Testosterone: Back in the Spotlight
The Forgotten Hormone
For decades, testosterone was framed as a male hormone and treated as irrelevant or even risky for women. Yet as early as the 1930s, testosterone was being trialled in women for its effects on vitality, mood and energy. It was not associated with libido at the time, primarily due to social and moral attitudes of the era. By the late 20th century, testosterone had quietly disappeared from most therapeutic options for women, overtaken by the focus on estrogen and progesterone. Libido is simply sexual motivation or desire - it’s closely linked to overall drive and energy, not something separate from them. While testosterone directly supports sexual and urogenital health, its benefits extend far beyond that, influencing mood, vitality and motivation as a whole.
Before we talk about therapy, it’s worth remembering that testosterone is not an add-on or synthetic fix. It is part of the body’s natural design, produced in the ovaries, adrenal glands and peripheral tissues. Throughout life, it supports strength, drive, mood, focus and physical recovery long before any prescription is ever needed. Understanding this natural system helps explain why restoring balance later can be effective.
I advocate for starting with natural support - building health and vitality through nutrition, movement and practices that regulate and nourish the nervous system in this world of constant stress and overstimulation.
Integration is at the heart of lasting wellbeing. The body, mind, emotions and soul are not separate systems but one responsive network. Eastern traditions have long understood this, and modern science now echoes it: when the body feels supported and safe, hormones recalibrate and vitality returns from the inside out.
Testosterone Therapy: Every Body’s Choice
What excites me most about testosterone therapy is that it is not foreign to the body. It is a bioidentical hormone, identical in structure to what we naturally produce in the ovaries, adrenal glands and peripheral tissues. Women make three to four times more testosterone than estrogen before menopause, yet are rarely told this or offered support as levels decline.
Knowing that, as early as 1937, testosterone had already been trialled with success for women’s gynaecological issues adds valuable perspective.
A 1948 paper titled Male Hormone in Gynaecology and Obstetrics and in Cancer of the Female Breast (by A. A. Loeser, Obstet Gynecol Surv, 1948) describes the protective effects of this so-called “male” hormone on female breast tissue, along with its use in conditions such as:
• heavy or painful periods
• fibroids
• endometriosis
• premenstrual tension
• breast pain or benign breast lumps
• bladder issues
• morning sickness
• breast cancer
It does make me personally wonder why a treatment showing such promise for women’s health - particularly for breast protection - has remained largely overlooked for so long.
The safety data for testosterone therapy is stronger than most people realise. Long-term research, including studies that extend beyond the typical GP-level understanding, demonstrates that physiological dosing is not only well-tolerated but also beneficial across multiple systems. Studies show positive outcomes for mood, muscle, bone density, metabolic health and even protection against breast cancer and cardiovascular risk reduction.
Testosterone is an important, relevant hormone in women’s health. The research has shifted the conversation: at the right dose, testosterone is not only safe but can play a crucial role in strength, cognition, metabolism and emotional well-being.
Another important shift in understanding is that support for healthy testosterone levels may be needed well before menopause. Many high-performing, high-stress women in their 30s and 40s begin to experience the early signs of testosterone decline - fatigue, reduced libido, slower recovery, low mood and changes in focus or motivation.
For younger women who enter menopause early or who have naturally low testosterone, therapy can be an effective way to restore energy and bring levels back into a healthy range. Supporting testosterone earlier in life helps protect muscle, bone, cognitive function and overall vitality in the decades ahead.
Testosterone is no longer just a midlife or postmenopausal consideration. It is returning as a whole-body hormone relevant across the lifespan - not only for women but also for men and gender-diverse people. It is a human hormone that has been overlooked for far too long.
Why the Disconnect?
Even though testosterone is produced naturally in women and supports whole-body health, it has been largely excluded from mainstream care. Most women are never tested for it, and when symptoms arise, they are often attributed to stress, ageing, depression, thyroid imbalance or estrogen decline.
Prescribing guidelines restrict testosterone use to one diagnosis: hypoactive sexual desire disorder (HSDD) after menopause. This somewhat neglectful and narrow criterion ignores decades of research linking testosterone to bone strength, cognition, metabolism, energy, mood and cardiovascular health.
Meanwhile, men have long been prescribed testosterone for a range of symptoms, often with fewer barriers and lower costs.
The contrast highlights both a cultural bias, damaging to women, and a clinical gap. Hormones have been categorised through a male-female lens, rather than seen as shared biological systems with different dosing needs.
Testosterone has been viewed as male territory and estrogen/progesterone as female territory. This has shaped how research is funded, how results are interpreted and how treatments are offered. The result is that women have been excluded from access to a hormone they already produce, rely on and in many cases would benefit from supporting.
