's testosterone seriously. For decades, the conversation about testosterone therapy has been almost exclusively male-oriented — the research, the prescribing guidelines, the cultural conversation. Women were largely left out of it.
There is no FDA-approved testosterone product for women in the United States. That doesn't mean testosterone therapy for women is experimental or fringe — it means the pharmaceutical development pipeline didn't prioritize it. Providers who do address it use low-dose compounded testosterone in forms appropriate for women, which is considered off-label but is supported by a meaningful and growing body of clinical evidence.
The 2019 Global Consensus Statement on Women's Testosterone, published in major gynecology and endocrinology journals, concluded that testosterone therapy is evidence-based for the treatment of hypoactive sexual desire disorder in postmenopausal women — and recognized a growing evidence base for broader application. It's not a fringe conversation. It's an underserved one.
What Low Testosterone Actually Feels Like in Women
The symptoms are real, they're recognizable, and they're frequently written off as something else entirely.
If you've been experiencing any of the following — particularly if they've been gradually worsening over several years — low testosterone is worth evaluating:
Persistent fatigue that doesn't resolve with adequate sleep
Loss of motivation or drive that used to come naturally
Difficulty building or maintaining muscle despite consistent training
Low or absent libido — a change from your own baseline, not a comparison to anyone else
Brain fog, difficulty with focus, or slower thinking than you're used to
Low mood, emotional flatness, or a general loss of vitality that doesn't meet the criteria for clinical depression but doesn't feel like you either
Reduced physical strength or endurance that isn't explained by your training
Weight gain around the middle that persists despite reasonable effort
None of these are specific to testosterone alone. But when several are present together — especially in a woman who has been told her estrogen, thyroid, and other labs are normal — testosterone is a logical next marker to evaluate.
How Treatment Works — And What Honest Monitoring Looks Like
Low-dose testosterone therapy in women typically uses compounded testosterone in cream, injection, or troche form, at doses that are a fraction of what would be used in men. The goal is to restore testosterone to the optimal range for a woman — not to approach male levels, which is both unnecessary and associated with the androgenic side effects most women reasonably want to avoid.
Side effects at appropriate doses are uncommon but real, and they deserve honest disclosure. They can include acne, mild hair growth, oilier skin, and in cases of excessive dosing, voice changes or clitoral sensitivity. These are dose-dependent — they are most likely to occur when levels are pushed too high, which is why monitoring matters.
At NOVA Wellness, every patient on testosterone therapy receives baseline labs before starting, follow-up testing at appropriate intervals, and dose adjustments based on how they feel and what their levels show. We're not trying to optimize a number. We're trying to help a person feel like themselves again — and staying in that with them over time is what makes the difference between a prescription and a plan.
A Note on the Conversation You Deserve to Have
One of the things I hear from women who come to NOVA is that nobody has ever talked to them about testosterone. Not once. Not in their 20s when it was declining. Not in their 30s when the symptoms were beginning. Not in their 40s when they finally brought it up and were redirected to antidepressants or told it was normal for their age.
That's a failure of the system, not a reflection of whether the conversation is worth having. It is worth having. You are worth the full picture.
If any of this resonates with where you are — I'd like to talk.
Book a free 30-minute consultation at novawellnessut.com or call and text us at (801) 449-1402.
Matt Nelson, NP
NOVA Wellness — Orem, Utah
(801) 449-1402 · novawellnessut.com
