What’s the Role of Testosterone in Women’s Health?
Updated on June 26, 2026
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In May 2026, the Endocrine Society and other international experts have officially renamed polycystic ovary syndrome (PCOS) to polyendocrine metabolic ovarian syndrome (PMOS). This change better reflects the condition’s nature as a systemic metabolic disorder. This article has been updated to reflect the new terminology.
Although not in the same abundance as people assigned male at birth, those assigned female at birth also produce the androgen hormone testosterone in their ovaries and adrenal glands. Testosterone is known as a male sex hormone, but females also have levels of the hormone in their system, just as males have low levels of estrogen in theirs.
Females need small amounts of testosterone as part of the mix of hormones that keep mood, energy levels, sex drive, and bodily functions running smoothly. Without enough testosterone, females may experience low sex drive, depression, low energy, difficulties conceiving, and skin problems, among other issues. And too much testosterone can lead to acne, excess body hair, irregular periods, and male pattern baldness. Too much testosterone may be a sign that you have polyendocrine metabolic ovarian syndrome (PMOS), a condition that can lead to long-term health issues.
This article explains the relationship between testosterone and women’s health, including the role it plays, what happens when levels change, and when to manage levels with your doctor.
What Impact Does Testosterone Have on Women’s Bodies?
Normal levels of testosterone have multiple functions on the overall health of women.
It Keeps Bones Healthy
Having optimal testosterone levels supports healthy bone growth and strength, according to research. Even though other papers have concluded that estrogen plays a more significant role in bone formation, testosterone still has an indirect role to play, mainly because the body converts it to estradiol, a type of estrogen. One study compared spine bone density in postmenopausal women who had higher testosterone levels with those who had lower levels. The authors found higher bone density in the spines of the women with higher testosterone levels, which may support a bone-strengthening role for testosterone.
It Might Support Cognitive Health
Mixed research has explored the link between testosterone and cognitive function in females. One study found that lower testosterone levels were linked to worse performance on tests of global cognition, processing speed, and verbal memory. However, more recent research found no link between a drop in testosterone levels and cognitive decline.
For now, the Endocrine Society's guidelines state that not enough evidence supports the link to recommend testosterone supplementation to manage cognitive decline.
It Maintains Sex Drive
Testosterone plays a role in driving desire, fantasy, and thoughts about sex, known as libido, and even helps provide the energy for sex in women, says Aaron Spitz, MD, a urologist based in Laguna Hills, California.
However, low libido can occur due to a complex combination of physical, mental, and emotional factors. While low libido can be a symptom of low testosterone in women, it doesn’t immediately point to low testosterone.
What Happens When a Woman’s Testosterone Levels Are Low?
Testosterone levels decrease somewhat in females between ages 20 and 40. However, unlike estrogen, there does not appear to be an abrupt and profound reduction around menopause — levels have generally plateaued by the time a female reaches menopause. However, once they reach menopause, testosterone levels may have dropped to around half of their previous levels.
Still, some females experience lower testosterone levels after menopause that can cause a decrease in sex drive. Other symptoms may include:
- Low energy and fatigue
- Reduced muscle tone and strength
- Vaginal dryness
- Depression
- Anxiety
What Happens When a Woman’s Testosterone Levels Are Too High?
Most often, high levels of a type of androgen known as free testosterone are linked to PMOS, a condition that interferes with monthly periods and the body’s ability to ovulate. According to the U.S. Department of Health and Human Services Office on Women’s Health, 5 to 10 percent of women of childbearing age are affected with this health problem.
However, high testosterone levels can occur for other reasons, including rare genetic conditions like Cushing's disease and congenital adrenal hyperplasia, tumors that secrete androgens, and the adverse effects of certain medications.
PMOS can cause the following symptoms:
- Missed Periods or an Irregular Menstrual Cycle A high level of androgens can make periods infrequent, irregular, or nonexistent.
- Infertility Since females with PMOS may not ovulate, they have difficulties becoming pregnant.
- Excess Hair Growth The hormonal imbalances associated with PMOS can lead to hair growth on the back, chest, abdomen, and face.
- Ovarian Cysts Since the ovaries may not release eggs from the ovarian follicles, the immature follicles can fuse together to form large ovarian cysts.
- Skin and Hair Problems Females with PMOS may experience oily skin, acne, dark patches of skin, hair loss on the scalp, and male-pattern baldness
- Miscarriage If they do get pregnant, women with PMOS have an increased risk for miscarrying.
