Hormone Balance and Testosterone Therapy in Premenopausal Women

Introduction

Hormones are powerful chemical messengers that control nearly every system in the body. They help regulate energy, growth, mood, reproduction, and even how the brain functions. When they are in balance, the body usually works smoothly. When they are out of balance, even by a little, women can experience a wide range of symptoms that affect both physical health and emotional well-being. Much of the focus on hormone health in women has traditionally been placed on estrogen and progesterone. These are the main hormones that control the menstrual cycle, fertility, and pregnancy. But there is another hormone that plays an important role in women’s health that often does not get as much attention: testosterone.

Many people are surprised to learn that testosterone is not only a male hormone. Women produce testosterone too, though in much smaller amounts than men. In fact, the ovaries and adrenal glands make testosterone throughout a woman’s life, even before menopause. While estrogen and progesterone levels rise and fall in a predictable pattern across the menstrual cycle, testosterone helps support energy, bone strength, muscle mass, brain function, and sexual health. It is an essential piece of the hormonal puzzle that keeps women feeling balanced and healthy.

In recent years, doctors and researchers have been paying more attention to testosterone in women, especially in those who are premenopausal. “Premenopausal” refers to the years when women are still having regular periods, meaning their ovaries are still active. During this stage of life, many women expect their hormones to be in good balance. However, symptoms such as low energy, decreased sexual desire, mood swings, and difficulty concentrating may appear, and some of these may be linked to changes in testosterone. This has led to growing interest in the possible role of testosterone therapy for premenopausal women.

Testosterone therapy is the medical use of testosterone to restore levels that are too low. For men, testosterone therapy has been widely studied and prescribed for decades. For women, the subject is more complex and less researched. While there is evidence that low testosterone in women can cause certain symptoms, there is still debate among experts about when therapy is appropriate, how safe it is, and how it should be monitored. Because of this, many women turn to the internet with questions. Some of the most common include: Is testosterone therapy safe for women who are still having periods? What symptoms can it help with? How do doctors test for low testosterone? Are there risks? And does it affect fertility or weight?

This article, Hormone Balance and Testosterone Therapy in Premenopausal Women, aims to answer those questions in a clear and evidence-based way. The goal is to give readers a strong understanding of what hormone balance means, the role testosterone plays in the female body, and what is currently known about testosterone therapy for premenopausal women. By focusing on the top questions that women are asking online, this article will provide a resource that is both practical and easy to understand.

We will begin by reviewing how hormones work together to maintain balance in the body, and why even small shifts can create noticeable symptoms. From there, we will look at what testosterone therapy is, what forms it comes in, and why some women may be prescribed it even before menopause. The heart of the article will explore the ten most common questions about testosterone therapy in premenopausal women, using medical research and expert guidelines to explain the answers in detail. These questions cover topics like safety, side effects, fertility, how therapy is given, and who should avoid it.

In addition, this article will explain how doctors monitor hormone levels during treatment, what the current scientific guidelines recommend, and where gaps in research remain. Since lifestyle plays an important role in hormone balance, we will also highlight how nutrition, exercise, sleep, and stress management can influence natural testosterone levels. Finally, we will look at the ethical and regulatory issues that surround testosterone therapy, such as the fact that there are currently no testosterone products approved by the U.S. Food and Drug Administration (FDA) specifically for use in women.

By the end of this article, readers should have a clear picture of what hormone balance means for premenopausal women, why testosterone is important, and what the potential benefits and risks of therapy may be. While the medical community continues to study this area, women deserve access to reliable, understandable information. This introduction is the starting point for a detailed discussion that will guide women through the most important questions they may have about testosterone therapy before menopause.

Understanding Hormone Balance in Premenopausal Women

Hormones are chemical messengers in the body. They move through the blood and help control many body systems, including growth, mood, sleep, energy, and reproduction. In women, three key hormones—estrogen, progesterone, and testosterone—play important roles in health, especially before menopause. This stage of life is called the premenopausal period, when women still have regular menstrual cycles. Understanding how these hormones work, how they change, and what happens when they are not balanced is the first step to understanding why some women may consider testosterone therapy.

The Role of Estrogen

Estrogen is often thought of as the main female hormone. It is made mostly in the ovaries, and smaller amounts come from the adrenal glands and fat tissue. Estrogen has many jobs:

• It helps regulate the menstrual cycle.

• It supports bone strength.

• It affects cholesterol and heart health.

• It influences mood and brain function.

• It keeps skin and vaginal tissue healthy.

