Often blamed for bar brawls, lewd behaviour and the darker traits of toxic masculinity, testosterone has long had a branding problem. Historically, it's been framed as the preserve of those who possess Y-chromosomes; a blunt-force hormone best left to men.
But what if a carefully calibrated dose of the "him" hormone could help women in their midlife not only feel more like themselves again, but navigate the emotional, physical and psychological curveballs of this stage with greater confidence?
"Testosterone is one of the most under-discussed hormones in women's health, and one of the most powerful," says Vanessa Coppola, a doctor of nursing practice, board-certified menopause practitioner and founder of the women's wellness practice Bare Soul.
"It's thought of exclusively as a 'male hormone' but it influences everything from our energy and metabolism to our mood, libido, mental clarity, and that subtle but undeniable sense of inner vitality that so many women feel slipping away in their forties and fifties."
Rebranding testosterone
Yet testosterone is often left out of the menopause conversation and women pay the price for that silence. "It's about feeling alive again," Vanessa explains. "It restores the feeling of being anchored in your own body – strong, sharp, connected and fully present. For many midlife women, testosterone is the missing piece of the hormonal puzzle that nobody bothered to hand them. And as women, we deserve every part of our biology back."
Testosterone levels and midlife
"Women are made up predominantly of oestrogen and progesterone, with some testosterone, while men are mainly testosterone with a little bit of oestrogen and progesterone," explains Dr. Amalia Annaradnam, founder of the Hormone Wellness Clinic. "Testosterone can start to decline even before we hit menopause and our periods stop."
By the time menopause arrives, total testosterone production may fall by as much as 50%, Vanessa adds, a decline that is often compounded by age-related reductions in adrenal output.
"I sit across from women every day who think they're 'just getting older', 'just stressed', or 'just tired'. What they’re actually experiencing is the impact of a hormone that has never been explained to them," she says.
So why isn't testosterone a routine part of HRT? "There is no testosterone replacement therapy licensed for women in the UK, but that doesn't mean it isn't prescribed," says Amalia.
"Many private doctors prescribe it and some specialist NHS clinics do too. Because it's unlicensed, some GPs feel understandably cautious, as it's not their area of expertise but many of my patients do receive it on the NHS if I oversee their care." Androfemme is a commonly prescribed female formulation but it is expensive, so some doctors opt for male versions such as Testogel or Testim using smaller doses. "The British Menopause Society has good guidance for clinicians on testosterone prescribing," Amalia adds.
How do you know if you need testosterone?
"Symptoms of low testosterone can include fatigue, loss of muscle mass, low libido, brain fog, increased body fat, loss of drive and confidence and bone loss, to name a few," says Amalia. But both experts note that symptoms can be wide-ranging and nuanced from emotional flatness to lack of motivation.
"When women tell me, 'I don't feel like myself anymore' or 'my sex drive has gone', testosterone is often part of the conversation," says Vanessa, who notes that symptoms can be non-specific and may overlap with oestrogen deficiency, thyroid disorders, mood conditions or general ageing.
"However, when several of these concerns appear concurrently, testosterone decline should be part of the clinical evaluation."
Blood testing remains key. "I always take a baseline blood test before starting any hormone therapy," says Amalia. "I look at a full hormone profile and prescribe testosterone as part of HRT if women have symptoms and a low total testosterone level."
Vanessa adds that many women experience symptoms before their blood results fall clearly outside the reference range; another reason why specialist care matters.
Hair today, gone tomorrow?
Unsurprisingly, one of the biggest concerns among my friends was hair; thinning on the head and growth everywhere else. "Common side effects [of taking testosterone] can be acne, hair thinning or irritability if the dose is too high," says Amalia. "That's why it’s so important to see a hormone specialist. Women who are testosterone-sensitive or have a history of polycystic ovary syndrome often need much smaller starting doses."
Anabel Kingsley, a consultant trichologist at Philip Kingsley, agrees that the relationship between testosterone and hair is complex. "For some women, testosterone can exacerbate female-pattern hair loss if follicles are sensitive to it. However, clinically low levels of testosterone can also contribute to hair loss, so restoring levels may actually improve hair in certain women."
Hair loss, Anabel stresses, is highly individual. "The benefits of testosterone can be significant and I wouldn't let fear of hair loss put you off trying it. Have an open conversation with your doctor about risks and benefits. Scalp treatments can help protect follicles and encourage growth."