The perception of testosterone as a male hormone has done women a significant disservice. In reality, testosterone is a vital female hormone, and its decline — which begins subtly in the mid-20s and accelerates with menopause — is responsible for a cluster of symptoms that many women accept as inevitable when they are anything but.
The pill’s effect on testosterone is one of the most underappreciated aspects of oral contraceptive use. The synthetic oestrogen in combined oral contraceptives dramatically raises SHBG, binding more testosterone and making it biologically unavailable. Studies show that SHBG remains elevated for months or even years after stopping the OCP in some women. Women who notice a persistent reduction in libido, energy or mood after starting or stopping hormonal contraception should ask their doctor to measure free testosterone and SHBG, not just total testosterone.
Surgical menopause — the removal of both ovaries — creates the most acute form of female testosterone deficiency. The ovaries produce approximately 50% of a woman’s testosterone; their removal causes an immediate, significant decline. Women who have undergone oophorectomy and are not receiving testosterone replacement deserve a conversation with their healthcare provider about whether therapy is appropriate.
For women considering testosterone therapy, the evidence base specifically supports its use for hypoactive sexual desire disorder (HSDD) in postmenopausal women. The Global Consensus Statement on menopausal testosterone therapy provides a framework for safe, evidence-based prescribing. HealthLab’s directory can help you find a South African practitioner equipped to assess and manage testosterone deficiency appropriately.
