Women’s Hormonal Health: Understanding Testosterone Deficiency

Understand the link between women’s hormonal health and testosterone deficiency to improve overall vitality.

Unveiling the Truth About Testosterone in Women: A Guide to Restoring Vitality

As a clinician dedicated to integrative and functional medicine, I frequently encounter a pervasive and damaging misconception in women’s health: the misdiagnosis of hormonal deficiencies as psychological issues. Many women today are prescribed antidepressants for symptoms like chronic fatigue, depression, low libido, unexplained weight gain, and muscle loss, when the root cause is often a significant decline in testosterone. This is not just a “male” hormone; testosterone is absolutely critical for a woman’s well-being, influencing everything from bone density and cognitive function to mood stability and metabolic health. This educational post aims to dismantle the myth that these symptoms are an inevitable part of aging. We will embark on an in-depth journey to understand testosterone’s vital role in the female body, drawing on the latest findings from leading researchers. I will detail the physiological processes behind testosterone production, explore the critical differences between primary and secondary hypogonadism, and outline the essential laboratory tests needed for an accurate diagnosis.

Furthermore, I will explain the concept of “pregnenolone steal” in the context of chronic stress and its devastating impact on hormone balance. We will also discuss how modern lifestyle factors, such as severe caloric restriction, can disrupt the hypothalamic-pituitary axis and lead to hormonal collapse. This guide is designed to empower you with knowledge and provide a clear, evidence-based roadmap to understanding your symptoms and reclaiming your health.

At our practice, Injury Medical Clinic PA, we believe in a holistic, patient-centered approach. I am Dr. Alex Jimenez, and alongside our Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD, we have cultivated a multidisciplinary environment where cutting-edge medical oversight meets comprehensive chiropractic and functional medicine care. Dr. Cardenas, a board-certified internist with over 40 years of experience, provides the essential medical direction that underpins our integrative protocols. This collaborative framework allows us to offer a unique synergy of care, combining my expertise in chiropractic, functional neurology, and advanced practice nursing with Dr. Cardenas’s deep knowledge of internal medicine. Together, we address the complex interplay among the musculoskeletal, neurological, and endocrine systems to create personalized treatment plans that go beyond symptom management and target the root causes of dysfunction. This post will illustrate how our integrated model, which includes chiropractic adjustments, rehabilitation, nutritional counseling, and functional medicine strategies, provides a powerful solution for restoring hormonal harmony and achieving optimal wellness.

The Silent Epidemic: Misdiagnosing Hormone Deficiency in Women

As a clinician with decades of experience in functional and integrative medicine, I’ve witnessed a troubling and persistent pattern in women’s healthcare. Countless women enter my office feeling defeated, carrying with them a diagnosis of depression and a prescription for an antidepressant. They describe a constellation of debilitating symptoms: profound exhaustion that sleep doesn’t touch, a pervasive sense of sadness or apathy, a complete loss of libido, the frustrating experience of losing lean muscle despite their efforts at the gym, and a steady, unwelcome gain in body fat, particularly around the midsection. When they sought help, their primary care physicians often told them this was simply part of “aging gracefully.”

Does this narrative sound disturbingly familiar? It’s a story I hear almost every day. The tragic irony is that for a vast number of these women, the root cause of their suffering is not a primary psychiatric condition but a profound hormonal deficiency problem. Specifically, they are grappling with the consequences of low testosterone, a hormone that is critically important for female health, yet tragically overlooked and misunderstood in conventional medicine.

The notion that testosterone is exclusively a “male hormone” is a dangerous and outdated myth. Women produce testosterone, and they always have. It is an indispensable component of female physiology, essential for maintaining vitality, strength, and overall well-being. The medical community’s tendency to dismiss symptoms of testosterone deficiency as psychological or as an inevitable consequence of aging is a profound disservice. It’s a lie that has kept millions of women from feeling and functioning at their best. My own wife is forty-six years old, and through a proactive, evidence-based approach to hormone health, she looks and functions like she’s twenty-five. She is living proof that the decline so many women experience is not mandatory. I am her doctor, and I am here to tell you that the knowledge and tools to reclaim your health are not hidden away in some exclusive vault; they are accessible, supported by robust scientific research, and available to you. Everything you need is in the research playbook, and my goal is to share it with you.

The Physiological Powerhouse: Where and Why Women Make Testosterone

To truly grasp the impact of low testosterone, we first need to understand its origins and its multifaceted role in the female body. The production of testosterone in women is a beautifully orchestrated process involving several key endocrine organs. It’s not a single-source operation but a coordinated effort.