Estrogen levels rise and fall each month during the menstrual cycle. Levels are lowest during a woman’s period and highest before ovulation, when an egg is released. These changes are normal and are part of a healthy reproductive system.

The Role of Progesterone

Progesterone is another important hormone made by the ovaries. After ovulation, the ovary produces progesterone to prepare the body for a possible pregnancy. Its main jobs are:

• Supporting the uterine lining so an embryo can implant.

• Balancing the effects of estrogen, especially on breast tissue and the uterus.

• Helping regulate mood and sleep.

If pregnancy does not happen, progesterone levels drop, and this triggers the menstrual period.

The Role of Testosterone in Women

Many people think of testosterone as only a male hormone, but women produce it too, in smaller amounts. It comes from the ovaries and adrenal glands. In women, testosterone plays several key roles:

• Supporting sex drive and arousal.

• Helping build and maintain muscle mass and bone strength.

• Supporting energy levels and motivation.

• Influencing mood, confidence, and focus.

Although testosterone levels in women are about 10 to 20 times lower than in men, it is still essential for health and wellbeing.

Hormone Fluctuations in the Menstrual Cycle

Every month, hormone levels rise and fall in a set pattern. A typical cycle has four phases:

1. Menstrual phase (days 1–5): Estrogen and progesterone are at their lowest. This is when the uterine lining sheds and bleeding occurs.

2. Follicular phase (days 1–13): Estrogen begins to rise, and the body prepares an egg for ovulation. Testosterone also increases slightly during this time.

3. Ovulation (around day 14 in a 28-day cycle): Estrogen peaks, and testosterone also reaches higher levels, which can increase sex drive.

4. Luteal phase (days 15–28): Progesterone rises after ovulation, balancing estrogen. If no pregnancy occurs, both hormones drop, leading to the next period.

These shifts affect mood, energy, appetite, and even sleep. For most women, the cycle feels balanced, but some experience stronger changes that cause distress.

Signs of Hormonal Imbalance in Premenopausal Women

When hormones are not balanced, symptoms may appear. Some possible signs include:

• Irregular periods: cycles that are too short, too long, or skipped.

• Mood changes: anxiety, depression, or irritability.

• Low libido: reduced sexual desire or satisfaction.

• Fatigue: constant tiredness, even with rest.

• Weight gain or difficulty losing weight.

• Acne or unwanted hair growth, which may signal high androgens.

• Hair thinning, which may come from low estrogen or other shifts.

• Sleep problems, often linked to changes in progesterone.

Not all symptoms mean a hormone problem, but when several appear together or are severe, doctors may recommend testing.

Why Balance Matters

Hormones do not work alone. Estrogen, progesterone, and testosterone act in balance, like instruments in an orchestra. When one is too high or too low, the whole system is affected. For example:

• Too much estrogen compared to progesterone can cause heavy periods, breast tenderness, and mood swings.

• Low estrogen can lead to vaginal dryness, poor sleep, and bone loss.

• Low testosterone may reduce energy, lower sex drive, and decrease muscle strength.

Because these hormones interact, changes in one often affect the others. This is why careful evaluation is needed before considering hormone therapy.

Hormone balance in premenopausal women is complex but essential for health. Estrogen, progesterone, and testosterone each play unique roles in reproduction, mood, energy, and body function. Fluctuations during the menstrual cycle are normal, but imbalances can lead to symptoms that affect quality of life. Understanding this foundation makes it easier to explore how therapies, including testosterone, may help when imbalances occur.

What is Testosterone Therapy for Women?

Testosterone therapy for women is a medical treatment that gives the body more testosterone when natural levels are low. Many people think of testosterone as only a male hormone, but this is not true. Women also make testosterone, though in smaller amounts. It plays an important role in energy, mood, sex drive, bone health, and muscle strength. When levels drop too low, some women notice unwanted symptoms like fatigue, loss of interest in sex, or even muscle weakness. Testosterone therapy aims to restore balance and improve these symptoms.

Understanding Testosterone in Women

Testosterone is produced in a woman’s ovaries, adrenal glands, and peripheral tissues. Even though women make about ten times less testosterone than men, the hormone is still critical for health. In premenopausal women, levels naturally rise and fall during the menstrual cycle. They are usually highest in the middle of the cycle, around ovulation, and lower during menstruation. This rhythm supports sexual function, energy, and even mood stability.

When production falls below normal, doctors may call this "androgen deficiency." While the condition is not as well defined in women as it is in men, low testosterone can still impact quality of life. Therapy is designed to supplement what the body is not making enough of.