It is time to reframe testosterone as a human hormone and recognise that its decline affects health and quality of life in all bodies. The science is far ahead of current prescribing practices, and the conversation is beginning to catch up.
But before we even look at how testosterone is made, it helps to understand why it matters so much. Like estrogen, testosterone interacts with receptors all over the body, shaping everything from energy and mood to metabolism and muscle tone.
Testosterone Receptors: Why It Matters Everywhere
Testosterone doesn’t just work in the muscles or reproductive organs. It acts through specialised receptors that are spread throughout almost every tissue in the body. These receptors allow cells to respond to even small amounts of circulating testosterone, influencing everything from muscle tone to mood.
Receptors for testosterone are found in:
• brain and nervous system
• muscles and bones
• skin and hair follicles
• blood vessels and heart tissue
• fat tissue and liver
• immune cells and reproductive organs
This wide distribution explains why testosterone influences energy, motivation, cognitive sharpness, bone density and metabolic balance, as well as libido.
After menopause, even when blood levels of testosterone are lower, these receptors remain active. Supporting natural production and conversion of testosterone ensures that these receptor sites continue to receive the signals they need for repair, vitality and overall well-being.
How Testosterone Works Specifically in Women
Women don’t rely on a single source of testosterone. Experts vary slightly on the exact source of women’s testosterone. Dr Linda Dear describes it as roughly 25 per cent from the ovaries, 25 per cent from the adrenal glands, and the remaining 50 per cent made through peripheral conversion in tissues such as fat, skin, liver and muscle. Professor Susan Davis simplifies it to about half from the ovaries and half from the adrenals, since both produce the precursor hormones that convert to testosterone. Either way, women continue to make testosterone throughout life - and after menopause, this local conversion in the body’s tissues becomes the key pathway to maintaining vitality.
Where It’s Made
Peripheral conversion happens in:
• Adipose (fat) tissue
• Skin
• Muscle
• Liver and other organs
How It Happens
The ovaries and adrenals release two key precursor hormones, DHEA and androstenedione, which circulate in the bloodstream. Enzymes in peripheral tissues then convert these raw materials into active testosterone right where it’s needed. This allows each tissue to fine-tune hormone levels locally; for example, muscle cells can generate testosterone to support strength and recovery, while brain tissue converts small amounts to aid focus and motivation.
Even after menopause, when ovarian output drops, these local conversion pathways remain active, meaning your body still can produce testosterone naturally.
Why It Matters, Especially After Menopause
As estrogen and testosterone from the ovaries decline, peripheral conversion becomes essential for maintaining:
• Muscle strength and recovery
• Cognitive sharpness and motivation
• Libido and mood
• Bone density
• Metabolic health
The adrenal glands continue to produce DHEA and androstenedione, but this
output can slow under chronic stress, poor sleep, nutrient deficiencies or long-term inflammation. That’s why your daily habits, the way you move, eat, rest and manage stress, can directly influence how much testosterone your body can make and use.
Supportive habits, such as strength training, maintaining a balanced body composition, consuming adequate protein and healthy fats, and taking in zinc and magnesium, along with consistent recovery time, help optimise this conversion. In contrast, over-training, under-eating, high stress, or erratic blood sugar can dampen adrenal output and reduce conversion efficiency.
Even in pre- and perimenopause, these same pathways are active. Nurturing them early helps smooth the hormonal transition later, preserving vitality, focus and libido well into post-menopause.
What Can Disrupt Testosterone production
• Low DHEA or androstenedione (read more about this in the next section)
• Chronic stress affects adrenal function
• Very low or very high body fat
• Inflammation or poor metabolic health
• Nutrient deficiencies (especially zinc, magnesium, protein and omega-3s)
How to Support Testosterone Naturally
• Strength training and weight-bearing movement
• Adequate healthy protein and healthy fats
• Sufficient zinc, magnesium and B vitamins
• Support adrenal health through rest
• Avoid aggressive calorie restriction or fasting
• Stabilise blood sugar
• Reduce chronic inflammation
Testosterone doesn’t simply disappear with age. The body has multiple ways to make and regulate it, and most of them respond directly to how you live, nourish and recover. With the right lifestyle, women can continue producing meaningful levels of testosterone naturally, long after menopause.
What Causes Low DHEA and Androstenedione
DHEA and androstenedione are the raw materials your body uses to make testosterone and estrogen through peripheral conversion. When levels of these precursors drop, the whole system can feel flat. Here’s what commonly causes that decline and what helps rebuild it.
Chronic or Long-Term Stress - The adrenal glands make both DHEA and cortisol. When stress is ongoing, the body prioritises cortisol (the survival hormone) and slows DHEA production. Over time, this shift lowers both androstenedione and testosterone.
