Understanding the Evidence and Supporting Healthy Hormone Function — Part 2
For many years, testosterone was considered primarily a “male hormone,” but we now know it plays a vital role in women’s health as well. Although women produce approximately one-tenth the amount of testosterone produced by men, this hormone contributes to sexual health, energy, mood, cognitive function, muscle maintenance, bone density, and overall quality of life.
Testosterone is produced by the ovaries, adrenal glands, and through the conversion of precursor hormones such as DHEA in peripheral tissues. Unlike estrogen, testosterone does not suddenly decline with menopause. Instead, levels tend to decrease gradually with age, while ovarian removal (surgical menopause), chronic illness, medications, and adrenal dysfunction may further reduce androgen availability.
Inspired by Dr. Doreen Saltiel
Testosterone Is More Than a Number
One of the most important advances in women’s hormone research is the understanding that symptoms, not simply laboratory values, should guide clinical decision making.
Hormones must not only be present but must also effectively signal through their receptors and function within a healthy endocrine environment.
Many women with “low-normal” testosterone concentrations feel well, while others with similar laboratory values experience reduced sexual desire, fatigue, diminished well-being, or decreased motivation. This highlights an important principle of hormone physiology.
For this reason, testosterone should never be evaluated in isolation. Sleep quality, stress physiology, thyroid health, metabolic function, nutritional status, inflammation, medications, and relationship factors all influence how women experience symptoms commonly attributed to testosterone deficiency.
What Does The Research Say?
Perhaps the most influential work in this field has come from endocrinologist Dr. Susan Davis and colleagues, whose international consensus recommendations helped establish an evidence-based role for testosterone therapy in women.
The 2019 Global Consensus Position Statement concluded that the only evidence-based indication for systemic testosterone therapy in women is hypoactive sexual desire disorder (HSDD) in postmenopausal women after a comprehensive evaluation has excluded other contributing factors.
Similarly, the International Society for the Study of Women’s Sexual Health (ISSWSH) Clinical Practice Guideline recommends carefully dosed transdermal testosterone for appropriately selected women with HSDD, emphasizing treatment to physiologic female concentrations with ongoing monitoring for efficacy and safety.
Importantly, neither guideline recommends testosterone simply to improve energy, mood, athletic performance, cognitive function, or body composition, as the evidence remains insufficient for these indications.
Lessons From The Intrinsa Clinical Trials
Much of today’s understanding comes from the Intrinsa clinical trials. Intrinsa was a transdermal testosterone patch developed specifically for women. Multiple randomized, placebo-controlled trials evaluated surgically menopausal women experiencing distressing low sexual desire.
Across these studies, women receiving physiologic doses of transdermal testosterone experienced:
- Improvements in sexual desire
- Increased frequency of satisfying sexual experiences
- Reduced personal distress related to low libido
- Improvements in overall sexual well-being
The therapy was generally well tolerated, with mild androgenic side effects such as acne or increased hair growth occurring in a small percentage of participants.
Although Intrinsa received regulatory approval in parts of Europe, it was never approved in the United States. This decision reflected requests for additional long-term cardiovascular and breast safety data rather than concerns regarding short-term efficacy. These landmark studies remain the scientific foundation for current testosterone practice guidelines.
Supporting Healthy Testosterone Function Naturally
Hormone replacement represents only one component of comprehensive hormone care. Supporting the body’s natural endocrine physiology remains essential for all women, regardless of whether testosterone therapy is appropriate.
Sleep: The Foundation of Hormone Production
Sleep is one of the most powerful regulators of endocrine health. While testosterone secretion in men is closely linked to the late stages of sleep, restorative sleep also supports healthy androgen production and overall reproductive hormone signaling in women through regulation of the hypothalamic-pituitary-gonadal axis. Poor sleep, sleep apnea, circadian disruption, and chronic sleep deprivation may all negatively influence hormonal balance.
Nutrition and Exercise
Adequate protein, healthy dietary fats, zinc, magnesium, vitamin D, and regular resistance training provide important physiologic support for healthy steroid hormone production, muscle maintenance, and metabolic health.
Stress Resilience
Chronic elevations in cortisol may suppress reproductive hormone signaling and alter the hormonal environment. Strategies that improve resilience, including exercise, mindfulness, and targeted nutritional support, may indirectly support healthy androgen function.
Botanical Support
Several botanicals, including ashwagandha, Tribulus, tongkat ali, fenugreek, maca, and others, have demonstrated potential to support hormonal health. Rather than directly increasing testosterone concentrations, these herbs appear to support the body’s response to hormones through effects on stress adaptation, inflammatory balance, enzyme activity, and receptor function.
More Than Hormone Levels Alone
At EndoAxis, we recognize that healthy hormone function depends on more than hormone levels alone. Sleep quality, nutrient sufficiency, metabolic health, stress resilience, and receptor responsiveness all influence how effectively hormones work within the body.
For some women, optimizing these foundational systems may improve symptoms without hormone therapy. For others, particularly postmenopausal women with carefully diagnosed hypoactive sexual desire disorder, evidence-based testosterone replacement may be an appropriate therapeutic option when prescribed and monitored by an experienced healthcare professional.
The goal is not simply to raise testosterone levels, but to restore healthy hormone function while addressing the physiologic foundations that allow hormones to work as intended.
In Health,
The EndoAxis Team
*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.