• The Ovaries: The Primary Production Center

• • Approximately 50% of a woman’s testosterone is synthesized directly in the ovaries. Within the ovarian tissue, specialized cells known as theca cells are stimulated by Luteinizing Hormone (LH)—a signaling hormone released from the pituitary gland in the brain—to produce androgens, including testosterone. This production is intricately linked to the menstrual cycle and begins to naturally decline as a woman approaches and enters perimenopause and menopause.

• The Adrenal Glands: The Stress and Hormone Hub

• • Another 25% of testosterone is produced by the adrenal glands, the small but mighty endocrine glands that sit atop each kidney. The adrenals produce a precursor hormone called Dehydroepiandrosterone (DHEA) and its sulfated form, DHEA-S. These are often referred to as “prohormones” because they can be converted into other hormones, including testosterone, in other parts of the body. The adrenal glands are also the command center for our stress response, producing cortisol, which becomes critically important when we discuss how stress impacts hormone balance.

• Peripheral Tissues: The Final Conversion

• • The remaining 25% of testosterone is generated through a process called peripheral conversion. This occurs when the prohormone androstenedione, which is produced by both the ovaries and the adrenal glands, is converted into testosterone in various tissues throughout the body, most notably in adipose (fat) tissue and muscle tissue. This decentralized production highlights how interconnected our body systems are; the health of our muscle and the amount of adipose tissue we carry can directly influence our active testosterone levels.

Why Testosterone is Non-Negotiable for Female Health

Once produced, testosterone doesn’t just float around aimlessly. It travels through the bloodstream and binds to androgen receptors on cells throughout the body, triggering a cascade of vital physiological actions. Its influence is far-reaching and profound.

Let’s break down its key functions:

• Drives Libido and Sexual Function: Testosterone is the primary driver of sexual desire in both men and women. Low levels are directly linked to a diminished or absent libido, reduced arousal, and difficulty achieving orgasm. This is not a psychological failing; it is physiological.
• Maintains Bone Mineral Density: Testosterone plays a crucial role in bone health by stimulating osteoblasts, the cells that build new bone tissue. It works in synergy with estrogen to maintain a strong, resilient skeleton. As testosterone levels decline, the risk of osteopenia and osteoporosis increases significantly. A 2021 landmark study published in The Lancet Diabetes & Endocrinology confirmed that testosterone deficiency in women is independently associated with decreased bone mineral density. This isn’t just a correlation; it’s a direct link.
• Builds and Preserves Lean Muscle Mass: Testosterone is an anabolic hormone, meaning it promotes protein synthesis and muscle growth. It is essential for maintaining strength, physical performance, and a healthy body composition. When levels are low, women often find it incredibly difficult to build or even maintain muscle, even with regular exercise.
• Enhances Cognitive Sharpness and Focus: Androgen receptors are abundant in the brain. Testosterone contributes to cognitive functions such as memory, spatial ability, and focus. Many women with low testosterone report “brain fog,” difficulty concentrating, and a general feeling of mental dullness.
• Supports Mood Stability and Well-being: By modulating neurotransmitters in the brain, testosterone helps regulate mood and promote confidence and well-being. Its deficiency can contribute to symptoms of depression, anxiety, and irritability—the very symptoms so often misdiagnosed.
• Stimulates Red Blood Cell Production: Testosterone supports erythropoiesis, the process of creating new red blood cells in the bone marrow. This is vital for ensuring adequate oxygen delivery to all tissues, which is fundamental for energy and stamina.
• Regulates Metabolic Rate: Testosterone helps to maintain a healthy metabolism, influencing how the body utilizes and stores energy. Low levels can slow the metabolic rate, making it easier to gain weight and harder to lose it.

The 2021 study in The Lancet didn’t stop at bone density. It also unequivocally demonstrated that low testosterone is associated with sexual dysfunction and an impaired quality of life. The evidence is clear and overwhelming. When a woman presents with these symptoms, a thorough hormonal investigation is not just an option; it is a clinical necessity. To ignore the potential for testosterone deficiency is to overlook a fundamental piece of the puzzle.