Sleep Deprivation - Deep sleep is when the brain and adrenals repair and coordinate hormone release. Consistent poor sleep reduces DHEA and disrupts the normal hormonal rhythm that supports focus, energy and recovery.
Nutrient Deficiencies - The adrenals need specific nutrients to make steroid hormones. Vitamin C, zinc, magnesium, B5, B6 and healthy fats all play vital roles. Restrictive diets, poor digestion or long-term inflammation can lower these precursors.
Over-Training or Lack of Recovery - High-intensity exercise without proper recovery can keep cortisol levels high and DHEA levels low. This can leave you tired, sore and slow to rebuild strength.
Under-Eating or Chronic Calorie Restriction - When energy intake stays too low for too long, the body shifts into conservation mode and reduces sex hormone production. Long fasting or very low-carb diets can contribute to this pattern.
Ageing and Hormonal Transition - DHEA peaks in our mid-twenties and gradually declines with age. By menopause, most women produce far less. However, good sleep, strength training, balanced nutrition and recovery can slow that decline significantly.
Surgical Menopause - When the ovaries are removed, the sudden loss of ovarian hormone production can significantly reduce both estrogen and testosterone, as well as the precursors DHEA and androstenedione. Because the change happens abruptly rather than gradually, symptoms can feel more intense. Supporting adrenal health, nutrient stores, and rest becomes especially important to help the body compensate for this loss of ovarian hormone output. Testosterone therapy is highly recommended in this circumstance to replace ovarian production.
Inflammation and Metabolic Dysfunction - Insulin resistance, chronic inflammation and liver overload from alcohol or toxins can interfere with the enzymes that convert cholesterol into DHEA and androstenedione.
Certain Medications - Long-term use of corticosteroids or hormonal contraceptives can suppress adrenal function and reduce DHEA output.
In Summary
Low DHEA and androstenedione often signal that the body is under strain from stress, under-nourishment, over-training or inflammation.
The encouraging truth is that these hormones respond positively to recovery, nutrient-rich food, regular sleep and strength-based movement. With the right habits, natural production can improve at any stage of life.
DHEA = precursor hormone made by the adrenals
Testosterone = end hormone made from DHEA and androstenedione
DHEA supplements can help a little, but require testing and caution
Testosterone therapy bypasses DHEA, replacing what’s missing directly
Lifestyle support (stress, sleep, movement, nutrition) improves both pathways naturally
Testosterone Across the Lifespan
Testosterone is not a hormone that fades with age. While levels do change over time, how testosterone behaves in the body is influenced by far more than chronology.
Nutrition, muscle activity, sleep, stress, metabolic health, sunlight exposure and toxin load all affect how much is produced, converted and used. Some people maintain strong testosterone levels well into later life, while others experience early decline due to factors like stress, surgery, burnout, medication, perimenopause, trauma, overtraining or illness.
Rather than viewing testosterone decline as inevitable, it is more accurate to see it as something that can be influenced through lifestyle, environment and endocrine health. Below is a general overview of how testosterone typically shifts over time, knowing that individual experiences vary.
20s to early 30s - Testosterone levels are at their natural peak in both women and men.
In women it supports:
energy
cognitive sharpness
sexual desire
fertility
physical strength
motivation and confidence
metabolic balance
In men it supports:
metabolic health
sperm production
mood stability
motivation and confidence
muscle strength
sexual function
By the mid-30s, testosterone begins a slow, age-related decline in both sexes.
Midlife (40s to 60s) - In women, around a quarter of total testosterone has already been lost by the mid-40s. This is due to age, not menopause itself. Menopause involves a sharp drop in estrogen, which exposes the effects of already-lowering testosterone and contributes to fatigue, muscle loss, mood changes and reduced metabolic resilience.
In men, testosterone typically declines by around 1 to 2 per cent per year after age 40. This can lead to:
lower energy
slower recovery
increased abdominal fat
loss of strength
reduced sexual function
lower mood
reduced muscle mass
higher risk of metabolic and cardiovascular issues such as insulin resistance, diabetes and heart disease
Later life (70+) - Testosterone does not disappear. In women, even as overall levels are low, the ratio of testosterone to estrogen often increases due to the steep decline in estrogen. Some researchers believe this relative increase may offer cardiovascular and cognitive support.
In men, testosterone continues to decline gradually, and low levels at this stage are associated with frailty, sarcopenia, osteoporosis, cognitive slowing, fatigue and higher mortality risk.
