Testosterone is often called a male hormone, but women make it too, only in much smaller amounts. A woman’s level is about one twentieth of a man’s.¹

About half of it comes straight from your ovaries. The other half is made in your skin and other tissues from “building blocks” released by your adrenal glands, two small glands on top of your kidneys. The main building block is called DHEA. DHEA does not act like testosterone itself; your tissues must convert it first.^1,2

In the blood, most testosterone is tightly bound to a carrier protein called SHBG (sex hormone-binding globulin). Only a tiny free part, around 1–2%, can actually work in your body.¹ This is why we always look at two numbers: your total testosterone and your free testosterone.

Why total can look fine while free is low. Estrogen tablets and the contraceptive pill pass through the liver first, and this raises SHBG. More testosterone is then locked up, so the free part falls, even if the total looks normal. Estrogen used on the skin hardly changes SHBG.^1,3 We measure SHBG for exactly this reason.

What testosterone turns into. In your skin, hair roots, vulva and clitoris, testosterone is changed into a stronger hormone called DHT (dihydrotestosterone). DHT is the form that acts on skin oil, acne and hair.^2,1 Skin with a lot of hair converts more testosterone into DHT. This is why we ask you to apply the gel only on skin with no hair. Part of testosterone is also turned into estrogen, mainly in the brain, bone, breast and ovary.⁴

• It falls well before menopause. Testosterone is highest in your 20s and then slowly falls.^5,6
• Natural menopause does not make it drop suddenly. Levels stay fairly steady through the menopause transition and may even rise a little in later life. DHEA, the main building block, keeps falling with age, by about 60% by the time of menopause.^6,4
• Removing both ovaries is different. Testosterone falls clearly and at once, because half of it came from the ovaries.³

How testosterone and DHEA change with age in women. The picture shows the direction of change only; it is not drawn from measured values.

Can DHEA fix low testosterone? Only a little. In a 2-year trial in older adults with low hormone levels, DHEA raised DHEA itself into the upper part of the young adult range, but testosterone in the women rose only slightly.⁷ So DHEA is not a way to correct low testosterone. If you take DHEA from anywhere, please tell us, because it adds to the testosterone we measure.

• Both ovaries removed. Half of your testosterone came from them, so this part does not come back.^6,3
• Early menopause, or a pituitary or adrenal gland problem. These need care from a specialist.⁶
• Medicines that switch off the ovaries before menopause.⁶
• The contraceptive pill or estrogen tablets. They lower the ovaries’ output and raise SHBG, so the free part falls.²
• Steroid tablets in high doses. They lower the building blocks from the adrenal glands.²
• Very hard endurance training and severe emotional stress. Physicians who focus on optimal hormone levels see lower testosterone in these situations.

Research has not yet followed women to see how much their level comes back after stopping the pill, training less or reducing stress. That is why we use the same approach for everyone: symptoms together with a blood test. If you can change one of these factors, your follow-up tests will show your new level.

Standard medical guidelines do not yet define a testosterone deficiency syndrome in women. The only use they recognise is low sexual desire that causes distress after menopause.^2,5 Physicians who focus on optimal hormone levels look for a wider range of signs:

• Mind: irritability, worry, low confidence, difficulty making decisions, strong emotions, low mood, poor tolerance of stress, poor memory
• Body: constant tiredness that is worse with effort, loss of muscle tone and strength, more fat around the belly, back and joint pain, dry skin, sweating, leaking urine
• Sex life: lower desire, less sensitivity of the clitoris and nipples, difficulty reaching orgasm, pain during sex, vaginal itching
• What a doctor may see: looking older than your age, a slack face and belly, fine wrinkles around the eyes and above the lips, thinning underarm and pubic hair, thin pale skin that bruises easily, vaginal dryness

These signs have many other causes. Low sexual desire, for example, can come from depression, some medicines, relationship problems, pain during sex, or a partner’s health problem. We ask about these and look after them before starting testosterone.^6,5 Only a blood test, read together with your symptoms, tells you whether testosterone is part of the picture.

We also ask you to fill in a short 10-question self-check before you start and at each follow-up. It is not used to decide whether you start; it helps you and your doctor see how your symptoms change.