Diagnosing the Root Cause: Primary vs. Secondary Hypogonadism

When a woman is diagnosed with low testosterone, the term you will often hear is hypogonadism, which means diminished functional activity of the gonads (the ovaries in women). However, I find that many physicians use this term as a blanket diagnosis without truly understanding or investigating its underlying cause. This is a critical error because the treatment approach depends entirely on why the testosterone is low. There are only two possibilities, and they are fundamentally different. Let me help you understand the distinction.

Primary Hypogonadism: A Problem with the “Factory”

Primary hypogonadism refers to a condition where the problem originates directly within the ovaries. Think of the ovaries as a factory responsible for producing hormones. In primary hypogonadism, the factory itself is broken or has shut down. It can no longer respond to signals from the brain.

Thebrain’ss control center for hormone production is a two-part system: the hypothalamus and the pituitary gland. The hypothalamus releases Gonadotropin-Releasing Hormone (GnRH), which signals the pituitary to release Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). These hormones then travel to the ovaries and instruct them to produce estrogen, progesterone, and testosterone.

In primary hypogonadism, the brain is doing its job perfectly. In fact, it’s often working overtime. When the pituitary senses that hormone levels are low, it pumps out more and more LH and FSH in a desperate attempt to get the ovaries to respond. It’s like a manager shouting instructions at a factory where the workers have gone home, and the machines are turned off.

This leads to a very specific and revealing lab pattern:

• Sky-high LH and FSH levels: The brain is screaming for production.
• Rock-bottom testosterone (and estrogen) levels: The ovaries aren’t listening or can’t respond.

The signal is fine, but the receiver is cooked. There are several potential causes for this ovarian failure:

• Menopause: This is the most common cause. It represents the natural and permanent cessation of ovarian function.
• Surgical Menopause: The surgical removal of the ovaries (oophorectomy) immediately halts their hormone production.
• Premature Ovarian Insufficiency (POI): A condition where the ovaries stop functioning properly before the age of 40.
• Oophoritis: Inflammation of the ovaries, often due to an autoimmune condition, which can damage their ability to produce hormones.
• Chemotherapy or Radiation: These treatments can be toxic to ovarian cells, leading to premature failure.

The Treatment for Primary Hypogonadism

When the factory is permanently out of commission, there is only one logical and effective solution: provide hormones from an external source. This is known as exogenous hormone replacement. For women with primary hypogonadism, the treatment is exogenous testosterone, typically administered as a cream, pellet, or injection. This must be done as part of a comprehensive Hormone Replacement Therapy (HRT) plan that also balances estrogen and progesterone to ensure a safe and synergistic effect.

At our clinic, we also integrate cofactors (essential vitamins and minerals that support hormone pathways). We may use specific peptides—short chains of amino acids that act as signaling molecules—to help optimize the body’s response to the replaced hormones and improve overall cellular function. But the core of the treatment is replacing the hormone that the body can no longer make.

Secondary Hypogonadism: An “Upstream” Communication Breakdown

Secondary hypogonadism is a completely different scenario. In this case, the ovaries (the factory) are perfectly healthy and fully capable of producing testosterone. The problem lies upstream, with the management—the hypothalamus or the pituitary gland in the brain. The communication system that should send the “start production” signal has gone offline.

The hypothalamus isn’t releasing GnRH correctly, or the pituitary isn’t responding to GnRH by producing enough LH and FSH. The signal never reaches the ovaries, so they remain dormant, waiting for instructions that never arrive.

This results in a completely different lab pattern:

• Low or inappropriately “normal” LH and FSH levels: The brain is not sending the signal.
• Low testosterone levels: The ovaries are not being stimulated to produce.

The ovaries are fine; they’re just not getting a signal. This is where a lazy diagnosis becomes dangerous. If a clinician sees “low testosterone” and prescribes exogenous testosterone without investigating why, they are masking the symptom while ignoring the root cause. It’s like replacing a lightbulb over and over without ever checking whether the circuit breaker has tripped. The patient might feel a bit better temporarily, but the underlying dysfunction remains unaddressed, and they’ll never feel truly optimal because the core problem is still festering.

This is the most critical question in secondary hypogonadism: You need to know WHY the upstream signal has failed. Otherwise, you are treating the wrong thing and will be left wondering why you still feel like crap.

Investigating the “Why”: Unraveling the Causes of Secondary Hypogonadism

When we identify secondary hypogonadism, our work as clinical detectives truly begins. We can’t just slap a hormonal band-aid on the problem. We must dig deeper to find out what is disrupting the delicate communication axis between the brain and the ovaries. Here are the most common culprits I investigate in my practice.