Research in older adults has shown that restoring testosterone to physiological (not high) levels can support:
bone density
muscle mass
metabolic function
sexual wellbeing
anemia correction
independence and quality of life
The Bigger Picture: benefits beyond libido
Testosterone is often reduced to its role in sexual desire, but research shows its influence is far broader and systemic. At physiological levels, testosterone contributes to multiple aspects of long-term health and daily function.
Muscle and bone - Testosterone supports muscle protein synthesis and bone density. It helps prevent sarcopenia and osteoporosis and improves physical strength, stability and injury resistance.
Metabolism and cardiovascular health - Healthy testosterone levels improve fat distribution, support glucose metabolism and influence insulin sensitivity. Research suggests a potential reduction in cardiovascular risk when testosterone is in balance.
Brain and mood - Testosterone has effects on neurotransmitter activity and brain function. It can improve motivation, memory and concentration and help stabilise mood.
Energy and drive - Many people report greater vitality, confidence and resilience under pressure when testosterone levels are adequate.
Sexual function - Libido, arousal and satisfaction are supported by testosterone, but this is only one part of its overall role.
Testosterone belongs in a whole-body conversation, not only a sexual health context. It affects structure, cognition, metabolism, motivation and long-term resilience.
Some Signs & Symptoms of Low Testosterone
Testosterone affects multiple systems in the body, so low levels can show up in different ways. Symptoms often overlap with stress, thyroid issues, perimenopause, depression or nutrient deficiency, which is why they are frequently overlooked.
Women - Low testosterone in women may present as:
loss of muscle tone or strength
low mood or emotional flatness
brain fog or reduced mental clarity
persistent fatigue or burnout
reduced libido or sexual responsiveness
vaginal dryness or discomfort
slower recovery from stress or exercise
increased anxiety or irritability
Not all women will experience all of these, but together they can indicate low androgen support.
Men - In men, a gradual decline may show up as:
fatigue or low physical resilience
fewer morning or spontaneous erections
reduced libido
increasing belly fat or loss of muscle strength
lower mood or motivation
slower recovery after exercise or illness
reduced sense of well-being
Because these changes often develop slowly, they are frequently misattributed to ageing or lifestyle.
All genders - Some symptoms are common across all bodies, including:
poor physical or emotional recovery
reduced drive or ambition
heightened anxiety or irritability
reduced stress tolerance
persistent fatigue or lack of stamina
decline in focus, clarity or confidence
These signs do not diagnose low testosterone on their own, but they are valuable indicators when viewed alongside hormone testing and overall health patterns.
Thyroid and Testosterone: untangling the overlap
Thyroid function and testosterone are closely linked, and many symptoms associated with low testosterone overlap with thyroid imbalance. This is especially true for women, who are more frequently affected by hypothyroidism and autoimmune thyroid conditions. Low thyroid function can contribute to:
fatigue
brain fog
low mood
hair changes
weight gain or difficulty losing weight
reduced libido
poor recovery
Thyroid hormones also influence how sex hormones are converted, transported and used. When thyroid function is low, the body may bind or metabolise testosterone differently, making less available for use.
Likewise, low testosterone can mimic or worsen symptoms often attributed to thyroid dysfunction, including:
poor metabolism
low mood
reduced energy
cognitive changes
changes in body composition
For women experiencing burnout, perimenopause, fertility issues, unexplained fatigue or hormonal symptoms, it is worth testing both thyroid and testosterone rather than assuming a single cause.
Useful thyroid testing includes:
TSH
Free T4
Free T3
Thyroid antibodies (TPOAb and TgAb) when indicated
Nutritional support for both thyroid and testosterone includes:
iodine
selenium
zinc
magnesium
adequate protein
omega-3 fatty acids
Lifestyle foundations also matter: reducing inflammatory load, improving gut health, moderating (or ideally removing) alcohol, checking your sugar sources and reducing, regulating stress and prioritising your sleep can improve both thyroid and androgen balance before medication is considered.
Natural and Supplemental Support
Before considering pharmaceutical options, it is important to create the right internal environment for hormone balance. Nutrient status, sleep, stress regulation, inflammation and metabolic health all influence how the body produces, converts and uses testosterone. These foundations make it easier to judge whether pharmaceutical support is necessary, and allow you to feel the benefits more clearly if treatment is started.
Herbs and plant-based support
Ashwagandha - has been shown in studies to support testosterone levels, lower cortisol and improve stress resilience.
Maca root - has a long history of use for libido, stamina and energy in both women and men. It does not supply hormones directly, but it can influence communication between the brain and the endocrine system. In practice, this means it may enhance the signalling between the hypothalamus, pituitary, adrenal glands and reproductive organs, helping the body regulate its own hormones more effectively.
