For years, the conversation around testosterone therapy for women has centered largely on libido.
But women who experience hormonal changes in midlife often describe a much broader picture: persistent fatigue, a flatter mood, reduced motivation, trouble concentrating, changes in sexual interest, and a general sense that they do not feel like themselves.
A 2026 study published in the Journal of Personalized Medicine offers an interesting new perspective.
Researchers evaluated 332 women receiving individualized testosterone replacement therapy (TRT) through a telehealth platform. Women reported changes across eight areas, including energy, mood, cognition, sexual interest, and relationship satisfaction, and a subgroup also had laboratory markers assessed before and after treatment.
The findings were notable: energy and fatigue showed the strongest reported improvement, while mood-related benefits also ranked ahead of sexual desire when women were asked where they noticed the greatest changes.
That does not mean testosterone is the answer to every case of fatigue, brain fog, or low mood. It also does not mean this study proves testosterone caused the reported improvements.
It does, however, add an important piece to the rapidly evolving conversation around women’s hormone health.
Key Takeaways From the 2026 Study
Among the 332 women surveyed:
- 84.3% reported improvement in energy or fatigue
- 70.8% reported improvement in depression-related symptoms
- 69.0% reported improvement in irritability
- 67.5% reported improvement in anhedonia, or reduced ability to experience pleasure
- 66.9% reported improvement in sexual interest
- 57.8% reported improved concentration
- 54.5% reported improved memory
- 89.7% reported some degree of improvement in overall quality of life
When participants were asked to identify the areas where they experienced the greatest benefit, energy/fatigue ranked first at 64.2%, followed by mood at 49.7% and sexual desire at 41.3%.
Those results challenge the idea that testosterone’s relevance to women begins and ends with sexual function.
Why Testosterone Matters in Women’s Health
Testosterone is often described as a “male hormone,” but women produce testosterone throughout their lives.
Alongside estrogen and progesterone, testosterone participates in a complex hormonal system influencing sexual function and numerous other tissues and physiological processes.
That is one reason evaluating women’s hormones works best when clinicians look at the larger picture rather than focusing on a single laboratory result.
At 1st Optimal, you can learn more about how these hormones interact in our guide to the women’s hormone trio: estrogen, progesterone, and testosterone.
Symptoms such as fatigue, low motivation, poor concentration, changes in mood, and reduced libido are also not specific to low testosterone. Thyroid dysfunction, iron deficiency, sleep problems, psychological stress, metabolic dysfunction, nutritional issues, medication effects, perimenopause, menopause, and other health conditions can produce overlapping symptoms.
That is why symptoms should be investigated, not simply assigned to one hormone.
What Did the New Testosterone Study Actually Examine?
The 2026 research was a retrospective observational study, meaning investigators analyzed outcomes from women who were already receiving testosterone as part of routine clinical care rather than randomly assigning women to testosterone or a placebo.
The study included 332 women between ages 27 and 78, with an average age of approximately 46. Half of the participants were between 40 and 49 years old.
Participants had used TRT for periods ranging from approximately one month to more than 12 months.
What Symptoms Did Researchers Measure?
The survey assessed eight domains:
- Energy and fatigue
- Memory
- Concentration
- Irritability
- Depression
- Anhedonia
- Sexual interest
- Relationship satisfaction
Researchers also evaluated overall quality of life and asked participants to select the areas in which they believed they had experienced the greatest benefit.
A subgroup of 120 women had paired laboratory results available from baseline and approximately 12 weeks after starting treatment.
Energy Was the Standout Finding
Perhaps the most striking result had nothing to do with libido.
84.3% of participants reported improvement in energy or fatigue, making it the most responsive symptom domain in the study.
When women were separately asked to identify their biggest areas of improvement, energy and fatigue again ranked first.
For women navigating perimenopause or menopause, that finding may feel especially relevant. Fatigue is frequently described during midlife, but its causes can be multifactorial.
Hormones may be part of that picture, but so may sleep quality, thyroid function, nutrition, metabolic health, stress, activity level, and other variables.
If midlife symptoms are affecting your energy, our guide to perimenopause, energy, weight, and metabolism provides additional context.
Mood-Related Improvements Were Also Significant
Sexual interest improved in 66.9% of participants, but several mood-related symptoms improved at similar or higher rates.
Researchers reported improvement in:
- Depression-related symptoms: 70.8%
- Irritability: 69.0%
- Anhedonia: 67.5%
And when participants selected their greatest perceived benefits, mood ranked second, ahead of sexual desire.
These results are intriguing, but they need careful interpretation.
This study was not designed to establish testosterone as a treatment for depression, and current consensus recommendations do not establish testosterone therapy as a general treatment for mood or well-being in women.
Anyone experiencing persistent depression, anxiety, loss of pleasure, or significant mood changes should receive an appropriate medical and mental health evaluation rather than assuming hormones are the sole cause.
Cognitive Changes May Take More Time
Memory and concentration produced more modest results than energy or mood.