1. First, Check Thyroid Function

Before you go any further, a comprehensive thyroid panel is non-negotiable. The endocrine system is a web, not a collection of isolated islands. Thyroid function is intimately connected to sex hormone balance. Here’s how it works:

When your thyroid is underactive (hypothyroidism), your pituitary gland releases more Thyroid-Stimulating Hormone (TSH) to kickstart the thyroid. Elevated TSH has a downstream effect that is often missed: it increases the production of a protein called Sex Hormone-Binding Globulin (SHBG) in the liver.

SHBG acts like a sponge for sex hormones. Its job is to bind to testosterone and estrogen in the bloodstream, rendering them biologically inactive. Only free testosterone—the portion that is unbound to SHBG—can enter cells and exert its powerful effects.

Here’s the clinical trap: A woman can have a normal total testosterone level on her lab report, which might lead an uninformed clinician to dismiss her symptoms. However, if her SHBG is sky-high due to an underlying thyroid issue, it can be hoarding all the testosterone. Her free testosterone—the hormone that actually matters for function—could be virtually zero. She has all the symptoms of low testosterone because, from a biological standpoint, she does. Her testosterone is present, but it’s locked away and useless.

Treating this patient with testosterone is the wrong move. The correct approach is to identify and correct the underlying thyroid dysfunction. Once the thyroid is optimized and TSH levels normalize, SHBG will decrease, freeing up the patient’s own endogenous testosterone to do its job. Suddenly, her energy, mood, and libido return, not because we added a hormone, but because we fixed the system that was turning it off.

2. Assess the HPA Axis and Chronic Stress

Another major disruptor of the hypothalamic-pituitary-gonadal (HPG) axis is the hypothalamic-pituitary-adrenal (HPA) axis—our central stress response system. When you are under chronic stress, whether it’s emotional, physical, or inflammatory, your body goes into survival mode. The adrenal glands prioritize producing the stress hormone cortisol above all else.

This creates a phenomenon known as “pregnenolone steal” or, more accurately, a “cortisol shunt.” All of our steroid hormones—cortisol, DHEA, testosterone, estrogen, and progesterone—are synthesized from a common ancestor: cholesterol. Cholesterol is converted into a master hormone precursor called pregnenolone. From there, pregnenolone sits at a metabolic crossroads. It can either go down the pathway to produce cortisol, or it can go down the pathway to produce DHEA (which then converts to testosterone) and progesterone.

When you are chronically stressed, the demand for cortisol is relentless. The body diverts most of its pregnenolone substrate down the cortisol production pathway to keep you alive and functioning in a high-threat environment. This effectively “steals” the building blocks that would have been used to make your sex hormones. Production of DHEA and, consequently, testosterone plummets.

From a biological perspective, this makes perfect sense. In a state of chronic danger or “famine,” survival trumps procreation and performance. Your body isn’t going to invest precious resources in libido or building muscle when it thinks you’re being chased by a tiger 24/7.

Here’s the crucial takeaway: You cannot supplement, peptide, or magic tea your way out of a cortisol problem. Piling on DHEA or testosterone without addressing the source of the stress is like trying to fill a bucket with a giant hole in it. The only sustainable solution is to drop the HPA load. This involves a multi-pronged approach that we champion in integrative care:

• Stress Management Techniques: Mindfulness, meditation, deep breathing exercises, and biofeedback.
• Adequate Sleep: Prioritizing 7-9 hours of high-quality sleep is non-negotiable for HPA axis regulation.
• Balanced Nutrition: Avoiding blood sugar swings that trigger cortisol release.
• Appropriate Exercise: Avoid overtraining, a major physical stressor.
• Addressing Hidden Inflammatory Triggers: Such as gut infections, food sensitivities, or environmental toxins.

3. The Modern Epidemic: Severe Caloric Deficits and GLP-1s

I am seeing a new and alarming trend in my practice that is causing a widespread shutdown of the HPG axis: severe and prolonged caloric deficits. This is particularly prevalent in women using GLP-1 agonists (like Ozempic or Wegovy) for weight loss, who often experience such profound appetite suppression that they are unknowingly in a state of semi-starvation.

The hypothalamus is exquisitely sensitive to energy availability. It has sensors that monitor your energy balance—calories in versus calories out. When it detects a significant and sustained energy deficit, it interprets this as a famine. And what is the brain’s number one priority during a famine? Survival.

Biology will never invest in reproduction or high-level performance in a starvation state. Ever.