Wild yam - is often marketed as a natural hormone booster, but this is a common misconception. It contains a plant sterol called diosgenin, which the human body cannot convert into progesterone or testosterone. Pharmaceutical companies can chemically convert diosgenin into hormones in a lab, but this process does not occur naturally in the body. Wild yam creams may help improve skin elasticity and hydration, but they do not replace or increase hormone levels.
Key nutrients
Zinc is essential for testosterone production and enzymatic activity. Deficiency is linked to reduced androgen function and immune imbalance.
Magnesium is required for hormone synthesis, energy metabolism and recovery. The most useful and well-absorbed forms include:
magnesium glycinate
magnesium citrate
magnesium malate
Avoid magnesium oxide, as it is poorly absorbed and mostly acts as a laxative.
Vitamin D deficiency is consistently associated with lower testosterone so correcting this improves overall endocrine health.
Omega-3 fatty acids aid hormone transport, cardiovascular function and inflammatory regulation.
Lifestyle factors with measurable impact
Strength and resistance training
Deep, restorative sleep
Adequate dietary protein and healthy fats
Remove alcohol entirely where possible, or strictly limit to no more than two drinks per week. Alcohol is a known hormone disruptor and cortisol spiker, and even moderate intake can lower testosterone and impair liver clearance of hormones
Remove or significantly reduce processed foods and refined sugars. Choose whole foods and natural alternatives, including sugar-free dark chocolate where desired
Support stable blood sugar through balanced meals, adequate protein, quality fats and reduced reliance on stimulants
Reduce chronic inflammation. This is often silent and shows up as joint stiffness, skin flare-ups, digestive issues, fluid retention, headaches, slow recovery after exercise, fatigue that does not improve with rest or generalised aches. Inflammation can be driven by stress, poor sleep, alcohol, processed foods, blood sugar swings, gut imbalance and/or nutrient deficiency
Manage psychological and physiological stress with practices such as yoga, breathwork, time in nature, restorative yoga and meditation; all of which are nervous system regulation therapies
These strategies enhance the body’s ability to produce and regulate testosterone naturally, reducing the hormonal disruption caused by modern stressors.
By addressing these foundations first, you create the conditions for better balance and gain a clearer sense of whether pharmaceutical therapy is needed or worth trying.
For Women: access, advocacy and prescribing reality
As of 2025, the only officially recognised reason most doctors will prescribe testosterone for women is a diagnosis of hypoactive sexual desire disorder (HSDD) after menopause. This requires persistently low sexual desire that causes distress and does not improve with standard hormone therapy. This seems to be because of the inability to find a ‘normal’ range of testosterone in blood levels for women, perhaps due to many other contributing factors.
But this is a striking limitation when compared to men, who can access testosterone for a wide range of symptoms, including low mood, low energy, muscle loss, fatigue, bone density decline and metabolic changes. In women, the conversation is still largely confined to sexual function. The assumption that testosterone is only relevant to female libido - and only after menopause - reflects a gender bias that has shaped research funding, medical training and prescribing norms.
This narrow prescribing approach ignores research showing benefits for muscle, bone, cognition, metabolism, cardiovascular health and mood. It has also reinforced the idea that testosterone is a “male” hormone rather than a whole-body hormone that women produce.
Meanwhile, access for gender-diverse people highlights the inconsistency. Trans men and some nonbinary individuals can be prescribed testosterone as part of gender-affirming care, outside the HSDD framework. They are not required to meet sexual dysfunction criteria, because their care is recognised under a different model -identity-based rather than symptom-based. Yet cisgender women seeking support for energy, metabolism, mood or musculoskeletal health still face the narrow libido-only prescription pathway.
Because most GPs are not trained in the broader research or updated safety data, many women find it more effective to take evidence into the appointment rather than trying to explain it during a short consult. Studies such as the four-year Libigel trial and the 2024 Agrawal analysis show strong safety outcomes and can help shift the conversation.
Women have the right to ask about pharmaceutical testosterone, to advocate for whole-body treatment and to question the limitation of libido as the only gateway to care. The goal is not to increase hormones beyond physiological levels, but to restore what the body naturally produced for decades.
Prescribing Guidance
When testosterone is prescribed for women, international consensus recommends:
Physiological doses - Very small amounts that mirror natural production, rather than male-level dosing.
Non-oral forms - Gels, creams or patches instead of pills, to avoid liver strain and maintain steadier absorption.
Monitoring for effectiveness and safety - Mild acne or increased hair growth are uncommon and usually only occur if the dose is too high or not reviewed. Regular follow-up ensures dose adjustments are made if needed.
Access is improving, awareness is growing, and long-term data now exceeds the level of evidence many older guidelines were based on. Women deserve the same opportunity as men - and the same pathway offered in gender-affirming care - to make informed choices about testosterone.
