Testosterone: Because Women Have Brains, Not Just Vaginas.
Can we talk about testosterone for a minute?
Somewhere along the way, we decided testosterone was a man hormone. You know, for growing beards, building muscle, and golf (I think). Women got estrogen, progesterone, and the privilege of being told to try yoga when we feel like garbage. Except women make testosterone, too. And not just a decorative amount. It's a biologically important hormone that interacts with our brains, muscles, bones, and sexual function. Yet somehow, when we talk about testosterone therapy for women, the conversation almost always starts and ends with sex. Don't get me wrong. I'm a big fan of women enjoying sex. But I'd also like them to remember why they walked into the kitchen.
Well, Would You Look at That.
A 2026 study published in the Journal of Personalized Medicine looked at 332 women receiving testosterone therapy and asked a question that, frankly, we probably should have been asking a long time ago.
How do you actually FEEL?
Not just whether you're interested in sex. Not just whether your libido has made a dramatic comeback. But how's your energy? Your mood? Your ability to concentrate? Do you actually enjoy things again, or are you just dragging yourself through the day fueled by caffeine and resentment?
Here's what women reported:
84% experienced improvement in energy and fatigue.
71% reported improvement in depressive symptoms.
69% felt less irritable.
68% reported more enjoyment in life.
Nearly 90% reported improvement in their overall quality of life.
And here's the part I really love: When asked where they noticed the biggest difference, energy and mood ranked higher than sex drive.
Imagine that.
Women would like to be awake, think clearly, have some motivation, and occasionally experience joy. All while wearing pants. Who could have predicted?
Now, these were self-reported improvements, not proof that testosterone caused them. But when that many women are describing meaningful changes in how they feel and function, I think it's worth paying attention. Especially when we're talking about symptoms women have been complaining about for decades, often only to be told they're stressed, depressed, or just getting older. Maybe there's more to the story. And maybe it's time we got curious enough to find out.
I've Been Seeing This in My Own Practice.
I prescribe testosterone for women, and I'm a fan. A pretty big one, actually. I've watched women who felt like they were dragging themselves through every day come back with more energy, better motivation, and a sense that their brains have finally rejoined the conversation. One of the most interesting things I've seen is in women with ADHD. I've had patients whose brain fog and concentration improved enough after starting testosterone that we were able to reduce their ADHD medication.
To be clear, that's my clinical experience, not proof that testosterone treats ADHD. But when you work in women's mental health, you start paying attention when a hormone seems to make that much of a difference in how someone functions. And it makes me wonder how many symptoms we've been treating in isolation without ever looking at the hormonal picture.
So Why Isn't Everyone Prescribing It?
Excellent question. I'm so glad you asked.
First, there's the research problem. Right now, the strongest evidence for testosterone therapy in women is for low sexual desire. Which is wonderful, but can we please acknowledge that women might want to use their brains, have energy, and experience joy, even when nobody is naked?
Research on testosterone's effects on cognition, mood, motivation, and overall well-being is much less convincing. Some studies have shown promising results, others haven't. We need better studies, and we need more of them. But there's a difference between saying something hasn't been adequately proven and saying it couldn't possibly help.
Then there's the FDA situation. There is still no FDA-approved testosterone product specifically for women in the United States. Men have multiple options. Women? We're often using carefully adjusted doses of products originally designed for men. Apparently, developing a testosterone product for half the population wasn't high on the to-do list. And because testosterone is a controlled substance, prescribing it comes with additional regulations and paperwork. Combine that with limited clinical training in menopause medicine, legitimate concerns about inappropriate dosing, and uncertainty about long-term safety, and you can see why many providers would rather avoid it altogether.
But here's where I get frustrated.
A lot of women aren't even being offered the conversation. Physicians like Dr. Rachel Rubin and Dr. Kelly Casperson have been pushing for better education, more research, and more thoughtful conversations about testosterone in women's health. Not because testosterone is magic, but because women deserve to know their options. And I agree. I don't think testosterone belongs in every woman's treatment plan. But I absolutely believe it deserves consideration for more women than we're currently talking about. We should be cautious about dosing. We should monitor levels. We should talk about side effects and acknowledge what we don't know.
But caution and dismissal are not the same thing.
If we're going to tell women there's not enough evidence to recommend testosterone for their brain fog, fatigue, or mood symptoms, that's fair. The evidence really isn't there yet. But then let's actually study those things. Because "we need more research" should be the beginning of a scientific conversation, not the end of a woman's appointment. And personally? I'd love to see us devote even a fraction of the enthusiasm we've shown for treating aging men's testosterone levels to figuring out what testosterone might mean for women.
It's not like we've been particularly stingy with prescriptions for erectile dysfunction.
Am I Saying Every Woman Needs Testosterone?
No. But I do think we should be having this conversation with a lot more women.
I check testosterone levels before prescribing, consider the symptoms and the bigger clinical picture, and use dosing intended to keep levels in the normal female physiological range. Too much testosterone can create problems, and more is definitely not better. But I'm also not interested in dismissing a treatment that I've watched make a meaningful difference in women's lives simply because the research hasn't caught up with every possible benefit. Estrogen matters. Progesterone matters. Testosterone deserves a seat at the table, too.
Preferably before we're all sitting around that table, exhausted, irritable, and wondering where we left our keys.
Again.
The study: Elggren et al. (2026). Testosterone Replacement Therapy in Women Is Associated with Improved Symptom Burden and Favorable Biomarker Changes: A Retrospective Observational Study. Journal of Personalized Medicine.