High levels of testosterone in women, whether caused by PMOS or another condition, can be associated with serious health conditions, such as being overweight or having obesity, type 2 diabetes, high cholesterol, high blood pressure, and heart disease.
Testosterone Therapy: When Should Women Consider It?
In its most recent guidance from 2019, the Endocrine Society recommends against the general use of testosterone therapy in healthy women for the treatment of the following conditions:
- Infertility
- Sexual dysfunction other than hypoactive sexual desire disorder (HSDD), a common disorder during midlife, for which testosterone supplementation has shown some benefits for sexual desire and emotional well-being in postmenopausal women (there’s no recommendation for premenopausal women)
- Cognitive function
- Cardiovascular health
- Metabolic syndromes
- Bone health
- General well-being
Is Testosterone Safe to Treat HSDD?
Some scientific evidence supports the short-term effectiveness and safety of testosterone therapy for postmenopausal women with sexual dysfunction due to HSDD. Experts suggest trying nonoral preparations, such as transdermal gels, for up to six months at around one-tenth of the dose that’s appropriate for males.
If your doctor prescribes ongoing therapy, practitioners should initially test testosterone levels after three to six weeks and then at six months to monitor for signs of androgen excess. If a woman hasn’t responded to treatment after the first six months of therapy, the treatment should be discontinued.
Side effects might include:
- Acne
- Increased sweating
- An unpleasant body odor
- More body or facial hair
Some people might have consistently excessive testosterone levels resulting from testosterone therapy, which may lead to a deepening voice, thinning hair on the scalp, and an enlarged clitoris.
Prescription testosterone products for males have been approved by the U.S. Food and Drug Administration only for individuals who have low testosterone levels caused by certain medical conditions. Some compounding pharmacies, which make products according to a doctor’s specifications, as well as over-the-counter products, have sidestepped this restriction for women by providing personalized testosterone therapy.
While this has led to varying safety, quality, and dosing standards for certain products, female-appropriate dosing, careful consideration of which females are appropriate candidates, and regular testing can mean that nonoral testosterone supplements show moderate therapeutic benefit for managing HSDD. However, long-term safety hasn’t been established.
EDITORIAL SOURCES
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Resources
- Testosterone for women. Women’s Health Concern. 2026.
- Low Testosterone in Women. Cleveland Clinic. April 12, 2023.
- Yang JX et al. Association between Serum Total Testosterone Level and Bone Mineral Density in Middle-Aged Postmenopausal Women. International Journal of Endocrinology. August 17, 2022.
- Grigoryan S et al. Hormonal Control of Bone Architecture Throughout the Lifespan: Implications for Fracture Prediction and Prevention. Endocrine Practice. July 2024.
- Dratva MA et al. Low testosterone levels relate to poorer cognitive function in women in an APOE-ε4-dependant manner. Biology of Sex Differences. June 5, 2024.
- Sultana F et al. Associations between declining testosterone concentrations and cognitive performance in community-dwelling older Australian women: a prospective cohort study. Climacteric. February 2026.
- Davis SR et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. The Journal of Clinical Endocrinology & Metabolism. September 2, 2019.
- Attention women: Low sex drive? Testosterone won’t help. UT Southwestern. August 18, 2022.
- BMS Statement on Testosterone. British Menopause Society. March 2, 2023.
- Hyperandrogenism. Cleveland Clinic. August 11, 2025.
- Polycystic ovary syndrome. Office on Women’s Health. October 24, 2025.
- PCOS, Pregnancy and Miscarriage. Miscarriage Hope Desk. April 5, 2021.
- Diabetes and Polycystic Ovary Syndrome (PCOS). Centers for Disease Control and Prevention. May 15, 2024.
- Coalition issues international consensus on testosterone treatment for women. Endocrine Society. September 3, 2019.
- Testosterone Therapy for Women. Cedars-Sinai. April 9, 2026.
- Testosterone Information. U.S. Food and Drug Administration. February 23, 2026.
- King JM et al. Trials and tribulations of testosterone therapy in women: Importance of adhering to the evidence. Cleveland Clinic Journal of Medicine. January 2021.
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Elise M. Brett, MD
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Elise M Brett, MD, is a board-certified adult endocrinologist. She received a bachelor's degree from the University of Michigan and her MD degree from the Icahn School of Medicine ...
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