Benefits of Testosterone at Physiologic Doses
Long-term research, including four-year safety studies, shows that testosterone at correct lower doses for women is linked to:
stronger muscles and bones, reducing fracture risk
improved mood, focus, and energy
more stable metabolism
recent studies show breast protective indicators and cardiovascular protective indicators compared with women not taking testosterone
This goes far beyond the short two-year trials that conservative guidelines still rely on. Women should know that the evidence for safety and benefits is already stronger than what the medical system currently acknowledges.
For example:
Agrawal et al., 2024 (J Sex Med): A large cohort analysis showing that women on testosterone had lower rates of breast cancer and cardiovascular events compared with matched controls.
Libigel Cardiovascular Safety Study (White, Grady, Giudice, Zborowski et al.): A 4-year, 3,656-participant trial in postmenopausal women that found no increase in heart attack, stroke, or breast cancer, and slightly reduced rates in women on testosterone compared with placebo.
Pharmaceutical Testosterone Options and Costs in
New Zealand
Access to testosterone treatment has shifted significantly in recent years, particularly with the funding of Testogel. However, disparities remain between what is available to men versus women, and who is expected to pay.
Androfeme (1% testosterone cream) - Androfeme is the only testosterone product specifically formulated for women. It is prescribed in very small doses and a single tube typically lasts two to three months, depending on individual needs. Despite being designed for women and backed by safety research, Androfeme is not funded in New Zealand. It must be paid for privately, costing approximately $120 to $150 per tube. This stands in contrast to the long-standing funding of testosterone products for men, and highlights a gender bias in how hormone therapies are prioritised and subsidised.
Testogel - Testogel, although originally marketed for men, is now the only fully funded non-injectable testosterone option available in New Zealand. Funding changes removed previous access restrictions, which means it can be legally prescribed to women at physiological doses and used off-label for menopause, hormonal decline, fatigue, surgical menopause, HSDD or other symptoms. The cost to the patient is simply the standard prescription fee (usually around $5), regardless of the actual box price. No special authority, private importation or compounding is required.
Sachet format and prescribing - In New Zealand, Testogel is supplied in single-dose sachets formulated for a full male dose. When prescribed for women, doctors can advise how to portion an appropriate physiological dose using only a fraction of a sachet. The gel is applied to clean skin and absorbed through the surface gradually.
Prescriber awareness
Although funding is no longer a barrier, many GPs still assume testosterone gel is only for men. Women and gender-diverse people often need to raise the option themselves or provide research to support the conversation. The funding change has solved the cost issue but not yet the knowledge gap.
Bioidentical testosterone
The testosterone in both Androfeme and Testogel is bioidentical, which means it is structurally identical to the testosterone produced by the human body. It does not come from human tissue. It is synthesised in a laboratory from plant-based precursors such as soy or wild yam (diosgenin), which are chemically converted into testosterone through industrial processes.
Wild Yam clarification
Wild yam in its natural state does not increase testosterone or progesterone in the body. Although it contains diosgenin, humans cannot convert it into hormones without pharmaceutical processing. Topical wild yam creams may improve skin elasticity or hydration, but they do not act as hormone replacement.
Testosterone Beyond the Binary: biology, identity and whole-body health
Testosterone is not a male hormone. It is a human hormone that exists across all bodies in varying ratios. Some people are born with hormonal patterns that do not match textbook definitions, while others use testosterone as part of gender-affirming care. Many people exist outside binary categories altogether, where biology, identity and individual experience intersect in unique ways.
Natural variation in hormones and development
Not everyone is born with the expected XX or XY hormonal presentation. Intersex variations, chromosomal diversity and differences in puberty timing or hormone expression are all part of natural human biology. Some people naturally produce testosterone and estrogen in ratios that fall outside standard reference ranges. These differences are not disorders – they are part of the spectrum of biological variation.
Testosterone in gender-affirming care
For transgender men and some nonbinary people, testosterone therapy is one option used to align the body with gender identity. Its effects are not limited to appearance. Research shows that hormone therapy in these contexts can support:
muscle strength and recovery
bone density and structural health
mood, motivation and mental stability
metabolic and cardiovascular function
sexual wellbeing in whatever form that takes
Long-term studies in female-to-male transitions have shown improvements in bone mineral density in the hip and spine, increased lean body mass and better metabolic outcomes when doses are individualised and monitored.
Systemic hormone, not a single-purpose intervention
Whether used for transition, symptom management or overall well-being, testosterone plays the same physiological roles in gender-diverse individuals as it does in cisgender populations. It contributes to:
mobility and physical resilience
cognitive clarity and emotional steadiness
muscle and bone preservation
metabolic function and cardiovascular support
sexual function and confidence
long-term independence and vitality
Some research has identified cardiovascular events in certain cohorts, but overall risk is low when dosing is physiological and monitoring is consistent. The safety pattern mirrors what is seen in cisgender men and women: long-term support is most effective when treatment is individualised and reviewed regularly.
