While there's a mountain of reporting on male testosterone levels, the sex hormone is vital to women too, playing a role in everything from blood cell production, muscle mass, bone strength and energy levels to libido, mood, sleep and metabolism.
However, is low testosterone really something women need to be concerned about?
If it is, what can we do to ensure we maintain exercise and live to our full potential – and continue to feel good?
How do women produce and use testosterone?
First, a science primer: women produce testosterone in the ovaries and adrenal glands. While they make more of female sex hormone oestrogen, relative to testosterone, men experience the reverse.
Testosterone is an androgen, essential for the development and maintenance of female sexual anatomy and physiology, as well as modulation of sexual behaviour. It supports muscle tissue and hair growth, and is also anabolic – meaning it builds and repairs muscle.
Within a women’s body tissues, testosterone converts into oestrogen. As Professor Susan Davis, endocrinologist and leading menopause researcher, points out, it is still not fully understood how much testosterone acts directly in tissues such as bone and brain, and how much of its effect comes via conversion to oestrogen.
“Blood level does not tell you how much is being made from adrenal hormones in cells like the skin and hair follicles,” says Davis. That is why some women who have more hair than others might still record low testosterone levels.
Are blood tests helpful?
This is an area of ongoing discussion. Dr Louise Newson, a GP and menopause specialist, maintains blood tests can be useful.
In clinical practice, she tests for both testosterone and SHBG (sex hormone binding globulin), a protein that regulates testosterone by binding to it in the bloodstream and rendering it inactive.
By testing both, Dr Newson can work out the free androgen ratio, or how much active, ‘free’ testosterone is available for the body to use.
“If this is low (less than 3%) and the woman also has symptoms of low testosterone then I will consider a trial of testosterone to determine if this improves her symptoms,” says Dr Newson.
Does testosterone plummet at menopause?
In short, no. Studies consistently show there is no change at the onset of natural menopause. As Professor Davis says, blood testosterone declines slowly from around the age of 20 to 60 and may then increase slightly.
But while ovaries don’t suddenly stop producing hormones overnight, it’s a very individual thing. Dr Nicky Keay, a medical doctor and specialist in exercise endocrinology, says: “The crucial thing that often gets overlooked is, what is the biological response of the woman to this hormone?
“If a woman has been fine all her life at a certain level, and testosterone goes down a minuscule amount as she ages, she probably won’t feel a big difference.
"But if she was on the higher end, because she's got PCOS (polycystic ovary syndrome), for example, and then it drops relatively low, maybe she will notice. There are lots of ifs and buts.”
Women who’ve had their ovaries surgically removed will experience a more abrupt hormonal change, with figures showing around 50% of testosterone production is lost overnight.
Others may notice very little difference as testosterone declines. Hormonal contraception (the pill) can also suppress ovarian testosterone production during reproductive years.
What are the warning signs of low testosterone in women?
While low testosterone is often talked about as being responsible for a raft of symptoms, including reduced muscle mass, Professor Davis is unequivocal:
“There is no evidence that a low blood testosterone is associated with low muscle mass. Most available [tests] cannot tell normal from low in women and there is no evidence that a low blood testosterone means anything.”
Dr Newson disagrees, arguing that testosterone works in every cell and is metabolically active. In her clinical experience, fatigue, low mood, poor recovery, reduced muscle strength and brain fog can all be features of testosterone deficiency.
“Testosterone improves and controls energy and metabolism as well as muscle synthesis and mitochondrial function,” she says.
“When women have low levels of this hormone, it is more difficult to repair tissues and produce adequate energy.”
Dr Keay adds that hormones operate as a system and rarely is one the sole culprit. “We sometimes set all our expectations on one thing – for example, I can't cycle so fast because I've got low testosterone – but it's important to take a holistic approach as it’s likely a combination of many factors,” she says.
This is supported by research from January 2026, which states that fluctuations in athletic performance are influenced by many hormones (oestrogen, progesterone and cortisol) and the way they interact, not testosterone alone.
Is low testosterone contributing to a dip in your performance?
