Testosterone Therapy for Women
The most commonly missed hormone in women’s HRT. Testosterone drives libido, energy, muscle mass, and cognitive clarity. Most protocols leave it out entirely. Our providers check total T, free T, and SHBG at every hormone evaluation.
Testosterone Is Not a Male Hormone. It Is the Engine of Female Vitality — and It Is Missing From Most HRT Protocols.
Before menopause, testosterone is the most abundant biologically active sex hormone in a woman’s body — exceeding estrogen levels by volume. It is the engine of vitality: the hormone that drives energy, desire, cognitive sharpness, and physical strength. Most women have no idea they produce it. Most HRT providers never check it. Standard HRT replaces estrogen and progesterone, which address the most visible menopausal symptoms: hot flashes, night sweats, sleep disruption, and mood changes. But testosterone, which declines steadily from the mid-20s and falls sharply at menopause, is almost never included. Women who are adequately estrogenized but still feel exhausted, mentally foggy, and completely uninterested in sex frequently have low testosterone as the missing variable. When testosterone is gone, the engine stalls — and estrogen alone cannot restart it. At Tactus Health, our providers check testosterone at every hormone evaluation and prescribe it when the labs and symptoms support its use.
Why Testosterone Matters in Women’s Health
Women produce testosterone in the ovaries and adrenal glands throughout their reproductive years, at levels approximately 10 times lower than men but biologically critical nonetheless. Testosterone in women is responsible for libido and sexual arousal, energy and motivation, maintenance of muscle mass and strength, cognitive clarity and focus, and mood stability. These are not peripheral concerns. They are central to quality of life.
Testosterone declines steadily from the mid-20s, drops significantly in perimenopause, and falls further at menopause. Surgical menopause following oophorectomy causes the most dramatic drop because the ovaries are removed entirely. Women on oral contraceptives often have significantly suppressed testosterone due to the elevated SHBG that synthetic progestins cause. Yet despite this well-documented decline and its well-documented consequences, testosterone is almost never included in standard women’s HRT protocols.
The North American Menopause Society (NAMS) recognizes testosterone therapy as safe and effective for hypoactive sexual desire disorder (HSDD) in postmenopausal women. It is the only evidence-based treatment for HSDD and functions through mechanisms that estrogen cannot replicate. Our providers prescribe low-dose testosterone when it is clinically indicated, with dosing calibrated by labs and monitored at follow-up.
Book Free ConsultationNo FDA-approved testosterone product exists for women in the US. Tactus Health uses 503A-registered compounding pharmacies for all women’s testosterone prescriptions. Every formulation includes a certificate of analysis.
The Three-Legged Stool of Women’s Hormone Health
Your hormonal health requires all three. Remove one leg and the stool is unstable. Most HRT prescribes two of three.
- Hot flash regulation
- Vaginal tissue health
- Cardiovascular protection
- Bone density (partial)
- Brain neuroprotection
- Deep restorative sleep
- Anxiety reduction (GABA)
- Endometrial protection
- Mood stabilization
- Fluid balance
- Libido and arousal
- Energy and motivation
- Muscle mass maintenance
- Cognitive sharpness
- Bone mineral density
Estrogen and progesterone are included in standard HRT. Testosterone is almost never checked. Yet for women who are still symptomatic on standard HRT, low testosterone is the most common missing variable. The stool needs all three legs to be stable.
Bone Density and Muscle Mass: The Case Beyond Libido
Most patients come to Dr. Ashar for testosterone because of low libido or fatigue. But the case for restoring testosterone extends well beyond sexual function. Two of the most significant long-term health risks for postmenopausal women — osteoporosis and sarcopenia — are directly influenced by testosterone levels.
Testosterone is a primary anabolic hormone: it stimulates the osteoblasts that build new bone and the muscle protein synthesis that maintains lean mass. Estrogen slows bone breakdown; testosterone actively drives bone formation. For women with osteopenia, testosterone is often the missing anabolic signal required to protect the skeletal system alongside estrogen therapy.
Sarcopenia — the progressive loss of muscle mass with aging — accelerates dramatically after menopause. Resistance training helps, but without adequate testosterone, the anabolic signaling that converts exercise stimulus into muscle protein synthesis is impaired. Women who add testosterone to their HRT protocol frequently report that the same exercise routine that was not building or maintaining muscle suddenly starts working again.
For women with osteopenia: If your DEXA scan shows bone loss and your current protocol includes only estrogen, your provider should discuss whether adding testosterone is appropriate to provide the anabolic stimulus estrogen alone cannot deliver. Our providers evaluate bone health in the context of the full hormone picture at your consultation.
Why Your Testosterone Can Be “Normal” and Still Be Deficient
Total testosterone is what most labs report. But total testosterone tells only part of the story. Sex hormone binding globulin (SHBG) is a protein that binds testosterone in the bloodstream and makes it biologically inactive. Only free testosterone, the portion not bound to SHBG, can actually enter cells and do its job.
A woman can have a total testosterone level in the normal range while her SHBG is so elevated that her free testosterone is essentially zero. This is common in women on oral contraceptives, women with thyroid conditions, and women in early perimenopause. If your provider only checks total testosterone and calls it normal, they may be missing the actual problem.
SHBG is elevated by oral estrogen, oral contraceptives, hyperthyroidism, and high-carbohydrate diets. Transdermal estradiol does not significantly raise SHBG — another reason our providers prefer transdermal delivery. Women who switch from oral to transdermal estrogen often see their free testosterone rise without any change in their testosterone prescription.