What Testosterone Therapy Involves

Testosterone therapy means giving the body a controlled dose of testosterone from outside sources. The goal is not to give the high levels used for male treatment, but rather very small doses suited for female physiology.

Doctors carefully adjust the amount so that blood levels stay within the normal female range. Too much testosterone can lead to unwanted side effects, so dosing is a key part of safe treatment.

Forms of Testosterone Therapy for Women

There are several different ways testosterone therapy can be given. Each has advantages and disadvantages, and the choice depends on medical advice, patient needs, and availability.

1. Topical gels and creams

• These are applied to the skin once daily.

• The hormone is absorbed slowly through the skin into the bloodstream.

• They allow for steady hormone delivery but require careful application to avoid transferring the medication to others through skin contact.

2. Transdermal patches

• Patches stick to the skin and release testosterone over time.

• They are convenient but may cause skin irritation.

• In some countries, patches are more common than in others.

3. Injections

• Testosterone can be injected into the muscle every few weeks.

• This method often results in peaks and drops in hormone levels.

• Some women may find the fluctuations uncomfortable, leading to mood or energy changes.

4. Pellets

• Tiny pellets containing testosterone are placed under the skin by a doctor.

• They release the hormone steadily over several months.

• This option does not require daily use, but it does involve a minor procedure.

5. Oral forms

• Pills are less common due to concerns about liver health.

• Doctors usually prefer skin-based or implanted methods for safety.

How Therapy for Women Differs from Therapy for Men

It is important to understand that testosterone therapy for women is not the same as therapy for men. Men usually need much larger amounts to treat conditions like low testosterone or hypogonadism. In women, the doses are far smaller—sometimes less than one-tenth of what a man might use.

The purpose is also different. In men, therapy may aim to restore fertility, sexual function, or muscle mass. In women, the focus is usually on relieving specific symptoms such as low sex drive, fatigue, or loss of well-being. Because women’s natural testosterone levels are lower, doctors must be extra cautious to avoid giving too much.

Why Precise Dosing Matters

Women’s bodies are sensitive to even small changes in testosterone. Too little may not relieve symptoms, but too much can cause side effects such as acne, excess hair growth, or changes in voice. For this reason, most doctors will monitor hormone levels with blood tests before and during therapy. Adjustments are made slowly and carefully.

Medical Oversight is Essential

Testosterone therapy should only be prescribed and monitored by a qualified healthcare provider. Self-treatment or using products not designed for women can be dangerous. Many over-the-counter supplements that claim to boost testosterone are not regulated and may not be safe. A doctor will choose the right form, dose, and follow-up plan to ensure benefits while lowering risks.

Testosterone therapy for women is a treatment that restores hormone balance when natural levels are too low. While testosterone is often seen as a male hormone, it plays a vital role in women’s health. Therapy can be delivered in several forms, such as creams, patches, injections, or pellets, and each option has unique benefits. The doses for women are much smaller than for men, and medical supervision is essential to keep therapy safe.

When used appropriately, testosterone therapy can improve symptoms such as fatigue, mood changes, or low libido, and can help restore a woman’s quality of life. However, the key is careful dosing, ongoing monitoring, and working closely with a healthcare provider.

Why Might a Premenopausal Woman Need Testosterone Therapy?

When most people hear the word testosterone, they think of men. But testosterone is also an important hormone in women’s health. Even though women make much less testosterone than men, it plays a key role in energy, muscle strength, mood, and sexual wellbeing. In some women, testosterone levels drop low enough to cause noticeable symptoms. For certain premenopausal women, testosterone therapy may be considered to help restore balance and improve quality of life.

The Role of Testosterone in Women

Testosterone in women is made mainly by the ovaries and adrenal glands. While estrogen and progesterone are the “main” female reproductive hormones, testosterone supports many body functions. It helps maintain muscle and bone strength, influences mood and energy, and plays a large role in sexual desire. Because testosterone is not measured as often as estrogen or progesterone, its role in women is sometimes overlooked.

Symptoms Linked to Low Testosterone

Doctors may consider testosterone therapy if a woman has clear symptoms of low testosterone that cannot be explained by other causes. Some common symptoms include:

• Low libido (sex drive): Many women report a decrease in sexual interest or arousal. Testosterone is one of the main hormones that supports sexual desire.

• Fatigue and low energy: Women with low testosterone may feel tired even after sleeping well.

• Mood changes: Irritability, sadness, or low motivation may appear. These symptoms can overlap with other conditions, so they need careful evaluation.

