Menopause is finally having its moment in the spotlight, thanks to high-profile women breaking the long-standing taboo around discussing this life stage. Yet, while discussions around hormone replacement therapy (HRT) have increased, one critical component remains largely overlooked — testosterone.

Traditionally seen as a “male hormone,” testosterone is equally vital for women’s health, playing a key role in mood, energy, libido, muscle mass, bone density, and cognitive function. Yet, it remains one of the most under-recognized and misunderstood pieces of the hormone puzzle.

The real role of testosterone in women’s health

In women, testosterone plays a critical role in regulating sexual desire and function, affecting more than half of naturally menopausal women. But the influence of testosterone extends beyond libido. Testosterone supports fat metabolism, stabilizes mood, enhances motivation, maintains lean muscle mass and strength, and may even offer protection for heart health. Research also shows that testosterone therapy can improve overall well-being and mood, making it a meaningful option for women experiencing hormone-related symptoms.

Cognitively, testosterone is just as essential. It supports memory, clarity, and focus, so when levels drop, women may experience what’s commonly referred to as “brain fog.” In fact, 44 to 62 percent of women report cognitive complaints during the menopausal transition. Too often, these symptoms are chalked up to aging, stress, or lifestyle, but low testosterone is frequently a contributing factor. This hormone influences how we process information, how energized and emotionally engaged we feel, and how connected we are to our bodies. When those levels drop, many women simply don’t feel like themselves.

While testosterone functions similarly in men and women, affecting mood, muscle, and metabolism, the amount produced differs significantly. Men naturally have much higher levels, which also contribute to secondary sex characteristics like facial hair, a deeper voice, and sperm production. Women produce smaller amounts, but these lower levels still serve crucial physiological and emotional functions. The key difference between men and women isn’t how testosterone functions, but how frequently its role in women is overlooked, minimized, and left untreated.

What many people don’t realize is that testosterone levels in women start to decline in the mid to late 20s. It’s a gradual process, but there’s a more noticeable drop during perimenopause and menopause. Symptoms might not show up right away, but over time, they can build. Women may notice they feel more fatigued, depressed, foggy, or just not like themselves. Libido often drops, and some women experience weight gain or a loss of muscle tone. Bone health can also be affected, potentially increasing the risk of fractures.

Addressing common fears and misconceptions

One of the biggest reasons women shy away from testosterone therapy is fear. We’ve been told for years that testosterone will make us appear “masculine.” Some worry it will cause aggressive behavior, deepen their voices, or lead to unwanted hair growth on the face or body. These are valid concerns, but they’re largely rooted in misunderstanding.

The reality is that when testosterone is prescribed and monitored correctly, those side effects are rare. Women are prescribed one-tenth the dose that men receive. That ratio is based on years of research and clinical practice guidelines put forth by the International Society for the Study of Women’s Sexual Health (ISSWSH). These guidelines are widely used by practitioners specializing in hormone care for women, and they outline how to safely and effectively dose testosterone for female patients. Treatment is typically administered via topical gels, injections, or pellets inserted under the skin by a health care provider.

Of course, there is a risk of side effects if doses are too high. If a patient begins to notice changes such as voice deepening or excess hair growth, they should contact their health care provider in order to revisit the dosage and taper as needed. With careful management, most women won’t experience those effects. Instead, they will feel more energized, more mentally clear, and more connected to themselves again.

A systemic gap in education and approval

One of the biggest barriers to testosterone therapy for women is the lack of education and regulation surrounding it. Most health care providers were never trained to fully understand testosterone’s role in female health. In medical school, although the focus and depth of coverage vary, it is barely discussed in relation to women. This educational gap leaves many clinicians hesitant to consider testosterone therapy, even when patients present with clear, persistent symptoms that could be linked to hormonal imbalance.

The regulatory landscape doesn’t make it any easier. In the U.S., there is no FDA-approved testosterone therapy formulated specifically for women. As a result, any treatment offered is technically “off-label,” often using male formulations at much lower doses. While this practice is legal and often highly effective, the absence of formal approval reinforces outdated fears and makes both providers and patients cautious and hesitant.

Still, research in this space is growing. Ongoing large-scale studies, such as the TRAVERSE trial, are working to clarify the safety and efficacy of testosterone therapy, particularly in men, reflecting the broader medical community’s evolving recognition of its potential benefits. But when it comes to women, most systems remain far behind.

Australia is the only country with a government-approved testosterone product designed for women. In the U.K., organizations like the National Institute for Health and Care Excellence (NICE), along with the British Menopause Society, provide guidelines for the use of testosterone in menopausal women. In the U.S., providers depend on the clinical guidelines from ISSWSH to guide safe and appropriate use. These evidence-based recommendations are widely respected among hormone specialists but have yet to be formally adopted into national health care systems, leaving women to navigate an underregulated system that too often fails to meet their needs.

The power of social media and shared knowledge

Despite the ongoing challenges, one unexpected source of progress has been social media. While it often carries a bad reputation for spreading misinformation, platforms like Instagram, Facebook, and TikTok are also helping reshape the conversation around women’s hormone health.

Women are connecting through online forums and private support groups, where they share their experiences, discuss what has worked for them, and exchange information they can bring back to their health care providers. This kind of peer-to-peer education is powerful. It’s giving women the language, confidence, and community they need to advocate for themselves.

Of course, there’s always a need to approach online advice with a critical eye. But overall, the trend is empowering. Women are no longer silently enduring midlife changes; they’re asking questions, pushing for better care, and taking a more active role in their health.

So, what can women do?

The first step is to track your symptoms. If you’ve noticed changes in energy, mood, libido, memory, or overall motivation, don’t brush them off as just part of getting older. Aging doesn’t have to feel like this. Writing things down and identifying patterns can give you clarity and a valuable starting point for conversations with your provider.

It’s important to find a provider who listens to you. If your concerns are dismissed or minimized, keep looking. You deserve a clinician who takes you seriously and is willing to explore every avenue. Ask directly about testosterone testing and treatment. Even though there’s no FDA-approved option specifically for women, there are safe, effective treatments when prescribed and monitored by an experienced professional.

Beyond clinical care, supporting your hormone health through lifestyle changes can make a meaningful difference. Getting quality sleep, managing stress, exercising regularly, and fueling your body with nourishing food are all essential. High cortisol, the stress hormone, can throw your entire endocrine system out of balance, including testosterone.

Don’t underestimate the power of community, either. Whether it’s through an online forum, a local support group, or just conversations with friends, connecting with others helps break the stigma and normalize these experiences. When we speak openly, we not only advocate for ourselves but we also help others find their voice.

Ultimately, no one knows your body better than you. You are your biggest advocate. If something feels off, don’t ignore it. Ask questions. Push for answers. Keep going until you feel heard. And if testosterone ends up being part of your solution, know that you’re far from alone.

We need a culture shift; one that recognizes testosterone as a vital component of women’s health. The sooner we acknowledge that, the sooner more women can get the care they deserve.

Menopause may finally be having its moment. Let’s make sure testosterone gets one too.

Andrea Caamano is a physician executive.