A Newson Research paper from July 2025, published in The Journal of Sexual Medicine, revealed that 79% of perimenopausal and postmenopausal athletes stopped or reduced exercising mostly in their 40s and 50s – mainly due to menopause symptoms (55%), muscle or joint pain (51%), or loss of stamina (41%). Of those using testosterone replacement, 73% felt it helped them return to or increase physical activity.
British Masters track cyclist Janet Birkmyre believes low testosterone has had a profound impact on her. The 59-year-old, whose impressive accolades include 49 World Masters Championship titles, recounts multiple debilitating effects, including slower recovery and the inability to continue lifting heavy weights. She has had to recalibrate her training.
“My levels are so low that they fall well outside the normal range and I’m struggling with worsening joint pain, severe headaches, low energy and brain fog.
"On top of that, sleep is compromised and I feel more emotional – the loss of mental resilience is really hard to deal with.”
Yet both Professor Davis and Dr Keay caution against assuming that testosterone is the sole cause of such symptoms.
Nutrient deficiencies such as Vitamin D, as well as high cortisol levels, which can be caused by ongoing emotional or physical stress, can also cause low muscle mass and severe fatigue in women.
What is the role of testosterone replacement therapy (TRT)?
The strongest evidence for testosterone replacement therapy (TRT) in women to date is for low sexual desire (Hypoactive Sexual Desire Disorder) when standard HRT is ineffective.
Both the British Menopause Society (BMS) and NICE (National Institute for Health and Care Excellence) recommend testosterone only in these circumstances.
And while the Birmingham Menopause Clinic states many women in specialist menopause clinics have reported benefits to cognition, energy, mood and musculoskeletal health when taking TRT, guidelines from the British Menopause Society in 2026 state that clinical trials to date have not demonstrated the beneficial effects. More robust studies are needed.
Can competitive athletes take TRT during menopause?
As Birkmyre knows only too well, TRT is banned by WADA (World Anti-Doping Agency) in the belief that it has the potential to enhance performance and alter normal physiology, possibly resulting in an unfair competitive advantage.
A 2025 report summarising WADA’s stance states that “in women there are almost no evidence-based, accepted medical indications for testosterone use”, beyond treatment for low sexual desire disorder (HSDD) after menopause.
Birkmyre says it is “incredibly difficult” knowing that TRT could potentially relieve some or all of her symptoms. “But so long as I hold a race licence, WADA rules prohibit me from even trying it”.
She continues to campaign for change, arguing that restoring age-appropriate levels of body-identical testosterone is not performance enhancement but health restoration.
Dr Keay can see the ethical argument, but acknowledges that proving the correct ‘natural’ level of testosterone to replicate for each athlete would be problematic and could also be open to abuse.
How can you take control?
With research still underway about exactly how low testosterone manifests itself in different women, it is a complicated picture, but things are changing.
Until recently, women in the UK who were prescribed testosterone were only offered products designed for men, which are difficult to dose at lower levels appropriate for females.
But in July 2025, AndroFeme, a 1% testosterone cream for postmenopausal women, was approved by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK and a commercial version is expected to be available in 2026, although inclusion via the NHS has not been confirmed.
Dr Keay also strongly advises women in their 40s and 50s to do strength training: “If heavy barbell work isn’t your thing, use resistance bands, do weighted lunges or Pilates.”
Strength training has several benefits beyond increasing overall fitness, including improving sleep and mood, and protecting bone density.
It is also important to fuel properly before training. As Dr Keay says, some women start putting on weight when hormones change so they reduce their calories before, during or after a workout.
“This will be counterproductive, because it will cause a big increase in cortisol, a catabolic hormone which promotes the storage of fat and will definitely reduce testosterone levels,” she says.
She also advises that women prioritise sleep, reduce alcohol and take vitamin D. “It’s an easy performance enhancer and it’s cheap,” she explains.
Dr Keay urges women to see perimenopause and menopause as an opportunity. “Every woman will experience the ‘female hormone odyssey’, so get clued up,” she advises. “It’s about quality training, not quantity.”