• Muscle weakness or loss of strength: Testosterone helps build and maintain lean muscle mass. Low levels may cause women to feel physically weaker.

• Difficulty concentrating: Some women describe “brain fog” or trouble focusing.

These symptoms are not unique to low testosterone. They may also be caused by stress, thyroid disease, depression, anemia, or perimenopause. That is why proper medical testing and evaluation are important before starting therapy.

Medical Conditions That Can Lower Testosterone

There are several conditions that may cause testosterone levels to drop in premenopausal women:

1. Surgical removal of the ovaries (oophorectomy): The ovaries make most of a woman’s testosterone. If they are removed, levels fall sharply.

2. Adrenal gland problems: The adrenal glands also make small amounts of testosterone. If they are not working well, levels may drop.

3. Pituitary gland disorders: The pituitary gland controls the ovaries and adrenals. Problems with this gland can lead to low testosterone.

4. Chronic illness or medication use: Long-term illness, chemotherapy, or certain medications (like steroids or opioids) may lower testosterone.

How Doctors Diagnose Low Testosterone

There is no single test that confirms “low testosterone” in women. Diagnosis is based on a combination of symptoms and blood tests.

• Lab testing: Blood tests measure total testosterone. Free testosterone (the active form) can also be checked. Because levels change during the day and menstrual cycle, timing matters. Doctors usually test in the morning, during the early part of the cycle.

• Symptom review: Doctors consider symptoms alongside test results. Some women may have symptoms with “normal” numbers, while others have low numbers without symptoms.

• Exclusion of other causes: Before testosterone therapy is suggested, doctors rule out other conditions like thyroid disease, depression, or iron deficiency.

Why Testosterone Therapy May Be Considered

When symptoms are strong and testing shows low or borderline testosterone, therapy may be an option. The goal is not to give high doses but to bring levels back into a normal female range. Potential reasons for considering therapy include:

• Sexual health: Women with low libido that does not improve with other treatments may benefit.

• Energy and motivation: For some women, restoring testosterone improves stamina and reduces fatigue.

• Mood and cognition: Therapy may support better mood stability and clearer thinking.

• Muscle and bone health: In some cases, therapy may help preserve lean body mass and protect bone density.

Prevalence and Recognition

It is hard to know exactly how many premenopausal women have low testosterone because testing is not routine. Studies suggest that a percentage of women in their 30s and 40s may experience symptoms related to low levels, especially those with surgical removal of the ovaries. However, awareness is growing, and more women are asking doctors to check testosterone as part of their hormone evaluation.

Monitoring and Follow-Up During Therapy

Starting testosterone therapy is not a “one and done” process. It is a treatment that must be guided by regular check-ups and careful follow-up. This helps ensure the therapy is both safe and effective. Without monitoring, women may face side effects or not receive the benefits they were expecting. Below we explain the key steps in monitoring testosterone therapy for premenopausal women.

Regular Medical Check-Ups

When a woman begins testosterone therapy, her doctor will set up follow-up visits. At first, these visits are often more frequent, such as every 2 to 3 months. Over time, if the therapy is working well, visits may be spaced out to every 6 to 12 months.

These visits are important for several reasons:

• Tracking symptoms: Doctors ask about energy, mood, sexual health, and physical changes to see if the treatment is helping.

• Checking for side effects: Doctors look for early signs of acne, unwanted hair growth, or changes in voice. These side effects may signal that the dose is too high.

• Making dose changes: Testosterone therapy is not “one size fits all.” Some women may need small dose adjustments to find the right balance.

Lab Tests and Hormone Panels

Blood tests are an essential part of monitoring. Doctors use these tests to measure hormone levels and ensure they are within the safe range.

The main tests include:

• Total testosterone: This gives the overall amount of testosterone in the blood.

• Free testosterone: This measures the amount of testosterone that is active and available for the body to use.

• Sex hormone–binding globulin (SHBG): This protein controls how much free testosterone is available.

• Other hormones: Doctors may also check estrogen, progesterone, and sometimes thyroid hormones, since all hormones work together.

Lab tests are usually done at the start of therapy, again after 6 to 12 weeks, and then every few months as needed. Timing is important because hormone levels can shift depending on the menstrual cycle and the form of testosterone therapy used.

Watching for Physical Changes

Physical signs often give the first clues about how well therapy is working. Women and their doctors should pay close attention to changes such as:

• Skin: Acne or oily skin may appear if testosterone is too high.

• Hair: New hair growth on the chin or upper lip can occur. Hair thinning on the scalp is another possible side effect.

