Sexual Medicine Reviews (SMR)Beyond Libido: The Multifaceted Role of Testosterone in Women

🎓 Expert Commentary / Peer Perspective

A narrative review spanning five decades of literature examined endogenous testosterone physiology in women. Authors describe it as the most abundant biologically active sex steroid in women, with roles extending well beyond sexual function.

Clinical Considerations

• Testosterone arises from ovarian, adrenal, neural, and peripheral pathways and persists after menopause, contrary to common assumptions.
• Physiologic levels are associated with bone, muscle, metabolic, endothelial, cognitive, and mood function across the lifespan.
• Levels vary with age, reproductive status, and hormonal milieu, complicating interpretation of circulating values and outcome links.
• Roles in neuroprotection, immune modulation, pelvic floor integrity, and fertility remain an emerging area of investigation with variable evidence strength.

Practice Applications

• Recognize testosterone as a normal component of female physiology across life stages.
• Interpret single circulating testosterone levels cautiously given age and reproductive-status variability.
• Avoid framing these physiologic associations as support for testosterone therapy beyond current guidelines.
• Monitor research standardizing female androgen assessment and clarifying the significance of altered levels.