“I’m exhausted all the time. Exercising feels harder. I feel like I’m on a hamster wheel, moving but not getting anywhere with my weight loss goals. I’ve gained weight even though my diet hasn’t changed. My motivation is gone.”

Women in their 40s and 50s often confide in me some complaint like this where I see my functional medicine clients at the Diabetes & Wellness Clinic in Norfolk, NE.

During the first session with me, clients’ first question or two usually involves estrogen or thyroid.

No doubt about it. Estrogen can work wonders. Just check out what I have to say about using vaginal estrogen cream for my sex life!

But there’s another hormone that often gets overlooked entirely by many women: Testosterone.

Yes, yes, testosterone is the male sex hormone. But women produce it too, and it plays a significant role in energy, metabolism, motivation, and muscle maintenance.

And here’s the surprising part: testosterone levels in women can decline by about 50% between the early 20s and early 40s, long before menopause even begins.

Yet testosterone is rarely tested in women unless libido becomes a concern.

That means many women may spend years dealing with fatigue, muscle loss and metabolic changes without realizing hormones could be contributing.

Testosterone: Don’t Fear The Male Sex Hormone

Women naturally produce testosterone in the ovaries and adrenal glands. While levels are significantly lower than in men, the hormone still plays an important physiological role.

Healthy testosterone levels help support:

• Lean muscle mass
• Bone density
• Energy levels
• Libido
• Cognitive function
• Metabolic health

Testosterone also helps regulate how efficiently the body uses glucose and maintains muscle tissue.

When levels decline, women may notice subtle but frustrating changes that often get dismissed as “normal aging.”

Testosterone Declines Earlier Than Most Women Realize

Estrogen levels tend to fluctuate dramatically during perimenopause. But testosterone behaves differently. Instead of fluctuating, it typically declines gradually beginning in a woman’s early 30s.

Research suggests women may lose up to half of their testosterone production between their early 20s and early 40s.

Because this drop is gradual, and because testosterone is rarely tested in women, the decline often goes unnoticed.

By the time symptoms appear, many women have already been operating at significantly lower levels for years.

The Motivation Hormone: An Overlooked Role

Here’s an angle that doesn’t get nearly enough attention….

Testosterone doesn’t just influence muscle and libido. It also affects drive and motivation. Testosterone interacts with the brain’s dopamine pathways, which regulate goal-directed behavior. This is important because dopamine is associated with:

• Motivation
• Initiative
• Focus
• Reward-driven behavior

When testosterone levels decline, some women describe feeling like their “get up and go” quietly disappeared. They’re not necessarily depressed, they’re just… flat. Many people assume this is burnout or stress. Low T, as the men call it, could be contributing.

When Low Testosterone Gets Misdiagnosed as Depression

Hormonal symptoms can sometimes overlap with mental health symptoms, such as fatigue, low motivation, reduced interest in activities and poor concentration.

These symptoms can resemble depression and sometimes antidepressants are prescribed.

But in some cases, hormonal changes may be contributing to those symptoms.

Research supports this possibility.

A 2014 study published in the journal Menopause found that lower androgen (male steroidal hormones) levels, including testosterone, were associated with reduced vitality, decreased well-being, and impaired sexual function in midlife women.

A large systematic review published in The Lancet Diabetes & Endocrinology in 2019 evaluated testosterone therapy in women and found that restoring physiological testosterone levels improved sexual function, desire, arousal, and overall well-being in women with low levels.

The takeaway isn’t that testosterone is a cure-all. But But hormonal health deserves consideration before assuming symptoms are purely psychological.

Muscle Loss, Metabolism and Midlife Weight Gain

Maintaining lean muscle mass is the biggest physiological selling point for testosterone therapy. This is because muscle isn’t just about strength; muscle mass greatly influences your metabolism. In other words, think about muscle not as something to flex to impress and point where the beach is, but as a metabolic organ.

The more lean muscle you maintain, the better your body regulates blood sugar and burns calories. The problem is that when testosterone declines, maintaining muscle becomes harder, even with regular exercise.

This decline in testosterone can contribute to:

• Slower metabolism
• Increased body fat
• Reduced strength
• Poorer blood sugar control

Which is one reason many women feel like their metabolism suddenly “breaks” in their 40s and 50s.

A Functional Medicine Perspective

In conventional medicine, hormone testing often focuses on estrogen, thyroid, and sometimes progesterone.

Functional medicine takes a broader view.

We evaluate the entire hormonal ecosystem, including:

• Testosterone
• Estrogen
• Progesterone
• Thyroid hormones
• Cortisol
• Insulin

Hormones operate as a network. When one shifts, others often follow.

Low testosterone in women can sometimes be associated with:

• Adrenal stress
• Insulin resistance
• Chronic inflammation
• Sleep disruption
• Nutrient deficiencies

Understanding these connections helps guide more personalized strategies for improving energy, metabolism, and overall health.

The First Step Is Knowing Your Baseline

If you’re experiencing symptoms such as:

• Low energy
• Reduced motivation
• Loss of strength
• Unexplained weight gain
• Declining libido

…it may be worth evaluating your hormone levels.

Testing provides a baseline and helps determine whether testosterone—or another hormone—may be contributing to how you feel.

References

1. Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Lancet Diabetes & Endocrinology. 2019.
   https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30189-5/fulltext
2. Wierman ME, et al. Androgen Therapy in Women: A Reappraisal. Menopause. 2014.
   https://journals.lww.com/menopausejournal/Fulltext/2014/09000/Androgen_therapy_in_women__a_reappraisal.17.aspx