• Voice: A deepening voice is rare but important to notice early because it may not reverse after stopping therapy.

• Body composition: Positive changes may include more lean muscle and improved energy.

These changes should be noted at every check-up and reported by the patient between visits if they are concerning.

Tracking Emotional and Cognitive Effects

Testosterone can affect the brain as well as the body. Women may notice improvements in focus, motivation, and mood. However, if the dose is too high, it may cause irritability, anxiety, or sleep problems.

Doctors often ask patients to keep track of emotional health with simple tools such as symptom diaries or questionnaires. This helps measure whether therapy is improving quality of life.

Adjusting the Dosage

Finding the right dosage of testosterone is a process. The goal is to use the lowest effective dose that relieves symptoms without causing side effects. If testosterone levels are too low, the therapy may not work. If they are too high, unwanted effects may develop.

Doctors make adjustments by:

• Lowering or raising the dose.

• Changing the delivery method (for example, switching from cream to patch).

• Rechecking lab results after any adjustment.

This careful, step-by-step approach reduces the risk of harm and improves treatment success.

Importance of Ongoing Medical Supervision

Some women may think they can continue therapy on their own once they feel better. However, stopping check-ups is risky. Hormones affect many organs in the body, including the heart, liver, and reproductive system.

Long-term medical supervision helps:

• Detect hidden problems such as changes in cholesterol or liver function.

• Prevent long-term risks by keeping testosterone in the safe range.

• Provide updated advice as new medical research emerges.

Monitoring and follow-up are central to safe testosterone therapy in premenopausal women. Regular check-ups, lab tests, physical and emotional tracking, and careful dose adjustments all work together to protect health. Therapy without monitoring may lead to side effects or missed benefits. With good medical guidance, however, testosterone therapy can be a safe and effective option for women who need it.

Current Guidelines and Research on Testosterone in Women

Testosterone therapy in women is an area that has gained much attention in recent years. For many decades, testosterone was seen only as a “male hormone.” Today, doctors recognize that women also make testosterone and that it plays an important role in sexual health, mood, and overall well-being. Even so, there is still a lot of debate about how and when testosterone should be used in women—especially in premenopausal women. This section looks at what the current medical guidelines say, what research studies have found, and where the gaps in knowledge remain.

Medical Society Guidelines

Several medical groups have created guidelines to help doctors use testosterone therapy in women. These guidelines are meant to keep treatment safe and based on science. Some of the most important come from:

• The Endocrine Society: This group recommends that testosterone therapy should only be used in women who have been carefully diagnosed with low sexual desire that causes distress, a condition sometimes called hypoactive sexual desire disorder (HSDD). They also state that blood levels of testosterone are not always enough to confirm the diagnosis, so symptoms must be considered as well.

• The International Society for the Study of Women’s Sexual Health (ISSWSH): In 2019, ISSWSH released a consensus statement saying that testosterone can be useful for women with HSDD, but only after other causes of low desire have been ruled out. They stress that therapy should be at doses that match normal female levels, not male levels, to reduce the risk of side effects.

• The North American Menopause Society (NAMS): Although NAMS mainly focuses on postmenopausal women, they note that testosterone can sometimes be considered in younger women if symptoms are severe. They emphasize that careful monitoring is essential.

Overall, these guidelines share one message: testosterone therapy for women should be cautious, personalized, and closely supervised by a trained clinician. There is no “one size fits all” approach.

What the Research Shows

Research on testosterone therapy in premenopausal women is still limited. Most large studies have been done in postmenopausal women. Still, some important findings are available:

1. Sexual Health: Multiple clinical trials show that testosterone can improve sexual desire, arousal, and satisfaction in women who have HSDD. The strongest evidence comes from studies using transdermal (skin-applied) testosterone patches or gels.

2. Mood and Energy: Some smaller studies suggest that testosterone may improve mood, reduce fatigue, and increase motivation. However, results are mixed. Not all women experience these benefits, and some studies find no change compared to placebo.

3. Bone and Muscle Health: Testosterone is known to help maintain muscle mass and bone strength in men. In women, the research is less clear. Some studies show small improvements in lean body mass, but the long-term effects on bones are not fully known.

4. Safety: Short-term studies suggest that low-dose testosterone therapy is generally safe when levels are kept within the female range. Side effects like acne, extra hair growth, and oily skin are the most common. More serious side effects, like voice changes or clitoral enlargement, are rare when doses are carefully managed. The biggest gap is that long-term safety studies (over many years) are still missing.

