The hormone behind libido, energy, muscle strength and motivation — and why women need it too.
Testosterone is almost universally thought of as a male hormone — but it is equally essential in women, just present in smaller amounts. Women produce testosterone in the ovaries and adrenal glands, with smaller contributions from peripheral conversion of androgen precursors like DHEA. It drives libido, physical energy, muscle strength, bone density, cognitive sharpness and motivation. Testosterone peaks in a woman's mid-twenties and declines gradually — halving by menopause. For women who undergo surgical menopause, the loss is abrupt and the consequences are immediate and significant.
| Marker | What It Means | Too Low | Too High |
|---|---|---|---|
| Free Testosterone | Only ~1–2% of total testosterone is free — this is what actually enters cells and drives effects. Most meaningful for symptoms. | Fatigue, low libido, poor motivation, muscle loss | Acne, hirsutism, oily skin, aggression |
| Total Testosterone | Standard blood test; can be normal while free T is low if SHBG is elevated (e.g. on the pill) | May appear normal even with symptoms | Seen in PCOS, adrenal hyperplasia |
| SHBG (Sex Hormone Binding Globulin) | Binds testosterone and makes it unavailable. High SHBG (from the OCP, thyroid issues, low androgens) dramatically reduces free T | More free androgens available — can contribute to PCOS symptoms | Binds excess testosterone — reduces free T; common on oral contraceptives |
| DHEA-S (Androgen Precursor) | Precursor to testosterone and oestrogen; declines with age and chronic stress; useful marker of adrenal androgen reserve | Fatigue, low libido, poor stress resilience, accelerated ageing | Rarely problematic at physiological levels |
Testosterone imbalance in women shows up in two directions — deficiency (most common in perimenopause and postmenopause) and excess (the hallmark of PCOS). Both are underdiagnosed and frequently misattributed to other causes.
Testosterone halves between the 20s and menopause. Symptoms accumulate gradually — low libido, flat mood, fatigue, muscle loss — and are frequently attributed to ageing or stress rather than hormonal deficiency.
Removal of the ovaries eliminates ~50% of testosterone production overnight. Causes sudden, severe loss of libido, energy and mood — often under-treated as doctors focus on oestrogen replacement alone.
The OCP raises SHBG dramatically, binding free testosterone and reducing its bioavailability. Some women experience low libido and mood changes — symptoms that can persist even after stopping the pill ('post-pill SHBG elevation').
Excess ovarian androgen production driven by insulin resistance and LH hypersecretion. Affects ~1 in 10 SA women. Causes: acne, hirsutism, scalp hair loss, irregular periods. Diagnosis requires clinical + biochemical assessment.
Testosterone converts to dihydrotestosterone (DHT) via the enzyme 5-alpha reductase — and DHT is far more potent at androgen receptors. Understanding DHT explains why some women experience hair loss and acne even with only mildly elevated testosterone.
Scalp hair follicle miniaturisation
DHT binds to androgen receptors in scalp follicles, progressively shrinking them. Female androgenic alopecia differs from male pattern — diffuse thinning over the crown.
Sebaceous gland stimulation
DHT drives sebum (oil) overproduction — causing acne, particularly cystic acne along the jawline and chin, and oily skin.
5-alpha reductase activity
Enzyme expression varies between individuals — women with higher 5AR activity convert more T to DHT, explaining why symptoms of androgen excess can occur even with borderline T levels.
Body & facial hair growth
DHT stimulates terminal hair growth in androgen-sensitive areas (face, abdomen, inner thigh) — the pattern and severity depend on individual receptor sensitivity.
5AR inhibitors (Finasteride)
Block DHT production — used off-label in women for androgenic alopecia and hirsutism. Contraindicated in pregnancy. Requires specialist supervision.
Spironolactone
Blocks androgen receptors rather than DHT synthesis — effective for acne and hirsutism; also mildly anti-DHT at the follicle level.
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The idea that testosterone is exclusively a male hormone is one of the most persistent misconceptions in women’s health. In reality, testosterone is a vital hormone for women, influencing physical vitality, emotional wellbeing, sexual health and cognitive performance throughout life.
Women produce testosterone primarily in the ovaries and adrenal glands. Although the amounts are much smaller than in men, the effects are significant. Testosterone peaks in a woman’s mid-twenties and then begins a slow, steady decline. By menopause, levels are roughly half of what they were at their peak — and for women who undergo surgical menopause (removal of the ovaries), the drop is sudden and dramatic.
Low testosterone is increasingly recognised as a contributor to the cluster of symptoms many women experience in their 40s and beyond — exhaustion that sleep doesn’t fix, a flat or low mood, lost drive and ambition, reduced interest in sex, and difficulty maintaining muscle tone despite regular exercise. These symptoms are often attributed to stress, burnout or simply getting older, and testosterone deficiency is rarely investigated as a cause.
On the other end of the spectrum, excess testosterone — most commonly seen in polycystic ovary syndrome (PCOS) — causes its own set of problems, including acne, hirsutism (excess facial and body hair), scalp hair loss and irregular or absent periods. PCOS affects up to 1 in 10 South African women of reproductive age and is one of the leading causes of female infertility.
Testing testosterone is relatively straightforward via a blood test, though results must be interpreted carefully. Total testosterone, free testosterone and SHBG (sex hormone binding globulin) are all relevant — a woman can have a normal total testosterone reading but low free (bioavailable) testosterone if SHBG is high, which is common in women on the oral contraceptive pill.
For women with confirmed low testosterone and significant symptoms, testosterone therapy — typically applied as a skin cream or gel — can be highly effective. It remains an off-label treatment in South Africa and should be prescribed and monitored by a specialist. HealthLab’s directory can connect you with knowledgeable practitioners in your area.