The "Missing Piece" Hormone: Why Testosterone Matters in Women's Health

For years, we've been told a pretty simple story: estrogen is the "female hormone" and testosterone (HRT) is the "male hormone."

But hormones don’t belong to one sex. Women make testosterone too, from both the ovaries and the adrenal glands, and it plays a real role in how the body functions across multiple systems. It also sits earlier in the hormone pathway as a precursor to estrogen, meaning your body actually uses it as part of the process of making other hormones.

Here's what most women don't know: testosterone begins a slow, gradual decline starting in our late 20s to early 30s. It's not the sharp drop we see with estrogen at menopause or the dramatic swings of perimenopause. Because it is a quiet decline, it often goes unnoticed until the picture has already shifted.

When something feels off but labs come back "normal"

I hear it often: "I just don't feel like myself anymore." It's not usually something dramatic. It's a slow shift including lower energy, more brain fog, less drive, a general sense of feeling off in your own body. Labs come back normal, and somewhere along the way, women start to think, this must just be aging. But this isn't a mindset issue. It's often a physiologic one.

Most people associate testosterone with libido, and that's where we have the strongest clinical evidence.  In practice, it rarely shows up in isolation. As levels shift often alongside changes in estrogen what women notice is broader: feeling more anxious or emotionally flat, less motivated, more easily overwhelmed. Thinking that doesn't feel as sharp. Fatigue that doesn't respond to rest. A body that doesn't respond to exercise the way it used to. Sexual health changes and includes lower desire, less responsiveness, feeling disconnected from that part of themselves. None of these symptoms belong exclusively to testosterone, but it is often one piece of what's driving them.

It's not the first step. But it belongs in the conversation.

One of the things I'm most deliberate about is hormone stacking. I like to start with one hormone at a time. For most women, addressing estrogen and progesterone first makes the greatest overall difference,  particularly for sleep, mood, and symptom stability. Often, once those are optimized, a lot of what feels like a testosterone problem resolves on its own. When it doesn't, testosterone becomes a thoughtful next step for the right candidate.

What about side effects?

This is usually the first concern, and it's a fair one. The answer comes down to dosing. When testosterone is used appropriately in women, the goal is physiologic dosing: restoring levels to a range that is normal for a woman, not pushing beyond it. At the right dose, significant hair growth is uncommon, and voice changes are rare, typically seen only with high, unmonitored levels.

The delivery method matters just as much. Transdermal creams or gels are generally preferred because they allow for gradual, adjustable dosing that can be modified over time. Pellets, by contrast, deliver a fixed dose that cannot be adjusted once placed,  which in some cases can push levels higher than intended with no way to course-correct. This isn't a fringe opinion: the Global Consensus Position Statement on testosterone in women which is endorsed by more than ten major medical societies including NAMS, the Endocrine Society, and the International Menopause Society explicitly does not recommend any testosterone preparation that results in supraphysiologic levels, including pellets. Not one major medical society recommends them. That lack of flexibility, and that level of consensus, is why delivery methods and careful monitoring aren't optional;  they're the whole point.

What the research actually shows

Testosterone has the strongest evidence base for low sexual desire affecting quality of life. It doesn't work for everyone. Roughly half of women notice a meaningful improvement which makes sense given how many factors influence desire. But clinical research is also increasingly pointing toward benefits for mood, cognition, and physical resilience, and we're still learning how it all connects. That uncertainty is not a reason to dismiss it. It's a reason to approach it thoughtfully.

The Dreava approach

This is never a one-size-fits-all conversation. It starts with understanding your symptoms, your patterns, and your goals. When appropriate, labs are evaluated in context, foundational hormones are addressed first, and if testosterone becomes part of the plan, it's done with physiologic dosing, ongoing monitoring, and shared decision-making without pressure or rush.

If you've been feeling off and can't quite explain why, there's often a reason. Testosterone isn't the whole story. But for some women, it's a meaningful piece of it,  and you deserve to know it's part of the conversation.