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“Life-changing.”
“My energy levels are back.”
“Sex got better.”
Viral TikToks and Instagram testimonials are claiming that testosterone can transform a woman’s energy, libido, and motivation. Sounds appealing, but the hype raises questions. How much is fact and how much is fiction?
We oftentimes think of testosterone as a definitively “male hormone,” but women produce it, too. While women produce less of it than men, it still affects sexual function, mood, muscle strength, and bone health. And, like men, production tends to decline with age.
Testosterone in Women
During adolescence and into early adulthood, testosterone drives libido, aids in the development of healthy muscle and bone, and contributes to cellular energy metabolism (which is why a decline can affect energy levels and cause fatigue, regardless of age). In the 20s and 30s, levels tend to stabilize and continue to support sexual health. Testosterone also helps regulate neurotransmitters in the brain, including dopamine and serotonin, which influence mood, motivation, and focus.
Perimenopause and menopause bring gradual declines in sex hormones, including estrogen and testosterone, which can manifest as decreased libido, changes in mood, fatigue, and reduced muscle mass. Depending on genetics, lifestyle, and overall health, some women may notice these changes more than others.
Men’s testosterone production is about 10 times higher than women’s, and it follows a relatively predictable decline with age. Women’s levels, by contrast, are much lower, fluctuate across the menstrual cycle, and drop more gradually (except after surgical menopause). Small shifts can have a large impact on energy, sexual desire, and body composition in females.
Women’s bodies are also more sensitive to excess testosterone, which is why there is concern about the latest trend in women receiving male-level testosterone therapies. Too much can lead to acne, unwanted hair growth, voice changes, or menstrual disruption, and some effects can become permanent.
Because symptoms like fatigue, low libido, or mood changes overlap with common life stressors or other health conditions, proper evaluation by a clinician is essential before attributing them solely to low testosterone.
Low Testosterone in Women
Low-T (low testosterone) is typically associated with men, even though women can experience a clinically significant testosterone deficiency. In women, it’s referred to as androgen insufficiency or, when it affects sexual function, hypoactive sexual desire disorder (HSDD).
Because testosterone levels are more predictable in men, finding Low-T and the solution is typically straightforward with blood work. Not the case for women. Levels are naturally lower and fluctuate across the menstrual cycle, so identifying low testosterone in women requires a combination of symptom assessment, hormone testing, and careful interpretation by a knowledgeable clinician.
The overarching effects of low testosterone in women include:
- Reduced sexual desire or arousal
- Difficulty achieving orgasm
- Low energy or fatigue that doesn’t get better with rest
- Decreased motivation, mood changes, mild depression, or irritability
- Loss of muscle mass or strength
- Cognitive changes, subtle or sudden, like difficulty concentrating or “mental fog.”
More nuanced symptoms that can be overlooked or brushed away include:
- Vaginal dryness and/or discomfort during sex, which can amplify low libido
- Low motivation or reduced “spark” in everyday activities, often chalked up to stress or aging
- Mild fatigue or sleep disturbances that are dismissed as lifestyle issues
- Mood swings or irritability, which may be misattributed to perimenopause or psychological stress
Small drops and big bumps in testosterone can have outsized effects, and the degree of impact varies between women. Self-diagnosing or chasing trends seen on social media can be misleading, or even risky.
When is testosterone replacement therapy (TRT) appropriate for a woman?
Testosterone replacement therapy (TRT) is not a “miracle hack” for energy, motivation, or libido. Instead, TRT can be clinically appropriate for women who have confirmed low testosterone and symptoms that impact quality of life, especially sexual function.
Having said that, the U.S. Food and Drug Administration (FDA) has not approved any testosterone therapies specifically for women, with the exception of treating hypoactive sexual desire disorder (HSDD) in postmenopausal patients. This means that any other use of testosterone in women is considered off-label, which requires careful evaluation and medical supervision.
Changes can take 6 to 12 weeks to notice, and benefits can be modest at first – slightly improved energy, a little bit better mood, sparks of interest in sex again. They aren’t likely to be instantaneous, despite social media claims.
Who might be a candidate?
- Women with hypoactive sexual desire disorder (HSDD) who haven’t responded to other interventions, including standard hormone replacement therapy.
- Those experiencing persistent fatigue, low mood, or reduced motivation are linked to androgen insufficiency.
- Women undergoing surgical menopause (e.g., oophorectomy) who experience an abrupt drop in hormone levels.
TRT works by restoring testosterone to a normal female range, not male levels. There are no sufficient studies on high-dose therapy or long-term use in women, which is why ongoing monitoring, blood work, symptom tracking, and dose adjustments are crucial – as long as that is taking place, therapy remains safe and effective.
The other concerning factor in the trending “male-level” super-doses women are talking about is the risk of permanent masculinizing effects. Excess testosterone can cause acne, unwanted hair growth on the face and body, deepening of the voice, and clitoral enlargement. Unlike temporary mood or energy changes, some adverse physical effects may not go away, even if therapy is stopped.
A safety note: Blood work should be checked at baseline (i.e., before therapy begins), 3 to 6 weeks after starting therapy, and at regular intervals thereafter. Ideal target levels are within the normal female premenopausal range, and side effects, such as acne or mild hair growth, are typically avoidable with proper dosing and adjustments.
Social posts are likely capturing the experiences of women taking testosterone that is appropriately dosed for their unique physiques and (hopefully) monitored under medical guidance; and they’re really excited! Gradual improvements in libido, energy, and mood are supported by clinical evidence, but the viral “overnight” transformations are likely exaggerated.
TRT for women is usually administered via low-dose transdermal gels or creams, and works best when combined with healthy sleep, stress management, and physical activity. Additional lifestyle factors, relationship dynamics, and psychological well-being all help determine the path that hormone therapy can take.
If you’re inspired by the last few videos you’ve seen of women having mind-blowing experiences with testosterone, don’t explore it on your own. A specialist like Dr. Taghechian can help determine whether it’s appropriate, establish the correct dose, monitor safely, and address related symptoms – low libido and vaginal changes respond well to additional therapies like labiaplasty, vaginal rejuvenation, or even a Sweet Spot Shot.
Schedule a visit and start feeling good again!