We don’t ask you to take our word for it. This is what research has found:

• Sex life. An analysis of 36 trials with 8,480 women found that testosterone improved desire, arousal, orgasm and pleasure, and reduced distress about sex, in women after menopause with low desire. Women had on average about one more satisfying sexual event a month than with a dummy treatment.^8,5 It worked whether or not women also used estrogen.²
• Early effect. The effect on sex life begins after 4 to 6 weeks.⁶
• Mood and thinking (early research). Small pilot studies in women around and after menopause found better mood, thinking and sexual desire.
• Skin (early research). In a small study, women given estrogen together with testosterone had 48% more collagen in their skin than women who were not.
• Heart and blood vessels (early research). In women aged 70 and over, those whose testosterone was not in the lowest group had less heart disease.⁶ In women with heart failure, testosterone on the skin improved physical fitness.²
• Blood fats, blood pressure and blood sugar. Testosterone on the skin did not make cholesterol, blood pressure or blood sugar worse in short-term studies, unlike testosterone taken by mouth.^5,8

We aim for the level of a young woman before menopause. Not lower, and not higher.

• Why not lower. The lower edge of our range is the level that physicians who focus on optimal hormone levels consider optimal for women. Waiting with a low level and ongoing symptoms is not what we want for you.
• Why not higher. More is not better. Unwanted effects of testosterone depend on the dose and are uncommon when levels stay within the normal range for women.² In a trial of women given testosterone injections, the voice became deeper only in the groups whose level was more than double the top of our range. Women given testosterone on the skin at female levels for 6 months had no change in their voice.⁹ Standard guidelines also advise against any product that pushes levels above the female range.⁵

If you are over 50. Your lab report may mark your result as “high” even when it is inside our target. The laboratory uses a lower range for women over 50. This is expected and does not mean you have too much.

Hair loss: what the evidence says. Many women worry that testosterone will make them lose hair. The best evidence says that at normal female levels it does not. Guidelines that reviewed the trials found a little more acne and facial or body hair in some women, but no hair loss, no enlarged clitoris and no voice change.⁵ In a 12-month trial, testosterone patches did not increase hair loss.² In a survey of 285 women treated with testosterone for at least a year, none reported scalp hair loss, and many of those whose hair was already thin reported regrowth.¹⁰ Thinning hair is common around and after menopause on its own, because the balance of hormones changes.¹¹ If your hair is already thin, you can still start; we take a photo of your scalp so we can compare later. This is exactly why your level should be measured and kept in range by a doctor, not guessed.

We use one test, called Free Testosterone, which gives us four results together:

• Total testosterone. Your doctor uses it together with free testosterone and your symptoms to choose and adjust your dose.
• SHBG. It tells us whether a normal-looking total is hiding a low free level.
• Albumin, another carrier protein in the blood.
• Free testosterone, calculated from the other three.

Guidelines advise checking testosterone before starting in every woman.⁵ The test is part of your Annual Panel.

On test day:

• Come in the morning. We compare every result at the same time of day.
• Stop biotin for 3 days before the test. Biotin, found in hair, skin and nail supplements, interferes with the test.
• If you still have periods, any day of your cycle is fine. Testosterone changes only a little across the cycle.²
• If you already use the gel, have your blood taken before you apply it that morning. This gives us your lowest level of the day, measured the same way every time, so each result can be compared fairly with the last.

Testosterone at the right level is safe for most women, but it is not one size fits all. Some women need special consideration before they start, and some need closer care than we can give. Before you start, our doctor goes through these with you:

• Pregnancy, planning a pregnancy, or breastfeeding. Testosterone can make a baby girl in the womb develop male features.¹² We do not start it at these times. If you still have periods, you need reliable contraception all the time you use it. We offer you a pregnancy test before you start, and you decide.
• Past breast, womb-lining or ovarian cancer, even if it was cured. Testosterone can be turned into estrogen, and research studies did not include women with these cancers.⁵ We refer you back to the specialist who looks after you.
• A high starting level, or new acne, hair growth or a deeper voice that appeared quickly. This means your body may already be making too much, and the cause needs to be found first, for example polycystic ovaries or, rarely, a growth that makes hormones.¹³ We refer you to a hospital before any treatment.
• Your voice is your work, for example if you sing or speak professionally. A voice that deepens from testosterone may not fully come back.¹ We explain this carefully and watch closely.
• Estrogen tablets or the contraceptive pill. You can still use testosterone; we simply read your free level together with the total.
• Children or a partner in close skin contact. The gel can pass to others through the skin, so we teach you how to protect them.¹²
• Blood thinners or insulin. You can still use testosterone; your own doctor may check these more often.¹²

Products bought elsewhere vary in quality and strength, so neither you nor a doctor can tell what level they give you. With us, every dose is matched to your blood test.

