The Testosterone Conversation I Keep Having in the Exam Room

And why I think every woman deserves to have it

There’s a moment that happens in the exam room regularly.

A woman usually somewhere between 38 and 58, though honestly the range is wider than that sits across from me and describes herself and what has been going on her life and “not feeling like herself”. She’s tired, but not the kind of tired that a good night’s sleep fixes. She doesn’t really want sex anymore, and she can’t tell if it’s her relationship, her body, or both. Her mind feels foggy in this low-grade way she can’t quite shake. She’s been working out consistently but her body isn’t responding the way it used to.

Then she adds, almost apologetically: “I know I’m probably just getting older.”

And I say: “You’re not.”

I run a comprehensive hormone panel and more often than not, there it is testosterone. Low, or low-normal, or just not where it should be for someone who wants to feel like themselves.

“Wait,” she usually says. “Isn’t testosterone... a male hormone?”

And this is the moment I love. Because the answer is so satisfying: No. It never was.

The Hormone Nobody Told Us About

Women have testosterone. We produce it in our ovaries and adrenal glands from the moment we hit puberty. It helps for libido. It may also help energy, muscle tone, bone density, mood, cognition, and general vitality. But the truth is we no FDA approved testosterone for females and the only indication we have for it is for low libido. We’ve just been culturally conditioned to think of it as foreign but what we see and hear int he exam room often tell us a different story,

Testosterone levels in women peak in the mid-20s and gradually decline from there. By the time we’re in our 40s often a decade before our periods stop levels can drop enough to meaningfully affect quality of life. Surgical menopause causes an even more dramatic drop, overnight and yet most women have never had their testosterone checked.

What Low Testosterone Actually Feels Like

It’s not dramatic. It’s not like a light switch. It’s more like a slow dimming. The things that used to energize you don’t anymore, your desire for sex, yes, but also for experiences, connection, life feels muted. You’re capable and functional and you push through, but there’s this persistent sense of running on less than full power.

You might be told you’re depressed, your stressed. You might be told it’s perimenopause, full stop, and that estrogen will fix it. Estrogen is important but for many women, it’s not the whole answer, just a piece of the puzzle.

The Conversation That Changes Things

When I bring testosterone into the hormone conversation and it clicks, the change in a patient is remarkable not just clinically, but emotionally. There’s relief. There’s the feeling of finally being seen. There’s sometimes a little grief for the years spent thinking something was fundamentally wrong with them.

Nothing was wrong with them. They needed information, clarity and the ability to understand and make decisions for themselves. And they needed a clinician willing to go beyond the standard checklist.

What I Want You to Take Away

If anything in this post resonated with you, testosterone is worth adding to the conversation with your clinician. Ask for a full hormone panel that includes total testosterone, estradiol, CBC, CMP, and SHBG. Find a clinician who looks at how you feel, not just whether your labs are technically “within range” and know that optimal and normal are not the same thing.

You are not just getting older. You are not imagining it and you deserve care that takes the whole picture seriously.

If you’re in the Atlanta area, The SHOW Center is exactly the kind of practice I’m describing. theshowcenter.com

For clinicians reading this who want clinical confidence in testosterone prescribing and midlife women’s health: The Q-Spot’s Midlife 101 course was built for you. theqspot.net