TRT for Women: How to Track Your Hormones
Testosterone replacement therapy is not just for men. An increasing body of evidence supports the use of low-dose testosterone therapy in women — particularly for those experiencing reduced libido, fatigue, brain fog, and loss of muscle tone related to menopause, perimenopause, or other hormonal conditions.
Yet women's hormone health remains underserved in mainstream medicine. Many women are told their symptoms are "just stress" or "normal ageing" when the underlying cause is a measurable hormonal imbalance. Regular blood testing and careful tracking of hormone levels can change this — giving women and their clinicians the data needed to make informed treatment decisions.
Understanding Testosterone in Women
While testosterone is often thought of as a "male hormone," women produce it too — primarily in the ovaries and adrenal glands. In fact, women produce more testosterone than estradiol throughout most of their lives, though at much lower concentrations than men.
Testosterone in women plays critical roles in:
- Sexual desire and arousal — testosterone is the primary driver of libido in both sexes
- Energy and vitality — low testosterone is associated with persistent fatigue
- Cognitive function — affects concentration, memory, and mental clarity
- Muscle mass and bone density — testosterone supports musculoskeletal health
- Mood regulation — influences motivation, confidence, and emotional resilience
Women's testosterone levels begin declining from the late 20s and drop by approximately 50% by menopause. Some women experience symptoms of testosterone deficiency well before menopause, particularly after surgical removal of the ovaries (oophorectomy) or with adrenal insufficiency.
When Women Might Consider TRT
The International Society for the Study of Women's Sexual Health (ISSWSH) and the Global Consensus Position Statement on testosterone therapy for women recognise the following primary indication for testosterone therapy in women:
- Hypoactive sexual desire disorder (HSDD) — persistent, distressing loss of sexual desire that is not explained by other factors
In clinical practice, many practitioners also consider testosterone therapy for:
- Persistent fatigue not explained by other causes
- Cognitive symptoms including brain fog and poor concentration
- Reduced muscle mass and strength despite adequate exercise
- Low mood and motivation that has not responded to other treatments
Importantly, testosterone therapy in women uses much lower doses than male TRT — typically aiming for physiological female ranges, not male levels. Dosing is usually one-tenth of male doses or less.
Key Hormone Markers Women Should Track
Hormone health in women involves a complex interplay of multiple hormones. Effective tracking requires monitoring several markers together, not just testosterone in isolation.
Testosterone
- Total testosterone — normal female range is approximately 0.5-2.5 nmol/L (varies by lab and age)
- Free testosterone — the biologically active fraction; often more clinically useful than total T in women
- Optimal timing: Test in the morning. For menstruating women, test during the early follicular phase (days 1-5 of cycle) for the most consistent results
Estradiol (E2)
- The primary estrogen in premenopausal women
- Affects bone health, cardiovascular protection, skin elasticity, mood, and cognition
- Levels fluctuate significantly across the menstrual cycle and decline sharply at menopause
- Tracking E2 alongside testosterone helps assess overall hormonal balance
Progesterone
- Essential for menstrual cycle regulation, sleep quality, and mood stability
- Drops significantly during perimenopause, often before estradiol declines
- Low progesterone relative to estradiol can cause estrogen dominance symptoms
Sex Hormone Binding Globulin (SHBG)
- Binds testosterone and estradiol, reducing their bioavailability
- Oral contraceptives and oral HRT significantly raise SHBG — potentially contributing to low libido even when total testosterone appears adequate
- Tracking SHBG alongside total testosterone explains why some women with "normal" total T still experience deficiency symptoms
DHEA-S
- A precursor hormone produced by the adrenal glands
- Declines steadily with age
- Some practitioners prescribe DHEA as an alternative or adjunct to direct testosterone therapy
Thyroid Function (TSH, Free T4, Free T3)
- Thyroid disorders are 5-8 times more common in women than men
- Symptoms of hypothyroidism (fatigue, weight gain, brain fog, low mood) significantly overlap with low testosterone
- Always rule out thyroid dysfunction before attributing symptoms solely to low testosterone
How to Track Hormones Effectively
Tracking hormones as a woman requires more nuance than male hormone tracking due to menstrual cycle fluctuations and the multi-hormone nature of female endocrinology.
For Menstruating Women
- Test on days 1-5 of your cycle (follicular phase) for the most consistent testosterone and SHBG readings
- Test progesterone on day 21 (or 7 days post-ovulation) if assessing ovulatory function
- Record your cycle day with each blood test so results can be interpreted in context
For Perimenopausal and Menopausal Women
- Cycles may be irregular, so test at any time but note your last menstrual period
- FSH and LH can help confirm menopausal status
- Track estradiol alongside testosterone to monitor overall hormonal decline
For Women on TRT or HRT
- Test 4-6 weeks after starting or adjusting any hormone therapy
- Monitor for signs of excess testosterone: acne, oily skin, facial hair growth, voice deepening, scalp hair thinning
- Track symptoms alongside blood results — libido, energy, mood, sleep quality — to correlate subjective improvement with objective data
- Retest every 3-6 months once stable
Safety Considerations
Testosterone therapy in women is generally well tolerated at physiological doses, but monitoring is essential to avoid androgenic side effects:
- Acne and oily skin — often the first sign of excess dosing
- Unwanted hair growth (hirsutism) — facial and body hair
- Scalp hair thinning — particularly in women with a genetic predisposition
- Voice changes — deepening can be irreversible and warrants immediate dose reduction
- Clitoromegaly — rarely seen at physiological doses but should be monitored
Regular blood testing ensures testosterone levels stay within the female physiological range and allows early detection of any concerning trends in liver function, lipids, or red blood cell counts.
Practical Tracking with BloodTrack
BloodTrack supports tracking all key female hormone markers including testosterone, estradiol, progesterone, SHBG, DHEA-S, and thyroid function. Upload your pathology reports, visualise trends across cycles and treatment phases, and share comprehensive summaries with your clinician.
For women navigating the complexity of hormone health — whether exploring TRT, managing perimenopause, or optimising HRT — having a clear, longitudinal view of your hormone data transforms guesswork into informed decision-making.
This article is for informational purposes only and does not constitute medical advice. Always consult your GP, endocrinologist, or women's health specialist for personalised guidance on hormone therapy.