Testosterone should be recognised as a legitimate, body-wide hormone for cisgender, transgender and nonbinary individuals alike. The framework for access and prescribing is changing, but understanding and language still need to catch up.
Testosterone Therapy: possible side effects and why they are rare at the right dose
When testosterone is prescribed at physiological doses and properly monitored, side effects are uncommon and usually mild. The concerns often raised - such as increased hair growth, voice changes or clitoral enlargement - are almost always linked to dosing that is too high or not adjusted over time.
More common, temporary or dose-related effects may include:
Mild acne
Slight increase in facial or body hair
Oilier skin
Fluid retention
These effects typically resolve with dose adjustment and monitoring.
More significant changes
Voice deepening or clitoral growth are rare at female dosing levels and tend to occur only when testosterone is prescribed inappropriately, taken without guidance or not reviewed regularly. Early changes can often be reversed by reducing the dose.
Regular monitoring makes therapy both safe and adjustable. Follow-up blood testing, symptom tracking and dose reviews help ensure levels remain within the physiological range for women or the appropriate range for transgender, nonbinary or male bodies.
Pharmaceutical testosterone used in this way is not designed to create masculinising effects. It is intended to restore what the body naturally produced earlier in life and support health across multiple systems.
Hormone Health Checklist for Women
At any age, if you are experiencing fatigue, brain fog, low mood, reduced libido, weight changes, poor recovery, anxiety or cycle disruption, it is worth checking more than one hormone system. Many people are only tested for thyroid or only for estrogen and miss the full picture. The list below can be taken to your GP as a practical starting point.
Thyroid tests to request
TSH (Thyroid Stimulating Hormone)
Free T4
Free T3
Thyroid antibodies (TPOAb and TgAb), especially if there is fatigue, anxiety, weight change or autoimmune history
Testosterone and androgen-related tests
Total testosterone
Free testosterone (or calculated free testosterone)
SHBG (sex hormone binding globulin) an important protein that is made by the liver and carries sex hormones in the bloodstream. This test enables a nuanced view ot testosterone
DHEA-S (adrenal precursor to testosterone)
Helpful additional tests
Estradiol (especially in perimenopause or menopause)
Progesterone
Ferritin (iron storage, linked to energy and hair changes)
Vitamin D
Zinc and magnesium (often low in stressed or depleted individuals)
Why this matters
Symptoms caused by low testosterone, thyroid imbalance, adrenal depletion or nutrient deficiency often overlap.
Testing a single marker in isolation can lead to a misdiagnosis or incomplete treatment. This checklist helps initiate a broader and more informed conversation with your GP, supporting better treatment decisions.
At this stage it really is the symptoms that indicate and help assessments to start and monitor T therapy. Be aware that many GPs will not be schooled in this area. You may need to help them out, armed with some of this information here.
Inform Yourself & Others
A Leading Voice - Professor Susan Davis
If you’re curious to explore the science behind testosterone in women, Professor Susan Davis, based at Monash University in Australia, is one of the world’s leading researchers in this field. You can find her research through the Monash Women’s Health Research Program and recent publications in The Journal of Clinical Endocrinology & Metabolism and The Lancet Diabetes & Endocrinology.
Here is a recent interview with Prof Susan Davis.
(I personally dispute her comments that there is a lack of research and evidence currently, given the research and evidence I alone have been able to find.)
MenoDoctor New Zealand
A leading New Zealand company founded by Dr Linda Dear.
Menodoctor at work is a powerful initiative designed to liberate the narrative within the workplace.
“We educate and empower Kiwi workplaces to become menopause-supportive for all”.
Find out more.
Inform your GP - Myths and Misconceptions
This PDF article is a good overview and easy read.
I recommend forwarding to your health provider or GP as an adjunct to conversations regarding the use of Testosterone Therapy.
Research Links
Historical Perspective: Eight Decades of Research
In 2009, endocrinologist Abdulmaged M. Traish and colleagues published Testosterone Therapy in Women with Gynaecological and Sexual Disorders: A Triumph of Clinical Endocrinology from 1938 to 2008 in The Journal of Sex Medicine.
The paper traced seventy years of clinical evidence showing that testosterone plays far broader roles in women’s health than once believed.