Approximately 54.5% reported improved memory and 57.8% reported better concentration. The researchers observed that cognitive improvements appeared to emerge later, particularly around four to six months of treatment.
That finding is interesting because patients often expect hormone-related changes to happen immediately.
In reality, symptoms can change on different timelines, and a slower response does not necessarily tell us whether testosterone itself is responsible.
The study’s observational design means other changes occurring over the same period could have influenced the results.
Quality of Life Appeared to Improve With Treatment Duration
Overall, 89.7% of women reported at least some improvement in quality of life.
The researchers also reported a relationship between treatment duration and the magnitude of perceived improvement.
Among participants at approximately one month, 5.4% described their quality-of-life improvement as significant. Among the smaller group treated for more than 12 months, that figure rose to 51.5%.
This does not prove that longer testosterone treatment automatically creates greater benefits.
Women who continue therapy longer may differ from women who discontinue it. Participants who are experiencing positive results may also be more likely to remain in treatment, creating what researchers call a selection effect.
Still, the pattern provides a useful question for future prospective trials to investigate.
What Happened to the Biomarkers?
The researchers had before-and-after laboratory data for 120 participants.
At approximately 12 weeks, they reported the following average changes:
| Biomarker | Baseline | Approx. 12 Weeks | Change |
|---|---|---|---|
| Total testosterone | 16.8 ng/dL | 42.3 ng/dL | +151.8% |
| Free testosterone | 1.2 pg/mL | 3.8 pg/mL | +216.7% |
| SHBG | 74.4 nmol/L | 64.5 nmol/L | -13.3% |
| Hemoglobin | 12.7 g/dL | 13.4 g/dL | +5.5% |
| Triglycerides | 159.6 mg/dL | 139.5 mg/dL | -12.6% |
The authors reported that post-treatment hemoglobin values remained within normal limits in this cohort.
These laboratory changes show that the treatment produced measurable physiological effects. But a favorable change in a biomarker should not automatically be interpreted as evidence of long-term health benefit.
For example, the reduction in triglycerides is interesting, but this observational study was not designed to establish that testosterone prevents cardiovascular disease.
This is exactly why good hormone care involves monitoring both symptoms and objective health markers over time.
For a deeper look at laboratory interpretation, see 1st Optimal’s guide to understanding your hormone lab results.
What This Study Does and Does Not Tell Us About Women’s TRT
This is where context matters most.
The study provides useful real-world data from several hundred women, and its inclusion of energy, mood, cognition, quality of life, and biomarkers broadens the research conversation beyond sexual function.
But it has several important limitations.
This Was Not a Randomized Controlled Trial
Participants were already receiving TRT.
There was no placebo or untreated comparison group, so the study cannot establish that testosterone itself caused the reported improvements.
Symptoms Were Assessed Retrospectively
The symptom data came from a post-treatment survey rather than validated symptom measurements collected before treatment and then prospectively repeated afterward.
That leaves greater room for recall bias and expectation effects.
Women Who Seek TRT May Not Represent All Women
Participants were receiving care through a direct-to-consumer telehealth platform specializing in hormone optimization.
That population may differ from women in the general population.
Treatment Was Individualized
Women received testosterone through different delivery methods, including topical, oral, and injectable approaches. The distribution of treatment modalities was not captured in the survey data.
There Is a Relevant Conflict-of-Interest Disclosure
Two study authors disclosed scientific advisory roles with Joi + Blokes, the telehealth platform through which participant data were collected. The authors stated that those roles did not influence the study design, analysis, or interpretation.
None of these limitations makes the study meaningless.
They simply mean the findings are best viewed as promising, hypothesis-generating evidence that should be tested in larger, prospective, controlled studies, a point the researchers themselves emphasize in their conclusion.
What Do Current Guidelines Say About Testosterone Therapy for Women?
This distinction is particularly important.
International consensus guidance has established the strongest evidence for testosterone therapy in postmenopausal women diagnosed with hypoactive sexual desire disorder (HSDD) after appropriate evaluation. Evidence remains insufficient to recommend testosterone routinely for cognitive health, general well-being, metabolic health, or other broad indications.
More recent clinical reviews continue to describe broader potential effects as an area of active research rather than established guideline-level indications.
So the new 2026 study should not be interpreted as replacing existing medical guidelines.
Instead, it raises worthwhile questions:
Could testosterone affect more dimensions of women’s health than researchers have traditionally measured?
And if it does, which women benefit, at what dose and duration, and with what long-term safety profile?
Those are questions future controlled trials need to answer.
A Better Approach: Treat the Person, Not One Lab Number
If you are struggling with fatigue, lower libido, brain fog, mood changes, poor recovery, or other symptoms, the goal should not be to chase a testosterone number.
The better question is:
What is actually driving your symptoms?
A comprehensive evaluation may consider your:
- Symptoms and health goals
- Menstrual and menopause history
- Medical and medication history
- Total and free testosterone
- Sex hormone-binding globulin (SHBG)
- Estrogen and progesterone status when appropriate
- Thyroid markers
- Complete blood count
- Lipid and metabolic markers
- Sleep, stress, nutrition, exercise, and recovery
Which tests are appropriate depends on the individual and should be determined by a qualified healthcare professional.
