Most women don't think about testosterone. It's not part of the conversation the way oestrogen and progesterone are. But testosterone matters for women just as much as it matters for men — and decades of clinical work shows that low testosterone in women correlates with fatigue, low libido, poor body composition, brain fog, and mood disruption (Davis SR et al., 2019, Nature Reviews Endocrinology).
The good news: you produce it. The difficult part: most women have no idea what their levels are, and nobody checks.
Where does female testosterone come from?
Your ovaries produce testosterone directly — roughly 25% of your circulating testosterone before menopause comes from ovarian synthesis. The adrenal glands contribute the rest via DHEA conversion. Your body also converts some testosterone locally from DHEA in tissue, but the bulk is produced by these two glands.
Normal reference ranges for women of reproductive age sit between 0.5–2.5 nmol/L (roughly 15–70 ng/dL in older units). This is wildly lower than men's 10–30 nmol/L, but "low" doesn't mean unimportant. You're extremely sensitive to even modest changes in your own baseline.
Why testosterone declines with age
If you're 30, your testosterone is probably fine. If you're 45, it's probably lower than it was at 35. Post-menopausal women see a roughly 50% drop from pre-menopausal peaks. This is partly ovarian senescence — your ovaries simply produce less — and partly the normal decline of adrenal function over time.
But here's the kicker: oral contraceptives significantly suppress ovarian testosterone production. The progestin component drives down LH (luteinising hormone), which tells your ovaries to make testosterone. If you've been on the pill for years, your "baseline" may actually be suppressed below your genetic potential. Some women find their energy and libido improve when they stop.
What does low testosterone actually do?
Fatigue and energy: Testosterone increases mitochondrial function. Low testosterone often presents as persistent tiredness that doesn't shift with sleep.
Libido and sexual function: Testosterone drives sexual desire in women, just as it does in men. Clinical populations with low testosterone frequently report absent libido. It also supports clitoral blood flow and arousal.
Body composition: Testosterone promotes lean mass retention and fat oxidation. Women with low testosterone often struggle with body recomposition despite proper training and nutrition — they lose muscle alongside fat rather than holding muscle.
Cognition and mood: Testosterone supports dopamine and contributes to motivation, focus, and resilience to stress. Some women describe low testosterone as "feeling flat" or unmotivated.
Bone density: Testosterone (like oestrogen) is protective for bone. Post-menopausal women with low testosterone have higher fracture risk.
What drives the decline?
Age is the obvious one. But several modifiable factors matter:
Sleep deprivation suppresses testosterone production. Chronic poor sleep can reduce your levels by 20–30%.
Chronic stress elevates cortisol, which inhibits GnRH (gonadotropin-releasing hormone), the signal that tells your ovaries to produce testosterone. Stress management isn't optional.
Zinc deficiency impairs testosterone synthesis. UK deficiency rates are surprisingly high in women who don't eat enough meat or shellfish.
Oral contraceptives suppress ovarian production, as mentioned. Progestin-only methods affect you less.
How to measure it
Ask your GP to test total testosterone and free testosterone (the biologically active portion). Some labs will also measure SHBG (sex hormone-binding globulin), which determines how much testosterone is available to your tissues.
Normal range:
- Total testosterone: 0.5–2.5 nmol/L (premenopausal), 0.2–0.8 nmol/L (postmenopausal)
- Free testosterone: roughly 5–15 pg/mL (varies by lab)
If you're experiencing fatigue, low libido, or brain fog and your levels come back at the lower end of normal or below, that's worth taking seriously. "Normal" doesn't always mean "optimal for you."
Natural optimisation: the same foundations as men
If you're looking to support testosterone production without clinical intervention, the principles are identical to male hormone optimisation:
Resistance training: Strength work stimulates testosterone production. Compound movements (squats, deadlifts, presses) are most effective. Aim for 2–3 sessions weekly of meaningful load.
Sleep: 7–9 hours nightly is non-negotiable. Testosterone is produced during sleep, particularly during deep NREM and REM phases. One week of 5-hour nights will suppress your levels measurably.
Stress management: Chronic cortisol elevation suppresses GnRH and LH. This might be meditation, time in nature, or simply reducing overcommitment. Ashwagandha (KSM-66 extract) has evidence for cortisol reduction in chronically stressed populations.
Zinc: 8–11 mg daily for adult women (RDA). If you're deficient, supplementation over 6–8 weeks can improve testosterone. Good sources: beef, oysters, pumpkin seeds.
Magnesium: 310–320 mg daily. Magnesium glycinate is absorbed well and won't cause digestive upset. It also supports sleep quality, which indirectly supports testosterone.
Adequate calories: Severe calorie restriction suppresses reproductive hormones including testosterone. If you're in a prolonged deficit, your body downregulates production as an energy-conservation mechanism.
Clinical options in the UK
If optimisation of lifestyle factors doesn't shift your levels and you're symptomatic, there are clinical options, though availability is inconsistent:
DHEA supplementation: Oral DHEA (25–50 mg daily) has evidence in post-menopausal women for improving libido, energy, and vaginal health. It's available over the counter as a supplement (not a licensed medicine in the UK). We'll cover DHEA in detail in a dedicated guide.
Testosterone cream or gel: Some UK private practitioners and menopause clinics will prescribe transdermal testosterone for symptomatic women, particularly post-menopausal. This is evidence-based but requires clinical assessment. Discuss with a menopause specialist or your GP if this interests you.
Topical DHEA (Prasterone): FDA-approved in the US for vaginal atrophy in post-menopausal women. Not yet standard in UK practice but available privately.
The bottom line
Testosterone matters for you. If you're fatigued, unmotivated, or experiencing sexual dysfunction, and you've ruled out thyroid dysfunction or iron deficiency, ask your doctor to check your testosterone. Most won't volunteer to, so you need to ask.
Start with the foundations: sleep, training, stress management, and micronutrient adequacy. These shift testosterone meaningfully and have side benefits everywhere else. If you're still symptomatic after 8–12 weeks of solid fundamentals, consider DHEA or discuss clinical testosterone replacement with a menopause specialist.
Seb covers hormone optimisation and evidence-based health for adults over 30. He writes for maleoptimal.co.uk and maintains a focus on clinical evidence, practical implementation, and what actually works.
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