Testosterone for women
You've heard about estrogen. You've heard about progesterone. But there's a third hormone quietly running a lot of the show in your body — and most women have no idea it even exists in them.
Testosterone. Yes, that hormone. And yes, it's yours too.
If you've been experiencing low libido, persistent fatigue, brain fog, stubborn weight gain, or a loss of the drive and motivation that used to feel like you — low testosterone may be a significant piece of the puzzle. Here's what you need to know.
Testosterone Is Not a "Male Hormone"
One of the most persistent myths in women's health is that testosterone belongs to men. In reality, testosterone is one of the most important hormones in the female body — and in your 20s and early 30s, your ovaries produce more testosterone than estrogen.
- Libido and sexual arousal — the primary hormone behind desire, sensation, and orgasm
- Energy and drive — the "get up and go" that carries you through your day
- Mood and resilience — lower testosterone is closely linked to depression and emotional flatness
- Muscle strength and tone — testosterone helps you build and maintain lean mass
- Bone density — protecting against osteoporosis and fracture risk
- Cognitive function — focus, mental clarity, and memory all have testosterone receptors
- Metabolism — influencing how your body manages insulin, fat storage, and weight
- Vaginal and pelvic floor health — androgen receptors are present throughout the genitourinary system
"This is not a minor supporting role. Testosterone is a central player in how you feel, function, and age."
When Does Testosterone Decline in Women?
Testosterone levels in women begin declining in the mid-30s — well before menopause. By the time a woman reaches perimenopause, her testosterone levels may already be significantly lower than they were a decade earlier.
Unlike estrogen, which drops sharply at menopause, testosterone declines more gradually with age. However, surgical menopause (removal of the ovaries) can cause a sudden, dramatic drop. Certain medications — including oral contraceptives and some antidepressants — can also suppress testosterone levels by increasing sex hormone-binding globulin (SHBG), a protein that binds testosterone and makes it unavailable to the body.
By the time a woman is 10 years post-menopause, her testosterone levels may be roughly half of what they were in perimenopause.
Symptoms of Low Testosterone in Women
Because testosterone touches so many body systems, its symptoms can feel scattered and confusing. They're often dismissed — even by healthcare providers — as stress, aging, or simply "how it is" now.
Common signs of low testosterone in women include:
If several of these feel familiar, you're not imagining it — and you're not just getting older.
Testosterone and Perimenopause: The Missing Piece
Perimenopause — the transition period before menopause — is increasingly recognized as a time of significant testosterone disruption. Many women in their 40s (and even late 30s) are experiencing symptoms of low testosterone without ever receiving a proper evaluation.
Because testosterone receptors are found throughout the brain, bones, bladder, muscles, and pelvic floor, even moderate declines can produce wide-ranging symptoms. The overlap between low-testosterone symptoms and general perimenopause symptoms means that testosterone is often overlooked when practitioners focus exclusively on estrogen and progesterone.
At Evoke, we look at the full hormonal picture — including testosterone — because incomplete hormone assessment leads to incomplete care.
What the Research Actually Says
The strongest evidence for testosterone therapy in women supports its use for hypoactive sexual desire disorder (HSDD) — clinically significant low libido that causes personal distress. A comprehensive review of 36 randomized controlled trials found transdermal testosterone to be an effective treatment for postmenopausal women with low sexual desire.
This evidence is strong enough that the Global Consensus Position Statement on Testosterone Therapy for Women — endorsed by The Menopause Society and the Endocrine Society — supports its use for this indication. Emerging research is also exploring testosterone's role in bone mineral density, cognitive function, mood, cardiovascular health, and muscle mass maintenance.
The science is evolving. What's clear is that testosterone is a legitimate, evidence-supported part of comprehensive hormonal care for women.
How Is Testosterone Therapy Administered in Women?
Testosterone for women is prescribed at much lower doses than for men — calibrated specifically to restore female physiological levels, not exceed them. Common delivery methods include:
- Transdermal cream or gel — applied to the skin daily; the most commonly prescribed form in Canada, offering precise, adjustable dosing
- Compounded formulations — custom preparations from a licensed compounding pharmacy, allowing dose precision tailored to your specific needs and labs
At Evoke, we work with licensed Canadian compounding pharmacies to ensure your prescription is formulated appropriately for your body — not adapted from a male-dosing framework.
What to Expect: The Evoke Approach
Responsible testosterone therapy includes comprehensive assessment, monitoring, and ongoing optimization. Here's how we do it:
Comprehensive Baseline Labs
We measure total testosterone, free testosterone, SHBG, estrogen, progesterone, thyroid, cortisol, DHEA, and metabolic markers — the full hormonal ecosystem, not a single number.
Symptom-First Assessment
Lab values provide context, but how you feel is the primary guide. Hormone levels don't tell the whole story — your lived experience does.
Personalized Treatment Plan
Your care plan is built around your specific body, labs, and symptom picture. No one-size-fits-all protocols here.
Ongoing Monitoring and Optimization
Testosterone is reassessed at 3 months, with continued follow-up to keep levels in the optimal physiological range and adjust as your body responds.
Support Between Appointments
Hormone optimization isn't a set-it-and-forget-it process. We stay available as you adjust and refine your results.
Frequently Asked Questions
Is testosterone therapy safe for women?
When prescribed at physiological doses and properly monitored, testosterone therapy for women has a strong safety profile. Like any treatment, inappropriate dosing carries risks — which is why individualized care and ongoing monitoring matter.
Is testosterone therapy covered by BC or Alberta health plans?
Testosterone therapy for women is typically prescribed off-label in Canada and is generally not covered under provincial formularies in BC or Alberta. Costs vary depending on the pharmacy and formulation — we can guide you through this at your consultation.
Will testosterone make me look or feel more masculine?
No — not at the doses used in women's hormone therapy. Physiological replacement doses are calibrated to restore normal female testosterone levels. Virilizing side effects occur with supraphysiological dosing, which is not the goal of hormone optimization.
Can I access testosterone therapy in perimenopause, not just menopause?
Yes. Many women benefit from testosterone support during perimenopause, though the approach is always individualized. We assess your full hormone picture to determine whether it's appropriate for your specific situation.
Do I need to be on estrogen first before starting testosterone?
Generally, optimizing estrogen and progesterone first is recommended, as these can independently improve many symptoms — including libido. However, this is a clinical decision made on a case-by-case basis. Some patients come to us already on HRT and are looking to add testosterone as the missing piece.
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Ready to Feel Like Yourself Again?
If your symptoms aren't fully resolved and you haven't had a thorough testosterone evaluation, it may be time to look at the complete hormonal picture.
Book Your ConsultationThis article is intended for educational purposes and does not constitute medical advice. Hormone therapy should be discussed with a licensed healthcare provider. Evoke BHRT Inc. provides individualized clinical care through licensed Nurse Practitioners authorized to practice in British Columbia and Alberta, Canada. Prescription medications are issued only after a clinical consultation and when medically appropriate.