When Testosterone May Be the Missing Variable
Women who are adequately estrogenized but still experience these symptoms often have low testosterone as the contributing factor.
The Standard HRT Protocol Leaves Testosterone Out.
Conventional hormone therapy training focuses almost entirely on estrogen and progesterone. These are the hormones that decline most acutely at menopause and produce the most visible symptoms. Testosterone’s slower decline from younger ages, combined with the absence of any FDA-approved women’s testosterone product in the US, means most providers simply never include it in the evaluation.
The result is patients who are on HRT, whose hot flashes and sleep have improved, but who still feel fundamentally “off” and cannot understand why. The answer is frequently in the testosterone panel, specifically in the free testosterone and SHBG values that most providers never check.
How Women’s Testosterone Is Delivered at Tactus Health
Two delivery options available. The right choice depends on your preference for daily application versus quarterly in-office procedures.
A low-concentration compounded testosterone cream or gel applied daily to the inner arm, thigh, or abdomen. Prepared by a 503A-registered compounding pharmacy and shipped directly to you. Available via telehealth for Georgia residents.
- Dose precisely controlled and adjustable
- Ships directly to your door
- No in-person procedure required
- Available via telehealth for Georgia residents
- Dose adjusted easily based on follow-up labs
Monitoring Is Not Optional
Women’s testosterone therapy is safe and effective when dosed correctly and monitored consistently. Our providers require follow-up labs at every protocol adjustment.
Why monitoring matters: Virilizing side effects (acne, increased body hair, voice changes) occur at supraphysiologic levels. At physiological female doses with regular monitoring, these risks are essentially eliminated. Virilization is not expected when testosterone is kept within the female physiological range, which is why our providers confirm your level with follow-up labs and adjust only within that range.
Dr. Ashar N.
Dr. Ashar holds a Doctor of Nursing Practice and two national board certifications, one in family practice and one in psychiatric mental health.
She founded Tactus Health to close the gap she watched her own family fall through: symptoms that were real, labs that came back normal, and no one willing to connect the two.
She is responsible for the protocols our medical team follows, and for the training of the clinicians who deliver them. Holding both certifications is why those protocols treat hormones, mood, sleep and metabolism as one system rather than five separate appointments.
See Dr. Ashar in Sugar Hill or via Georgia Telehealth
In-person consultations at our Sugar Hill, GA clinic. Telehealth available to all Georgia residents. Labs drawn at any Quest Diagnostics or Labcorp statewide. Compounded testosterone cream ships directly to your door.
Women’s Testosterone Therapy FAQ
At physiological doses with appropriate monitoring, yes. NAMS recognizes testosterone therapy as safe and effective for HSDD in postmenopausal women. Risks such as acne, increased body hair, and voice changes are associated with supraphysiologic levels that exceed the female reference range. Dr. Ashar’s monitoring protocol prevents this by checking labs at every follow-up and keeping doses within the female physiological range.
Not at physiological doses. The doses used in women’s testosterone therapy are approximately 10 times lower than male TRT. Virilizing side effects occur when testosterone exceeds the female physiological range, which is why monitoring is essential. The goal is restoring what was lost, not exceeding normal female testosterone levels.
Total testosterone can be in the normal range while free testosterone is very low due to high SHBG. SHBG binds testosterone and makes it biologically inactive. Most standard panels only check total testosterone. Our providers check total T, free T, and SHBG together. If your SHBG is elevated, your free testosterone may be essentially zero even when total testosterone appears normal. This is particularly common in women on oral contraceptives, women on oral estrogen, and women with thyroid conditions.
Same hormone, completely different dosing and delivery. Women’s testosterone therapy targets the female physiological reference range, which is approximately 15 to 70 ng/dL depending on age. Men’s TRT targets male ranges of 300 to 1000 ng/dL or higher. Women typically use low-concentration compounded cream or gel applied to the skin, not the high-concentration injectable formulations used in male TRT.
Yes, for Georgia residents. Compounded testosterone cream and gel can be prescribed via telehealth and shipped directly to you. Labs are drawn at any Quest Diagnostics or Labcorp in Georgia. HRT prescribing is Georgia-only due to licensure requirements.
Yes. Testosterone declines from the mid-20s onward and can be deficient in premenopausal women, particularly those who have been on oral contraceptives for extended periods, women with primary adrenal insufficiency, and women in early perimenopause. NAMS recognizes HSDD can occur before menopause. Our providers evaluate candidacy based on your labs and symptoms regardless of menopausal status.
The Test Takes 5 Minutes to Order.
If your HRT is helping but you still feel flat, foggy, or disinterested, your free testosterone and SHBG have probably never been checked. Book a consultation with Dr. Ashar and find out.
HRT telehealth available to Georgia residents · In-person Sugar Hill, GA
Important Safety Information: Testosterone therapy for women requires a prescription from a licensed provider following clinical evaluation and laboratory confirmation of deficiency. No FDA-approved testosterone product exists for women in the US. Compounded testosterone is prepared by 503A-registered pharmacies and is not individually FDA-approved. Risks at supraphysiologic doses include acne, increased body hair, voice changes, and clitoral enlargement. These risks are prevented by appropriate dosing and regular monitoring, which Dr. Ashar requires at every protocol adjustment. Not appropriate during pregnancy. Individual results vary. All prescriptions issued by Dr. Ashar N., DNP, APRN, FNP-C, PMHNP-BC. HRT telehealth is available to Georgia residents only. Questions: [email protected] | (678) 892-9230 | 1400 Buford Hwy NE Suite K 2, Sugar Hill, GA 30518.