Gaps and Controversies

Despite progress, many questions remain:

• Limited Research in Premenopausal Women: Most data comes from postmenopausal women. Very few large studies focus on premenopausal women, so doctors often have to make decisions without strong evidence.

• Lack of FDA-Approved Products: In the United States, there are no testosterone products specifically approved for women. Doctors sometimes prescribe male formulations at lower doses or use compounded creams. This raises concerns about consistency, dosing accuracy, and safety.

• Individual Differences: Not all women respond to testosterone in the same way. Some see big improvements, while others notice little change. More research is needed to understand why.

• Long-Term Effects: We still do not know the full impact of using testosterone therapy for many years. This includes questions about heart health, breast health, and mental well-being.

Researchers are continuing to study testosterone therapy for women. More clinical trials are underway to answer key questions about safety and long-term outcomes. There is also growing interest in how testosterone interacts with other hormones, like estrogen and progesterone, during the menstrual cycle.

In the future, we may see new products designed specifically for women, with doses that are carefully tested for safety and effectiveness. Until then, testosterone therapy remains an option that requires careful judgment, close monitoring, and shared decision-making between a woman and her healthcare provider.

Lifestyle and Non-Medication Approaches to Support Hormone Balance

Hormone balance is not only about medical treatments or prescriptions. For many premenopausal women, everyday lifestyle choices have a powerful effect on hormone health, including testosterone levels. While testosterone therapy may be needed in certain cases, habits such as nutrition, exercise, sleep, and stress management can play a major role in supporting the body’s natural hormone balance. Below, we explore how each of these areas contributes to hormone health and practical steps women can take.

Nutrition and Micronutrients

Food is one of the most important tools for supporting hormone health. Hormones, including testosterone, are made from building blocks in the foods we eat. A balanced diet helps the body produce hormones in the right amounts.

1. Protein: Protein is essential for muscle repair, stable energy, and hormone production. Sources such as chicken, fish, beans, tofu, and eggs help the body maintain lean muscle and regulate metabolism. Women with too little protein may feel tired and experience muscle weakness, which can worsen the symptoms of low testosterone.

2. Healthy Fats: Hormones are partly made from fats. Healthy fats, like those from avocados, olive oil, nuts, seeds, and fatty fish, support hormone production. In contrast, diets very low in fat or too high in processed fats can disrupt the body’s hormone balance.

3. Complex Carbohydrates: Whole grains, fruits, and vegetables provide fiber and steady energy. They also help regulate blood sugar. Stable blood sugar prevents spikes in insulin, a hormone that can affect how the body produces and uses testosterone.

4. Micronutrients: Certain vitamins and minerals are linked to healthy testosterone levels.
   • Vitamin D: Plays a role in hormone signaling. Women low in vitamin D may also have lower testosterone.

   • Zinc: Found in meat, shellfish, pumpkin seeds, and legumes, zinc helps the body produce testosterone.

   • Magnesium: Supports muscle and nerve function and may influence hormone balance. Leafy greens, nuts, and whole grains are good sources.

Eating a diet rich in whole, minimally processed foods supports not just testosterone but the entire endocrine system.

Exercise

Physical activity is one of the most reliable ways to support hormone balance. Different forms of exercise affect testosterone and other hormones in unique ways.

1. Strength Training: Lifting weights or doing bodyweight exercises like squats, push-ups, or lunges can help raise testosterone levels naturally. Even moderate resistance training a few times a week has been shown to support muscle mass and hormone health.

2. Cardiovascular Exercise: Activities such as walking, cycling, or swimming improve blood flow, reduce stress, and support overall hormone balance. While too much intense cardio can sometimes lower testosterone, moderate levels support health and weight balance.

3. Flexibility and Mind-Body Exercises: Yoga and stretching reduce stress hormones like cortisol. Since cortisol competes with testosterone in the body, lowering stress through gentle movement can help protect natural testosterone levels.

A balanced exercise routine combining strength, cardio, and flexibility training gives the best support for hormone balance.

Sleep

Sleep is often overlooked, yet it is one of the strongest regulators of hormone health. Testosterone, like many hormones, is released in a daily rhythm, and much of its production occurs during deep sleep.

• Quality Sleep: Women who regularly sleep fewer than 6 hours a night may experience lower testosterone and higher stress hormones.

• Sleep Hygiene: Consistent bedtime routines, limiting screens before bed, and keeping the bedroom dark and cool can improve sleep quality.

• Rest and Recovery: Sleep is also when the body repairs tissues and muscles. Poor sleep disrupts these processes and can worsen fatigue, mood swings, and low libido—all symptoms linked to hormone imbalance.