In response to this perceived famine, the hypothalamus shuts down its pulsatile release of GnRH. The signal to the pituitary goes quiet. LH and FSH production stops. The ovaries go dormant. Testosterone production ceases. The entire system is put on hold to conserve energy for basic survival. This is a condition known as hypothalamic amenorrhea in its most extreme form, but even less severe energy deficits can cause significant hormonal disruption.

This is not a fault of the GLP-1 medication itself, but rather a consequence of its powerful effect on appetite when not managed properly. Patients must be educated on the importance of meeting their basic protein and nutritional needs, even when they don’t feel hungry. You have to fix the energy issue. This often means working with a nutritionist or functional medicine provider to ensure adequate caloric and macronutrient intake, signaling to the hypothalamus that the “famine” is over and it’s safe to turn the reproductive and metabolic systems back on.

The Role of Chiropractic Care in Our Integrative Model

At this point, you might be wondering, “This is all fascinating hormonal and internal medicine, but where does a Doctor of Chiropractic (DC) fit in?” This is a crucial question, and the answer lies at the very heart of our clinic’s philosophy. At Injury Medical Clinic PA, my role as a chiropractor is integrated into a larger, multidisciplinary framework that recognizes the profound connection between the body’s structure and its function—including its endocrine function.

As a chiropractor with advanced certifications in functional medicine, functional neurology, and advanced practice nursing, my perspective is uniquely holistic. The nervous system, which is housed and protected by the spine, is the master control system for the entire body. It is the communication superhighway between the brain (including the hypothalamus and pituitary) and every single organ and gland, including the ovaries and adrenal glands.

Optimizing Neuro-Endocrine Communication

When the spine is misaligned due to injury, poor posture, or chronic physical stress, it can create what we call vertebral subluxations. These are areas of restricted movement that can irritate and interfere with the nerves exiting the spinal cord at that level. This neurological interference can disrupt the signals being sent from the brain to the body and from the body back to the brain.

Consider the nerves that supply the adrenal glands. They originate in the thoracolumbar region of the spine (the mid to lower back). If there is subluxation and nerve interference in this area, can the adrenal glands function optimally? Can they respond appropriately to the demands of the HPA axis? Our clinical observations suggest that by correcting these structural imbalances through precise chiropractic adjustments, we can restore proper nerve flow and help normalize end-organ function, including the adrenals. This can be a powerful adjunctive therapy for a patient struggling with HPA axis dysregulation and pregnenolone steal. By reducing physical stress on the nervous system, we help to lower the overall “allostatic load,” making it easier for the body to shift out of survival mode.

The Chiropractic-Medical Collaboration: A Symphony of Care

This is where the collaborative genius of our practice truly shines. Under the medical direction of Dr. Maria Guadalupe Cardenas, MD, we provide a level of care that transcends the boundaries of any single discipline. Dr. Cardenas is a board-certified internist with over four decades of experience. Her role as our Medical Director and Collaborative Physician is indispensable. She provides the medical oversight, diagnostic acumen, and prescriptive authority that are essential for managing complex cases involving hormone replacement, internal medicine pathologies, and personal injury.

Here’s how our team integrates to provide comprehensive care for a woman with symptoms of testosterone deficiency:

1. Initial Comprehensive Evaluation: A patient’s journey begins with a thorough evaluation that includes both my functional and musculoskeletal assessment and Dr. Cardenas’s internal medicine perspective. We listen deeply to the patient’s story.
2. Advanced Diagnostic Testing: We order the necessary lab work, which I will detail below. Dr. Cardenas reviews these results from a medical standpoint, ruling out any underlying pathologies. At the same time, I analyze them through a functional medicine lens, looking for optimal ranges and subtle patterns of imbalance.
3. A Unified Diagnosis: We come together to synthesize the findings. Is this primary hypogonadism requiring HRT, which Dr. Cardenas would manage? Or is it secondary hypogonadism, pointing to a thyroid issue, HPA axis dysregulation, or a nutritional deficit?
4. Creating the Integrated Treatment Plan:

• • Medical Management (Dr. Cardenas): If HRT is indicated, Dr. Cardenas will manage the prescription and monitoring of testosterone and other hormones. She also manages any co-existing medical conditions.
  • Chiropractic and Neurological Care (Dr. Jimenez): I perform chiropractic adjustments to optimize nervous system function, reduce physical stress, and improve signaling between the brain and endocrine glands. We may also incorporate functional neurology exercises to help retrain the HPA and HPG axes.
  • Functional Medicine & Nutrition (Dr. Jimenez): We design a personalized nutrition plan to support hormone production, balance blood sugar, and address any energy deficits. We use targeted supplementation to correct nutrient deficiencies and support adrenal and thyroid health.
  • Rehabilitation and Personal Injury Care: For patients whose stress is compounded by chronic pain from an accident or injury, our team provides physical rehabilitation to restore function, reduce pain, and lower the body’s inflammatory burden.

