Testosterone: The Most Abundant Hormone in Women

If testosterone were a party guest, women would be the hosts. Androgens are the most abundant hormone in women. Yet this class of hormones (that includes DHEA and testosterone) still gets introduced like it wandered in from the men’s side of the room.

Women make testosterone every day, from the ovaries and adrenal glands, plus local “on-site” production inside tissues (yes, your body is that efficient). ⁽⁷⁾ Here’s the detail that flips the script: testosterone circulates at relatively high concentrations in women compared with estradiol, even though estradiol gets most of the spotlight. ⁽⁷⁾

So why does this matter?

Because testosterone is not a decorative hormone. It is your infrastructure.

Testosterone is more abundant than estrogen (in circulation)

Estradiol is powerful, but it tends to be measured in picograms per milliliter. Testosterone is typically measured in nanograms per deciliter. Different units, different ranges, and a reminder that “abundance” depends on what we mean. Still, the clinical takeaway is simple: testosterone is not rare in women, and its biology is not optional. ⁽⁷⁾

What testosterone governs

In women, androgens are tied to:

• Libido and sexual motivation ^{(1, 2, 4, 8)}
• Mood and sense of well-being ^(1–4)
• Energy and vitality ^{(2, 4, 6)}
• Musculoskeletal health, including lean mass support and physical function as we age ⁽⁷⁾

I also think of testosterone as a kind of inner voltage, not “aggression,” but agency. The quiet willingness to initiate, to lift, to desire, to make a move in your own life.

Testosterone can start declining earlier than you think

Many women assume testosterone only becomes relevant after menopause. But androgen levels can decline across the reproductive years, and the experience can show up earlier than the cultural storyline suggests. ^{(4, 7)} For some women, changes begin in their 20s and 30s, especially if sleep is shredded, stress is chronic, oral estrogen raises SHBG, or ovarian function changes after surgery. ^{(2, 4, 7)}

Low testosterone is a symptom pattern, not a single symptom

When testosterone is low, women may report:

• Fatigue that feels like low battery, not just “busy”
• Loss of lean muscle, slower recovery, reduced exercise adaptation
• Less sexual desire, less responsiveness, less spark
• Diminished well-being, lower motivation, a flatter emotional landscape ^{(2, 4)}

Important nuance: the science is not always tidy. Some studies do not find a clean line between a single blood level and sexual function, partly because assays struggle at low concentrations and because tissue-level production matters. ^{(5, 6)} In other words, you can have symptoms with “normal” labs, and you can have low labs with few symptoms.

This is why I do not treat numbers. I treat the person, then use labs to sharpen the picture.

Why testosterone often gets missed

Most “standard hormone panels” focus on estradiol, progesterone, FSH, LH, and sometimes thyroid markers. Testosterone, especially free testosterone, is often absent or interpreted without context. ^{(3, 7)}

And if a clinician does order testosterone, the method matters. Many routine tests are less reliable at the low ranges common in women. ⁽³⁾ Translation: you can get a number that looks precise and still be misled.

What to ask for

If you want a clearer window into androgen status, ask for:

• Total testosterone
• Free testosterone
• Consider adding SHBG, because it helps explain how much testosterone is actually available to tissues ^{(2, 7)}

Then interpret results alongside symptoms, medications (especially oral estrogen), cycle stage, perimenopause status, and overall metabolic context. ^{(2, 7)}

One more clinical reality check

Testosterone therapy has the strongest evidence base in postmenopausal women with hypoactive sexual desire disorder (HSDD, or low desire), and it should be approached with dosing discipline and follow-up. ⁽⁸⁾ For premenopausal women, data are more limited and the decision is more individualized. ^{(7, 8)}

The goal is not “more testosterone.” The goal is enough for your full function.

Enough vitality to move through your day without dragging your nervous system behind you like a suitcase with a broken wheel.

Enough desire to feel like your body is on your side.

Enough agency to remember you are not just surviving your life, you are steering it.

If you want to learn more about testosterone, get my New York Times bestselling book, WOMEN FOOD AND HORMONES.

REFERENCES

1. Davis, S. R., and J. Tran. “Testosterone Influences Libido and Well Being in Women.” Trends in Endocrinology & Metabolism 12, no. 1 (2001): 33–37. https://doi.org/10.1016/S1043-2760(00)00333-7. PMID: 11137039. (PubMed)
2. Davis, S. “Testosterone Deficiency in Women.” Journal of Reproductive Medicine 46, no. 3 Suppl (March 2001): 291–296. PMID: 11304877. (PubMed)
3. Rivera-Woll, L. M., M. Papalia, S. R. Davis, and H. G. Burger. “Androgen Insufficiency in Women: Diagnostic and Therapeutic Implications.” Human Reproduction Update 10, no. 5 (2004): 421–432. https://doi.org/10.1093/humupd/dmh037. PMID: 15297435. (PubMed)
4. Bolour, S., and G. Braunstein. “Testosterone Therapy in Women: A Review.” International Journal of Impotence Research 17, no. 5 (2005): 399–408. https://doi.org/10.1038/sj.ijir.3901334. PMID: 15889125. (PubMed)
5. Bhasin, Shalender, Paul Enzlin, Andrea Coviello, and Rosemary Basson. “Sexual Dysfunction in Men and Women with Endocrine Disorders.” The Lancet 369, no. 9561 (February 17, 2007): 597–611. https://doi.org/10.1016/S0140-6736(07)60280-3. PMID: 17307107. (PubMed)
6. Gotmar, A., M. Hammar, M. Fredrikson, G. Samsioe, C. Nerbrand, J. Lidfeldt, and A.-C. Spetz. “Symptoms in Peri- and Postmenopausal Women in Relation to Testosterone Concentrations: Data from The Women’s Health in the Lund Area (WHILA) Study.” Climacteric 11, no. 4 (August 2008): 304–314. https://doi.org/10.1080/13697130802249769. PMID: 18645696. (PubMed)
7. Davis, Susan R., and Sarah Wahlin-Jacobsen. “Testosterone in Women, the Clinical Significance.” The Lancet Diabetes & Endocrinology 3, no. 12 (December 2015): 980–992. https://doi.org/10.1016/S2213-8587(15)00284-3. PMID: 26358173. (PubMed)
8. Uloko, Maria, Farah Rahman, Leah Ibrahim Puri, and Rachel S. Rubin. “The Clinical Management of Testosterone Replacement Therapy in Postmenopausal Women with Hypoactive Sexual Desire Disorder: A Review.” International Journal of Impotence Research 34, no. 7 (November 2022): 635–641. https://doi.org/10.1038/s41443-022-00613-0. PMID: 36198811. (PubMed)