Getting 7–9 hours of restful sleep each night is one of the simplest and most effective ways to support hormone health naturally.

Stress Management

Chronic stress has a strong negative effect on hormone balance. The body responds to stress by releasing cortisol. When cortisol levels stay high for too long, they can suppress testosterone production.

1. Relaxation Practices: Techniques like deep breathing, meditation, or mindfulness help lower cortisol and improve overall hormone balance.

2. Physical Activity: Exercise, especially yoga or walking outdoors, combines movement with stress relief.

3. Hobbies and Social Support: Spending time on enjoyable activities or connecting with loved ones provides emotional balance that also reduces stress hormones.

By lowering stress, women allow their bodies to maintain a healthier balance between cortisol, estrogen, progesterone, and testosterone.

Lifestyle approaches cannot replace medical treatment when therapy is needed, but they create a foundation for healthy hormone balance. Nutrition provides the raw materials, exercise stimulates natural production, sleep restores balance, and stress management protects hormones from disruption. For premenopausal women, focusing on these habits may reduce symptoms of hormone imbalance, enhance the benefits of medical therapies, and support long-term health.

Ethical and Regulatory Considerations

Testosterone therapy in premenopausal women is an area of medicine that brings up many important ethical and regulatory questions. While research shows potential benefits, there are also limits to what has been proven, and rules about prescribing differ from country to country. In this section, we will look closely at three major areas: the approval status of testosterone therapy, the difference between compounded and standardized formulations, and the medical responsibility doctors have when prescribing this type of treatment.

FDA Approval Status and Off-Label Use

In the United States, the Food and Drug Administration (FDA) has not approved testosterone therapy specifically for women. Most testosterone products are designed and tested for men. Because of this, when doctors prescribe testosterone for women, they are prescribing it “off-label.”

What does off-label mean?

• Off-label use happens when a doctor prescribes a medicine for a group of patients or a condition that is not written on the official approval label.

• This is legal and common in medicine, but it requires extra care. Doctors must rely on their own clinical judgment, research studies, and patient needs rather than official approval documents.

Why does this matter?

• Without FDA approval, there is less standardized information on the right dose for women.

• It also means there are fewer long-term safety studies.

• Insurance companies may not cover off-label prescriptions, making treatment expensive for patients.

Some other countries, such as Australia, have approved specific low-dose testosterone products for women, but availability is limited worldwide. This difference shows the gap between what research suggests could help women and what is officially allowed in practice.

Compounded vs. Standardized Formulations

Since there are no FDA-approved testosterone medications made for women, many doctors turn to compounded formulations.

What are compounded drugs?

• These are medications made by special pharmacies that mix or adjust ingredients based on a prescription.

• A compounding pharmacist might create a cream, gel, or capsule at a much lower dose than products designed for men.

Benefits of compounding:

• Allows doctors to prescribe a dose that fits women’s lower testosterone needs.

• Offers flexibility in delivery method (cream, gel, pellet, or lozenge).

Concerns about compounding:

• Compounded medications are not regulated the same way as commercial drugs.

• Quality and purity can vary between pharmacies.

• There is less oversight, so risks like contamination or inconsistent dosing are higher.

Standardized formulations are medications that are mass-produced, tested for safety and quality, and approved for specific uses. While these exist for men, women often do not have access to standardized low-dose options. Until such options are widely available, women and doctors face the challenge of choosing between using a male-dose product (at a reduced dose) or turning to compounded versions.

Medical Responsibility in Prescribing

When a treatment is off-label and evidence is still growing, the responsibility on doctors is very high.

Ethical duties of doctors include:

1. Informed Consent – Doctors must explain to patients that testosterone therapy for women is off-label, what benefits it may bring, and what risks are still uncertain. Patients need to understand clearly before they agree to treatment.

2. Evidence-Based Practice – Even though not FDA approved, doctors should base their decision on the best available studies, clinical guidelines, and expert consensus.

3. Monitoring and Safety – Regular blood tests, check-ups, and symptom tracking are required to lower the risk of side effects. Ignoring monitoring is unsafe and unethical.

4. Avoiding Over-Prescribing – Some clinics may promote testosterone therapy as a cure-all for aging, weight loss, or beauty. Over-promoting without evidence can harm patients and reduce trust in medicine.

Doctors also face the ethical question of fair access. Since compounded medications can be costly, not all women who might benefit can afford treatment. This creates inequality in who receives care. Balancing patient needs, costs, and safety is a difficult but important duty.

