Testosterone in Women: The Overlooked Hormone for Mood, Energy, and Mental Health

When most people think about testosterone, they think about men — muscle mass, libido, aggression. But testosterone is also a critical hormone for women, and low testosterone in women is one of the most commonly missed causes of depression, fatigue, low libido, brain fog, and poor quality of life.

At Roth Family Medicine & Mental Health in Pocatello, Idaho, we take a comprehensive approach to hormonal health in women — one that includes testosterone alongside estrogen and progesterone. For many of our patients, optimizing testosterone is the missing piece that finally resolves symptoms that antidepressants and other treatments couldn't touch.

Women produce testosterone in the ovaries and adrenal glands. While women's testosterone levels are roughly 10–20 times lower than men's, testosterone plays essential roles in female physiology:

• Brain function: Cognitive clarity, focus, motivation, and mood regulation
• Energy and vitality: Physical energy, stamina, and sense of wellbeing
• Sexual function: Libido, arousal, and sexual satisfaction
• Muscle and bone: Maintaining lean muscle mass and bone density
• Cardiovascular health: Healthy cholesterol metabolism and vascular function
• Skin and hair: Skin thickness, collagen production, and hair health

Testosterone peaks in women in their mid-20s and declines gradually with age. By the time a woman reaches menopause, her testosterone levels may be 50% lower than they were at their peak. But testosterone decline doesn't wait for menopause — many women in their 30s and 40s already have significantly low levels.

The symptoms of low testosterone in women are often attributed to depression, burnout, or "just getting older" — when in fact they reflect a correctable hormonal deficiency:

Mood and mental health:

• Persistent low mood or depression that doesn't fully respond to antidepressants
• Anxiety and emotional fragility
• Irritability and mood swings
• Loss of motivation and drive
• Emotional flatness or numbness

Energy and cognition:

• Chronic fatigue despite adequate sleep
• Brain fog, poor concentration, and memory lapses
• Difficulty with word retrieval
• Reduced mental sharpness and productivity

Physical symptoms:

• Low libido and reduced sexual satisfaction
• Decreased muscle tone and strength
• Increased body fat, particularly around the abdomen
• Thinning hair
• Dry skin
• Reduced exercise tolerance and recovery

Wellbeing:

• Loss of the sense of vitality and "spark"
• Reduced confidence and assertiveness
• Feeling like a diminished version of yourself

If you recognize yourself in this list — especially if you've been told your labs are "normal" or your antidepressant "should be working" — low testosterone may be contributing to your symptoms.

Several factors contribute to testosterone deficiency being chronically underdiagnosed in women:

Inadequate testing: Many providers only check estrogen and progesterone in women, omitting testosterone entirely. When testosterone is checked, only total testosterone is often measured — missing free testosterone, which is the biologically active fraction.

Outdated reference ranges: Standard lab reference ranges for female testosterone are extremely wide and based on population averages rather than optimal function. A woman can be in the "normal" range and still have levels far below what she needs to feel well.

Symptom overlap: The symptoms of low testosterone in women overlap significantly with depression, hypothyroidism, and burnout — conditions that are often diagnosed and treated without investigating the hormonal root cause.

Lack of FDA approval: There is no FDA-approved testosterone product specifically for women in the United States (though testosterone is widely used off-label and is approved for women in other countries). This creates a knowledge gap and hesitancy among some providers.

Dismissal of symptoms: Women's complaints of fatigue, low libido, and mood changes are sometimes dismissed or attributed to stress, aging, or psychological factors rather than investigated for hormonal causes.

Understanding why testosterone is low helps guide treatment:

Age-related decline: Natural decline with aging, accelerating around perimenopause and menopause

Oral contraceptives: Birth control pills significantly increase sex hormone-binding globulin (SHBG), which binds testosterone and reduces free (active) levels — even when total testosterone appears normal

Oophorectomy: Surgical removal of the ovaries eliminates the primary source of testosterone production

Adrenal dysfunction: Chronic stress, HPA axis dysregulation, and adrenal fatigue reduce DHEA and testosterone production

Hypothyroidism: Thyroid dysfunction affects sex hormone metabolism and SHBG levels

Insulin resistance: Metabolic dysfunction disrupts hormonal balance

Nutritional deficiencies: Low zinc, vitamin D, and healthy fats impair testosterone synthesis

At Roth Family Medicine & Mental Health, our hormonal evaluation for women includes:

• Total testosterone and free testosterone (the biologically active fraction)
• SHBG (sex hormone-binding globulin) — high SHBG reduces free testosterone
• DHEA-S (adrenal androgen precursor)
• Estradiol, progesterone, FSH, LH — full sex hormone panel
• Thyroid panel (TSH, free T3, free T4, thyroid antibodies)
• Cortisol — adrenal function assessment
• Metabolic panel — insulin, glucose, lipids
• Nutritional markers — vitamin D, zinc, B12, iron

This comprehensive approach ensures we identify all hormonal and nutritional factors contributing to your symptoms — not just testosterone in isolation.

