Susan Merenstein, Pharmacist/Owner

(412) 586-4678

Testosterone for Women

  • Women make 1/10th as much as men-made in ovaries, adrenals, skin, muscles, and body fat
  • Testosterone is the precursor to Estradiol
  • Perimenopause levels drop slightly from the ovaries, but adrenally by 40%, and in other tissues by 60%
  • Estrogen Dominance increases Sex Hormone Binding Globulin (SHBG)-binds 10x tighter to Testosterone than Estradiol
  • Anabolic hormone essential for building and maintain the integrity of structural

tissue such as skin, muscles, bone, and brain

  • Increases muscle mass and strength
  • Helps maintain bone strength
  • Increases sense of emotional well-being
  • Helps maintain memory
  • Helps skin from sagging
  • Decreases excess body fat
  • Elevates norepinephrine in the brain

(Tricyclic affect)

  • Aids with pain control
  • Increases sexual interest and is important for nipple and clitoral stimulation

Symptoms of Testosterone Loss

  • Muscle wasting and weakness
  • Bone loss
  • Decreased libido
  • Weight gain
  • Fatigue, prolonged
  • Low self-esteem and blunted motivation
  • Depression
  • Decreased HDL
  • Dry, thin skin, with poor elasticity-vaginal dryness
  • Thinning and dry hair
  • Droopy eyelids
  • Sagging cheeks
  • Thin lips
  • Anxiety
  • Memory is not as sharp, memory lapses
  • Mental fuzziness and fog
  • Diminished feeling of wellbeing, no zest
  • Incontinence

Causes of Low Testosterone

  • Menopause
  • Childbirth
  • Chemotherapy
  • Adrenal stress or burnout
  • Endometriosis
  • Depression
  • Psychological trauma
  • Birth control pills
  • HMG-CoA-reductase inhibitors

Treatment Pearls

IMPORTANT- Increasing the level of Testosterone above the normal ranges does not stimulate a further increase in libido

  • Testosterone replacement should be transdermal and should not exceed 1mg/day-most oral Testosterone is destroyed in the GI tract.
  • Use the bio-identical form. Methyltestosterone has been associated with an increase in liver cancer.
  • If used transdermally must rotate sites between labia, clitoris and wrists.
  • In order for Testosterone to work well, Estradiol must also be optimized.
  • Without enough Estrogen, Testosterone cannot attach to brain receptors.
  • If Testosterone is given alone, it may increase plaque formation.
  • Study- showed the safety and efficacy of using testosterone for postmenopausal women with low sexual desire with administration via non-oral routes (e.g., transdermal application) preferred because of a neutral lipid profile.

Islam, R., et al., “Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data,” Lancet Diabetes Endocrinol 2019; 7(10):754-66.

  • This study showed improvement in scalp hair with testosterone use in women with low testosterone levels.

No subject complained of hair loss as a result of treatment casts doubt on the presumed role of testosterone in driving female scalp hair loss.

Reference: Glaser, R., et al., “Improvement in scalp hair growth in androgen-deficient women tested with testosterone: a questionnaire study,” Brit Jour Dermatol 2012; 166(2):274-78.

How to raise Testosterone levels:

  • Decrease calorie intake
  • Increase protein in the diet
  • Take the amino acids arginine, leucine, glutamine
  • Exercise
  • Get enough sleep
  • Lose weight
  • Reduce stress
  • Take Zinc if deficient (Zinc is needed for the metabolism of testosterone.)

Causes of Elevated Testosterone

  • Insulin Resistance
  • PCOS
  • Menopausal Transition
  • Testosterone Supplementation
  • DHEA Supplementation-In one study, DHEA raised Testosterone levels 50-100% from baseline in women

Symptoms of Elevated Testosterone

  • Anxiety
  • Depression
  • Fatigue
  • Hypoglycemia
  • Salt and sugar cravings
  • Agitation and anger and aggressive behavior
  • Irritability and Moodiness
  • Insomnia
  • Facial hair
  • Acne
  • Weight gain
  • Hair loss or unwanted hair growth on the face
  • Increased risk of heart disease
  • Male Pattern Baldness
  • Deepening of voice
  • Clitoral enlargement

Treatment of Elevated Testosterone

  • Saw palmetto
  • Metformin
  • Spironolactone

Measurement of Testosterone Levels in Women

  • Androgens, both in excessive and depleted states, have been implicated in female reproductive health disorders.
  • This study revealed that commercially available androgen assays have significant limitations in the female population. Furthermore, the measurements themselves are not always informative in the patient’s diagnosis, treatment, or prognosis.


  • Korkidakis, A., et al., “Testosterone in women: Measurement and therapeutic use,” Jour Obstet Gynaecol Can 2017; 39(3):124-130.
  • Shufelt, C., et al., “Safety of testosterone use in women,” Maturitas 2009; 63(1):63-6.
  • Bolour, S., et al., “Testosterone in women: a review,” Int Jour Impot Res 2005; 17(5):399-408.
  • Hubayter, Z., et al., “Testosterone therapy for sexual dysfunction in postmenopausal women,” Climateric 2008; 11(3):181-91.
  • Glaser, R., et al., “Testosterone therapy in women: myths and misconceptions,” Maturitas 2013; 74(3):230-34.
  • Journal of Clinical Endocrinology and Metabolism, Vol. 82, No. 5, p 1945
  • Oronzo et al, Eur J Epidemiology 2000: 16; 907-912
  • N Engl J Med 2000; 343; 682-88
  • Morales and Yen. J Clin Endocrinol Metab. 1994: 78; 1360-67

Suggested Testing:
Saliva/Blood Spot Combo Kit Test
Saliva 5 Test