The Need for Clearer Guidelines

Another ethical issue is the lack of strong, unified guidelines. While some professional societies, like the Endocrine Society and International Menopause Society, have published cautious recommendations, these are not official regulations. They often state that testosterone therapy may be considered for women with certain symptoms, especially low sexual desire, but should not be used as a general anti-aging treatment.

Without consistent guidelines, doctors may practice in very different ways. One doctor might feel comfortable prescribing testosterone, while another may refuse. This inconsistency can confuse patients and create mistrust.

Conclusion

Hormone balance is one of the most important parts of a woman’s health. For premenopausal women, hormones such as estrogen, progesterone, and testosterone all work together like a team. When even one of these hormones is too high or too low, the balance can shift. This imbalance may cause symptoms such as tiredness, low sex drive, mood swings, or changes in muscle and bone strength. Testosterone therapy is one option that doctors sometimes consider for women who show signs of low testosterone, but it is not a one-size-fits-all treatment.

Throughout this article, we looked at the role of testosterone in women’s bodies and answered many of the most common questions asked online. The first point to remember is that testosterone is not only a “male hormone.” Women also make it, though in smaller amounts. In women, testosterone helps with sexual desire, energy, motivation, bone health, and muscle strength. When levels drop, especially in some premenopausal women, the changes can be noticeable.

Testosterone therapy is meant to restore those levels when they are too low. It can come in different forms, such as creams, gels, injections, or small pellets under the skin. Each method has its pros and cons, and no single method is best for every woman. Doctors usually choose the form based on what is safe, effective, and easy to monitor. This is why medical guidance is so important—testosterone should never be taken without testing and supervision.

One of the biggest questions is safety. Current research shows that testosterone therapy may help certain women, but it is not risk-free. Short-term benefits can include better sex drive, more energy, and improved mood. Some women also notice changes in body composition, such as more muscle and less fat. However, side effects can happen. These include acne, oily skin, extra hair growth on the face or body, or deepening of the voice. Long-term risks are still being studied, especially related to the heart, metabolism, and reproductive system. Because the science is still developing, doctors are careful to weigh the possible benefits against the risks.

Another concern is fertility. Testosterone therapy may affect ovulation and menstrual cycles. For women who want to become pregnant, this is a serious consideration. Therapy may need to be avoided or stopped, depending on each woman’s health and goals. Doctors also warn that testosterone therapy is not recommended during pregnancy or breastfeeding.

Monitoring is a key part of safe treatment. Blood tests are needed to check hormone levels, and regular follow-ups allow doctors to adjust the dose if needed. This helps prevent over-treatment, which can cause more side effects. Good medical care means looking at the whole picture—test results, symptoms, and long-term health.

The interaction between testosterone and other hormones also matters. In women, hormones do not work in isolation. For example, estrogen and progesterone levels affect how testosterone acts in the body. Some women may be on birth control pills, hormone replacement therapy, or other medications. All of these factors can change how testosterone therapy works. This is why therapy must be personalized.

Research is still growing in this area. While testosterone therapy has been studied more in men, studies in women are fewer and sometimes show mixed results. Some medical groups support its careful use for specific symptoms, while others call for more studies before it is widely prescribed. This gap in research highlights the need for caution. Doctors must rely on current evidence but also keep in mind that knowledge is evolving.

Beyond medication, lifestyle plays a major role in hormone balance. Healthy eating, regular exercise, good sleep, and stress management all support natural hormone production. These steps may not replace therapy in every case, but they can improve overall health and make treatments more effective.

Regulation is another important point. In some places, there are no approved testosterone products made specifically for women, so doctors may use compounded formulations or lower doses of products made for men. This raises questions about consistency, quality, and long-term safety. For women, it means extra responsibility to ask questions and understand what they are being prescribed.

In summary, testosterone therapy in premenopausal women is a complex subject. It may offer real benefits for certain women who have low levels and troubling symptoms. At the same time, it carries risks and unanswered questions. The best approach is careful, evidence-based care guided by a healthcare professional who understands hormone health. Every woman’s body is different, and the choice to use testosterone therapy should be made after thorough testing, honest discussion of risks and benefits, and ongoing monitoring.

The future will likely bring more answers as new research becomes available. For now, the key takeaway is that hormone balance is vital for women’s health, and testosterone is part of that balance. But therapy is not a quick fix. It is a tool that must be used thoughtfully, safely, and individually. Women who are considering it should have open conversations with their doctors, ask about both the benefits and the risks, and take an active role in their health decisions.