When low testosterone is identified as a contributing factor to symptoms, several treatment options are available:

Topical testosterone cream or gel: Applied daily to the inner arm, thigh, or labia. Allows precise dose titration. This is the most commonly used approach for women.

Testosterone pellets: Small pellets implanted under the skin (typically in the hip or buttock) that release testosterone steadily over 3–6 months. Provides consistent levels without daily application.

Compounded testosterone: Because no FDA-approved female testosterone product exists in the US, testosterone for women is typically compounded by a specialty pharmacy to the prescribed dose and formulation.

For women with borderline-low testosterone or those who prefer to start with lifestyle interventions:

• Resistance training: Strength training is one of the most effective ways to naturally support testosterone levels
• Adequate sleep: Testosterone is produced primarily during deep sleep; poor sleep significantly reduces levels
• Stress management: Chronic stress elevates cortisol, which suppresses testosterone production
• Nutritional support: Zinc, vitamin D, healthy fats (especially saturated and monounsaturated), and adequate protein support testosterone synthesis
• DHEA supplementation: DHEA is a precursor to testosterone; supplementation under medical supervision can support testosterone levels
• Addressing oral contraceptives: Switching from oral to non-oral contraceptive methods can significantly improve free testosterone levels

When testosterone therapy is appropriate and well-dosed, women typically report:

• Improved mood and emotional resilience — often within 2–4 weeks
• Increased energy and motivation — frequently described as feeling "like myself again"
• Enhanced cognitive clarity — better focus, sharper thinking, improved word retrieval
• Improved libido and sexual satisfaction
• Better exercise performance and recovery
• Improved body composition — gradual increase in lean muscle, reduction in abdominal fat

The response is highly individual. Some women notice dramatic improvements quickly; others experience more gradual changes over 2–3 months. Dose optimization is an iterative process — we monitor symptoms and lab values and adjust accordingly.

Testosterone therapy in women is generally safe when properly dosed and monitored. Potential side effects at supraphysiologic (too-high) doses include:

• Acne
• Oily skin
• Increased facial or body hair
• Clitoral enlargement (rare, at high doses)
• Voice changes (rare, at high doses)

These side effects are dose-dependent and reversible with dose reduction. Proper monitoring — including regular lab checks and symptom assessment — prevents these issues in the vast majority of patients.

Testosterone therapy is not appropriate for women who are pregnant or trying to conceive, or those with certain hormone-sensitive cancers. A thorough evaluation will identify any contraindications before treatment begins.

Testosterone doesn't work in isolation — it's part of a complex hormonal symphony that includes estrogen, progesterone, thyroid hormones, cortisol, insulin, and more. At our practice, we evaluate and optimize the full hormonal picture.

For women in perimenopause or menopause, testosterone optimization is typically combined with estrogen and progesterone therapy for comprehensive hormonal support. For younger women, we focus on identifying and correcting the specific factors driving testosterone deficiency.

We also integrate hormonal care with mental health treatment when needed. For women with depression that hasn't responded to antidepressants, hormonal optimization — including testosterone — is often a critical component of a successful treatment plan. When hormonal issues are driving depression, no amount of antidepressant medication will fully resolve it.

If you're a woman in Pocatello, Chubbuck, Bannock County, or Southeast Idaho experiencing depression, fatigue, brain fog, low libido, or loss of vitality — and you haven't had a comprehensive hormonal evaluation — we'd love to help.

At Roth Family Medicine & Mental Health, we offer thorough hormonal assessments and individualized treatment plans that address the root causes of your symptoms rather than just managing them.

Call us at (208) 904-4705 or book online to schedule a consultation. We're accepting new patients and are committed to helping you feel like yourself again.

• Testosterone is essential for women's mood, energy, cognition, libido, and overall vitality
• Low testosterone in women is commonly missed because testing is inadequate and symptoms overlap with depression
• Oral contraceptives significantly reduce free testosterone by raising SHBG
• Comprehensive evaluation includes free testosterone, SHBG, DHEA-S, and full hormonal panel
• Treatment options include topical testosterone cream, pellets, and natural optimization strategies
• Testosterone therapy is safe when properly dosed and monitored
• Hormonal optimization is often the missing piece for women with depression that hasn't responded to antidepressants

Kyle Roth, FNP-BC, APRN, MSN, MHA is a board-certified family nurse practitioner specializing in hormone therapy, functional medicine, and integrative mental health care at Roth Family Medicine & Mental Health in Pocatello, Idaho.

This article is for informational purposes only and does not constitute medical advice. Hormone therapy should only be initiated under the supervision of a qualified healthcare provider.