That broader philosophy is central to 1st Optimal’s approach to women’s hormone care: testing, clinical review, and personalized treatment rather than making decisions based on one symptom or one isolated number.
For readers who want a deeper overview specifically focused on testosterone, see our complete evidence-based guide to women’s testosterone therapy.
The Bottom Line
The newest research on testosterone therapy for women adds an intriguing dimension to the hormone conversation.
In this 2026 observational study of 332 women, participants reported improvements not only in sexual interest but also in energy, mood, cognition, relationship satisfaction, and overall quality of life. Energy was the most commonly reported benefit, and a subgroup showed measurable changes in testosterone, SHBG, hemoglobin, and triglycerides.
Those findings are encouraging, but they are not the final word.
Because the study was retrospective, had no control group, and relied on post-treatment symptom reporting, it cannot prove that testosterone produced those benefits. Current guidelines also remain more conservative than the broader implications suggested by this study.
The takeaway is not that every woman with fatigue or brain fog needs testosterone.
It is that women experiencing changes in energy, mood, libido, cognition, or overall well-being deserve a thoughtful evaluation that takes their hormones, and the rest of their health, seriously.
Ready to Understand What Your Hormones Are Telling You?
If your energy, mood, libido, body composition, or mental clarity have changed and you are wondering whether hormones could be part of the picture, 1st Optimal can help you investigate the why before deciding on the what.
Our medical team combines comprehensive laboratory testing, clinical review, and personalized care to help identify factors that may be affecting how you feel.
Book a free health consult with 1st Optimal to discuss your symptoms, goals, and appropriate next steps.
This article is for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment. Testosterone therapy is not appropriate for everyone. Always work with a qualified healthcare provider before starting, stopping, or changing hormone therapy.
Frequently Asked Questions About Testosterone Therapy for Women
Does testosterone therapy help women with fatigue?
A 2026 observational study of 332 women receiving individualized TRT found that 84.3% reported improvement in energy or fatigue, making it the strongest reported symptom response in the study. However, because the research was observational and did not include a placebo control group, it cannot prove testosterone caused the improvement.
Fatigue can also be associated with thyroid disorders, anemia, poor sleep, stress, nutritional deficiencies, metabolic issues, medications, and numerous other factors, so a comprehensive evaluation is important.
Can testosterone improve mood in women?
The 2026 study found reported improvements in several mood-related domains, including depression-related symptoms, irritability, and anhedonia. These findings are promising but do not establish testosterone as a treatment for depression or another mental health condition.
Current consensus guidance does not recommend testosterone as a general treatment for mood or well-being in women.
How long does testosterone therapy take to work in women?
Timelines vary depending on the individual and the outcome being evaluated. In the 2026 observational study, energy appeared to improve earlier, while memory and concentration showed a slower pattern, with more noticeable gains emerging around four to six months.
The study design does not establish a guaranteed treatment timeline, and clinical response should be monitored individually.
Is testosterone therapy only used for libido in women?
The strongest established evidence and international consensus indication for testosterone therapy in women is the treatment of hypoactive sexual desire disorder in appropriately evaluated postmenopausal women.
Emerging research is exploring possible effects involving energy, mood, cognition, and other outcomes, but these broader uses currently have less definitive evidence.
What blood tests are commonly considered when evaluating testosterone in women?
Depending on the individual, a clinician may consider total testosterone, free testosterone or measures of testosterone bioavailability, and SHBG alongside other relevant hormone and health markers. Monitoring may also include laboratory measures related to blood counts and metabolic health depending on the treatment and medical history.
Testing should always be interpreted in the context of symptoms, health history, medications, life stage, and other potential causes of those symptoms.
Is testosterone therapy safe for women?
Safety depends on the patient, formulation, dose, treatment duration, medical history, and appropriate monitoring. Consensus guidance supports physiologic testosterone therapy for carefully selected women with HSDD, while acknowledging that long-term safety data remain more limited than short-term evidence.
Testosterone should therefore be prescribed and monitored by a qualified healthcare professional.
Can premenopausal women use testosterone therapy?
The 2026 observational study included women from ages 27 to 78 and did not exclude participants based on menopausal status. However, participation in an observational study is not equivalent to an established clinical indication.
Whether testosterone is appropriate for an individual requires a clinician to consider symptoms, diagnosis, reproductive status, medical history, laboratory findings, and current evidence.
Reference:
Elggren CW, Iverson CH, Morris MD, Cooper-Leavitt EF, Parker G, Richardson AW, Reynolds AP, Cortes PM, Bikman BT, Reynolds PR. Testosterone Replacement Therapy in Women Is Associated with Improved Symptom Burden and Favorable Biomarker Changes: A Retrospective Observational Study. Journal of Personalized Medicine. 2026;16(5):231. doi:10.3390/jpm16050231.