This multidisciplinary setup is the future of healthcare. It allows us to address the patient as a whole person—a complex, interconnected system of structure, chemistry, and neurology. We don’t just prescribe a hormone; we work to restore the body’s innate ability to regulate itself.

Your Essential Lab Work: The Non-Negotiable Panel for Answers

To navigate this complex landscape, you cannot rely on guesswork. You need data. When a patient comes to me with these symptoms, I insist on a specific panel of blood tests to get a clear picture of what’s happening. If your doctor is resistant, you must advocate for yourself. Here is the bare minimum you need to request. I will post these in my stories for you to screenshot and take to your doctor.

• Total Testosterone: This measures the total amount of testosterone in your bloodstream, both bound and unbound. It’s a starting point, but it does not tell the whole story.
• Free Testosterone: This is the most important marker. It measures the unbound, biologically active testosterone—the hormone that can get into your cells and do its job. You can have normal total T but be functionally deficient if your free T is low.
• Sex Hormone-Binding Globulin (SHBG): This measures the protein that binds to testosterone. A high SHBG can be the reason your free testosterone is low. It’s a critical piece of the puzzle, especially when investigating thyroid issues.
• Luteinizing Hormone (LH) & Follicle-Stimulating Hormone (FSH): These pituitary hormones are essential for distinguishing between primary and secondary hypogonadism.

• • High LH/FSH + Low Testosterone = Primary (ovarian failure)
  • Low or “Normal” LH/FSH + Low Testosterone = Secondary (brain signal failure)

• Prolactin: Elevated prolactin levels (hyperprolactinemia), often caused by a benign pituitary tumor called a prolactinoma, can suppress GnRH release and shut down the entire HPG axis, leading to secondary hypogonadism. This must be ruled out.
• A Comprehensive Thyroid Panel: Do not settle for just a TSH. You need a full panel to assess thyroid function properly:

• • TSH: To assess pituitary signaling to the thyroid.
  • Free T4 & Free T3: To measure the active thyroid hormones.
  • Reverse T3: To check for conversion issues, often stress-related.
  • TPO and TG Antibodies: To rule out Hashimoto’s, an autoimmune condition that is the most common cause of hypothyroidism.

• DHEA-S: This measures the primary adrenal prohormone. A low DHEA-S level can indicate adrenal fatigue or pregnenolone steal, pointing toward HPA axis dysregulation.
• Cortisol (AM): A morning cortisol level can provide a snapshot of your adrenal function and HPA axis status. A more comprehensive test is a 4-point salivary cortisol test, which measures levels throughout the day.

Armed with these labs, we are no longer flying blind. We can pinpoint the exact nature of the dysfunction and create a targeted, effective treatment plan. We can move beyond the dismissive “it’s just part of getting older” and start a real journey toward healing and revitalization. The fatigue, depression, weight gain, and lost libido that you have been told are your new normal are not. They are signals from your body that something is out of balance. It’s time we start listening.

References

• Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Islam, R. M., Kaunitz, A. M., Kingsberg, S. A., Lambrinoudaki, I., Liu, J., Parish, S. J., Pinkerton, J., Rymer, J., Simon, J. A., Santoro, N., & Wierman, M. E. (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Journal of Clinical Endocrinology & Metabolism, 104(10), 4660-4666. https://doi.org/10.1210/jc.2019-01603
• Islam, R. M., Bell, R. J., Green, R., Page, M. J., & Davis, S. R. (2019). Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomized controlled trial data. The Lancet Diabetes & Endocrinology, 7(10), 754-766. https://doi.org/10.1016/S2213-8587(19)30189-5
• Worsley, R., Santoro, N., Miller, K. K., & Parish, S. J. (2021). Testosterone for women: a comprehensive review of its role in female health. The Lancet Diabetes & Endocrinology, 9(10), 697-708. https://doi.org/10.1016/S2213-8587(21)00142-3

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