We use testosterone gel 1%, a body-identical hormone. It is made for men, and there is no testosterone product made for women available in Thailand. A woman needs only a small part of a sachet each day. Guidelines say that using the men’s product in women is reasonable when levels are kept within the female range, which is exactly what our blood tests are for.⁵ Because this is off-label use (outside the product’s official label), your doctor explains it and asks for your written consent first.

• Your doctor sets your dose from your blood test, starting low. You measure your daily amount with a syringe, and the nurse shows you how the first time.
• Your doctor looks at your total and free testosterone together with how you feel.
• If your level is below our target, your doctor raises the dose one small step, up to the highest dose we use.
• If your level is in the optimal range, you keep the same dose.
• If your level is above our target, or you notice oily skin, acne or more hair, your doctor lowers the dose one step.

• Why 3 months. Your level settles within a few days of using the gel every day,¹⁴ so a test at 3 months shows the dose you are really on. Many of our patients live abroad and cannot visit often, so we test every 3 months, start low, and teach you the early warning signs instead.
• Why every 6 months once on target. Guidelines advise checking testosterone every 6 months to make sure the dose is not too high.⁵
• Why we watch for oily skin and acne. These are usually the first signs that a dose is a little too high, and they come long before any extra hair. Telling us early lets us lower your dose before anything else appears.
• Every blood test comes with a consultation. Your doctor goes through your result, your symptoms and your self-check with you each time.

1. Handelsman DJ. Androgen Physiology, Pharmacology, Use and Misuse. In: Feingold KR, et al., editors. Endotext. South Dartmouth (MA): MDText.com; updated 2020.

2. Wierman ME, Arlt W, Basson R, et al. Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2014;99(10):3489–3510. doi:10.1210/jc.2014-2260

3. The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794.

4. Papadopoulou-Marketou N, Kassi E, Chrousos GP. Adrenal Androgens and Aging. In: Feingold KR, et al., editors. Endotext. South Dartmouth (MA): MDText.com; updated 2023.

5. Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660–4666. doi:10.1210/jc.2019-01603

6. Panay N, Fenton A, Hamoda H, et al. Recommendations and Key Messages on Women’s Midlife Health and Menopause. International Menopause Society; 2026 (summary published in Climacteric, 2025).

7. Nair KS, Rizza RA, O’Brien P, et al. DHEA in Elderly Women and DHEA or Testosterone in Elderly Men. N Engl J Med. 2006;355:1647–1659. doi:10.1056/NEJMoa054629

8. Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754–766.

9. Huang G, Pencina KM, Coady JA, Beleva YM, Bhasin S, Basaria S. Functional Voice Testing Detects Early Changes in Vocal Pitch in Women During Testosterone Administration. J Clin Endocrinol Metab. 2015;100(6):2254–2260. doi:10.1210/jc.2015-1669

10. Glaser RL, Dimitrakakis C, Messenger AG. Improvement in scalp hair growth in androgen-deficient women treated with testosterone: a questionnaire study. Br J Dermatol. 2012;166:274–278. doi:10.1111/j.1365-2133.2011.10655.x

11. Roeca C, Al-Safi Z, Santoro N. The Postmenopausal Women. In: Feingold KR, et al., editors. Endotext. MDText.com; updated 2025.

12. Prescribing information: testosterone gel 1% for topical use. ASCEND Therapeutics US, LLC; revised 10/2025.

13. Teede HJ, Tay CT, Laven J, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Hum Reprod. 2023;38(9):1655–1679. doi:10.1093/humrep/dead156

14. Package insert (Thailand): testosterone gel 50 mg in 5 g sachet, summary of product characteristics. Besins Healthcare.