Their review highlighted that from the late 1930s onward, doctors prescribed testosterone - mainly as testosterone propionate injections or implants - for a range of conditions, including:
• irregular or heavy menstrual bleeding
• endometriosis and dysmenorrhea
• menopausal symptoms and fatigue
• benign and malignant breast disease
• infertility and low sexual desire
The authors noted that early results were consistently positive, improving energy, mood, muscle tone and sexual wellbeing while often reducing breast pain and excessive bleeding.
They argued that by the 1950s, the growing emphasis on estrogen and progesterone largely displaced testosterone from mainstream care. Yet, data gathered across decades demonstrated that appropriate, physiological doses of testosterone were safe and beneficial for women - particularly for those experiencing hormonal decline, surgical menopause or adrenal insufficiency.
Traish et al. concluded that restoring testosterone to healthy ranges supports overall metabolic, cardiovascular, and musculoskeletal health, and that its long-standing safety record had been overlooked through gender bias and lack of education in women’s endocrinology.
Testosterone and Women
Agrawal P, et al. (2024). Testosterone therapy in females is not associated with increased cardiovascular or breast cancer risk: a claims database analysis.
Journal of Sexual Medicine.
https://pubmed.ncbi.nlm.nih.gov/38459625/White WB, Grady D, Giudice LC, Zborowski J, et al. (2012). Design of the Libigel Cardiovascular & Breast Safety Study in postmenopausal women with elevated cardiovascular risk and HSDD.
American Heart Journal.
https://pubmed.ncbi.nlm.nih.gov/22172433/
ClinicalTrials.gov: https://clinicaltrials.gov/study/NCT00612742Davis SR, et al. (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women.
Journal of Clinical Endocrinology & Metabolism.
https://academic.oup.com/jcem/article/104/10/4660/5556103Braunstein GD, et al. (2005). Safety and efficacy of a testosterone patch for hypoactive sexual desire disorder in surgically menopausal women: a randomised trial.
Archives of Internal Medicine 165(14):1582–1589.
https://pubmed.ncbi.nlm.nih.gov/16043675/Donovitz GS. (2022). A Personal Perspective on Testosterone Therapy in Women - What We Know in 2022.
Journal of Personalised Medicine 12(8):1194.
https://www.mdpi.com/2075-4426/12/8/1194Abdulmaged M. Traish, Robert J. Feeley, Andre T. Guay
Testosterone Therapy in Women with Gynaecological and Sexual Disorders: A Triumph of Clinical Endocrinology from 1938 to 2008”
Journal of Sexual Medicine, 2009.
Testosterone and Men
Lincoff AM, et al. (2023). Cardiovascular Safety of Testosterone-Replacement Therapy. New England Journal of Medicine 389(1):45–56.
https://www.nejm.org/doi/full/10.1056/NEJMoa2215025Grossmann M, et al. (2024). Testosterone Therapy in Older Men: Clinical Implications of Muscle and Strength Improvements. European Journal of Endocrinology 191(1):R22–R39.
https://academic.oup.com/ejendo/article/191/1/R22/7698939Zhang W, et al. (2025). Testosterone levels are positively linked to muscle mass but not strength in young to middle-aged males: results from a cross-sectional population study. Frontiers in Physiology.
https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2025.1512268/full
Testosterone in Gender-Diverse Populations
Hormone Therapy in Transgender and Gender-Diverse Individuals: Early Access Study (JAMA Network Open, 2022-2023)
This trial shows that testosterone therapy is associated with a significant decrease in gender dysphoria, depression and suicidality in transgender and gender-diverse people. JAMA Network
Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809058Association between Serum Testosterone and Measures of Cardiovascular Health Among Transgender Individuals Using Gender-Affirming Testosterone Therapy: Cross-Sectional Study
In this 2025 study, testosterone concentration was not significantly associated with blood pressure or arterial stiffness in a small cohort, suggesting that stable testosterone levels may not worsen vascular measures in gender-affirming therapy. PMC+1
Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC12172241/Turner A, Bhasin S, Conway AJ, et al. (2004). Testosterone increases bone mineral density in female-to-male transsexuals and hypogonadal men. Clinical Endocrinology (Oxf), 61(5): 560–566.
https://pubmed.ncbi.nlm.nih.gov/15521957/
Yoga Nidra is a powerful tool to help with nervous system balance and promote wellness on all levels.
If you need deep rest, or just want to tune in and understand how your body,
mind and spirit are truly feeling, book into this next Yoga Nidra Journey coming up on Sunday, 9 November.
Disclaimer
The information I share is for education, insight and general guidance only. It is not a substitute for personalised medical advice, diagnosis or treatment. I do not prescribe, diagnose or claim to treat any condition.
Please consult a qualified health professional before making changes to your medication, supplements, or treatment plan, especially if you have existing health concerns or are under medical care.
If you’re unsure what’s right for your body or would like support applying this information, you’re welcome to get in touch.