Women and Testosterone Therapy: The Real “Optimal Range”

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By Julian Joy, Nutritionist · Published July 19, 2026 · Last updated July 19, 2026

Educational content from Bearing. This is not medical advice. Testosterone therapy for women is a clinical decision that belongs with a qualified clinician who knows your history.

One of the most common things women tell me after starting testosterone is: “I finally have my energy back.”

I believe them. But I’ve started to wonder whether “energy” is always the right word. For some women, what actually changes may be closer to motivation: the drive to exercise, to socialize, to tackle the to-do list, to feel interested in life again. That’s a different thing from energy, and it matters, because it points to where the science is strong, where it is thin, and where the marketing has gotten ahead of the evidence.

Energy, or motivation?

There are good biological reasons to think a motivation effect is real. Testosterone interacts with brain regions involved in reward, motivation, and goal-directed behavior, including dopamine-related pathways. That gives us a plausible mechanism for why some women feel more driven, not just more awake.

But plausible is not the same as proven. And here is the uncomfortable part: most testosterone research in women was never designed to measure motivation, drive, or energy in the first place. The trials were built to answer a narrower question.

What the evidence actually shows

The strongest evidence, by a wide margin, is for hypoactive sexual desire disorder (HSDD) in postmenopausal women: low sexual desire that causes personal distress.

This is not a fringe position. The 2019 Global Consensus Position Statement on the Use of Testosterone Therapy for Women, endorsed by more than ten international medical societies including The Endocrine Society and the International and North American Menopause Societies, concluded that HSDD is the only evidence-based indication for testosterone in women, and that current evidence does not support prescribing it for any other symptom or condition.

That consensus rests largely on a 2019 systematic review and meta-analysis of randomized controlled trials in The Lancet Diabetes & Endocrinology. Pooling the blinded trial data, it found testosterone meaningfully improved sexual function in postmenopausal women, with non-oral routes such as transdermal preferred for a neutral effect on cholesterol. What it did not find was convincing benefit for the other outcomes women most often describe.

On mood and cognition specifically, later meta-analyses concluded testosterone does not reliably improve either in menopausal women, and the trials that exist are small. For depression, there is an observational association between testosterone levels and low mood, but a Mendelian randomization analysis found no evidence that testosterone actually causes the difference.

So the honest summary is this: the benefit for desire is real and well-supported. The benefits for energy, motivation, mood, and cognition are plausible and frequently reported, but not established. Absence of proof is not proof of absence. It mostly reflects that the right studies haven’t been done.

The “optimal range” question

This is where the phrase “optimal range” needs a hard look, because it is doing a lot of quiet work in a lot of marketing.

First, what’s normal. In premenopausal women, total testosterone typically runs somewhere around 10 to 55 ng/dL, though some labs cite 15 to 70 ng/dL (roughly 0.5 to 2.4 nmol/L). Levels are highest in the 20s and early 30s and drift down gradually with age. The ranges genuinely differ between laboratories and methods.

Second, and this is rarely said out loud: we often can’t measure it well. The common direct immunoassays are unreliable at the low concentrations found in women. The accurate method, liquid or gas chromatography with mass spectrometry (LC-MS/MS), isn’t always what a routine lab runs. So a woman can be handed a testosterone “number” that is, in the female range, not very trustworthy to begin with.

Third, what the guidelines actually target. Clinical guidelines do not define an “optimal” level for vitality. They define a safety boundary: dose to restore testosterone to the premenopausal physiologic range, and avoid supraphysiologic levels. The ISSWSH clinical practice guideline recommends transdermal dosing appropriate for women, monitoring blood levels every 4 to 6 months to catch overuse, and specifically advises against compounded products because of the lack of efficacy and safety data. In the US there is still no FDA-approved testosterone product designed for women, so treatment means careful off-label use of a fraction of a male dose.

The evidence-based target is physiologic restoration, not optimization above it. Anyone marketing a higher “optimal” number for energy is selling ahead of the data.

Put those three facts together and the answer to “what’s the real optimal range?” becomes clear, and it is not the answer the wellness market wants to sell. Bring a low level back into the normal premenopausal range, and stop there. There is no validated “optimal” range above physiologic that has been shown to deliver more energy, more drive, or more vitality. Above physiologic is simply where the side effects (acne, unwanted hair growth, and longer-term unknowns) begin, without proven upside.

And for the outcomes women actually describe, energy and motivation, there is no established optimal range at all, because those were never the primary endpoints of the trials that set the ranges.

Why the gap exists

None of this means women aren’t experiencing what they describe. It means the research was built to answer the question researchers chose to ask (desire), not the questions women keep bringing into the room (drive, focus, feeling like themselves again).

That is a study-design gap, not a verdict on women’s experience. The fix isn’t to dismiss the reports or to inflate the dose. It is to run the trials that measure motivation, energy, and mood as primary outcomes, in women, at physiologic doses, with accurate assays.

If you’re considering it

Not medical advice, but a fair-minded frame:

• The strongest, most reliable benefit is for distressing low sexual desire after menopause. If that is the target, the evidence is on your side.
• If your goal is energy or motivation, know that you may benefit, but you would be acting on mechanism and clinical experience, not settled proof. Go in with honest expectations.
• Work with a clinician who doses to the physiologic range, measures with an accurate assay, and monitors over time. “More” is not better here.
• Be skeptical of any program built around pushing your number high for “optimization.” That is where the risk lives and the evidence runs out.

The bottom line

Believe women. Study women. Don’t oversell the hormone.

The real optimal range isn’t a higher number to chase. It is physiologic restoration, honestly measured, paired with honesty about how much we still don’t know, and a commitment to finally studying the outcomes women have been describing all along.

References

1. Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660–4666. Link
2. 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. Link
3. Parish SJ, et al. ISSWSH Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. 2021. Link
4. Testosterone in Female Depression: A Meta-Analysis and Mendelian Randomization Study. Link

Reference ranges vary by laboratory and assay. Testosterone measurement in the female range is most accurate by LC-MS/MS.