Testosterone and Androgen Physiology in Women’s Health

Testosterone and Androgen Physiology in Women: What Subcutaneous Injections Mean in Real Care

Abstract: Testosterone is a normal female hormone. Women make it in the ovaries, adrenal glands, and inside many tissues. Levels fall slowly with age, not all at once at menopause. A single blood test rarely confirms deficiency. The strongest research support for therapy is for distressing low sexual desire after menopause, once other causes have been ruled out. Subcutaneous injections can provide steadier levels in men, but evidence in women is thinner and off-label. In El Paso, an integrative team can pair hormone review with chiropractic care, rehabilitation, and medical oversight so any treatment stays monitored and tied to muscle, joint, and recovery goals.

Testosterone is a female hormone

Many people still call testosterone a male hormone. That label is incomplete. Women keep lower amounts than men—often about 10 to 20 times less—yet those amounts still matter (Cleveland Clinic, n.d.; Davis & Wahlin-Jacobsen, 2015). For much of adult life, a woman’s circulating testosterone is higher than her circulating estradiol (Davis & Wahlin-Jacobsen, 2015).

Testosterone works in two ways:

• Directly, on androgen receptors in muscle, bone, brain, fat, skin, and sexual tissues
• Indirectly, when local enzymes turn it into estradiol or into the stronger androgen dihydrotestosterone (DHT)

These pathways help explain effects on sexual function, tissue upkeep, and metabolism even when blood levels look low (Davis & Wahlin-Jacobsen, 2015; Labrie et al., 2017).

Where women’s androgens come from

Women do not rely on one gland. Production is shared.

• The ovaries release some testosterone and larger amounts of precursors.
• The adrenal glands release DHEA and DHEA-sulfate (DHEAS), a large precursor pool.
• Peripheral tissues—fat, skin, muscle, and other organs—convert those precursors into the small amounts of hormone they need.

This last step is called intracrinology. Many tissues make the hormone they need on site and then break it down before much of it returns to the blood (Labrie et al., 2017). A blood testosterone result is only the visible tip of a larger local system.

Tissue enzymes can convert DHEA to testosterone, make DHT, or turn testosterone into estradiol. The same precursor can become an androgen in one tissue and an estrogen in another. Local enzymes, not just the lab, decide the outcome (Labrie et al., 2017; Schiffer et al., 2018).

A long slope, not a sudden cliff

Estradiol falls sharply at menopause. Androgens do not. DHEA and DHEAS begin to fall around the third decade of life and may be down roughly 60% by menopause (Davis & Wahlin-Jacobsen, 2015). A woman in her forties is already below her own earlier peak.

Midlife data measured by mass spectrometry found median testosterone falling from about 0.56 nmol/L in the early forties to about 0.42 nmol/L in the late fifties, with a low point near ages 58–59. In women of similar age, testosterone did not differ by menopausal stage. Natural menopause itself is not a stand-alone reason to administer testosterone (Wang et al., 2025).

Two exceptions matter:

• Surgical menopause (both ovaries removed) cuts the ovarian share at once
• Premature ovarian insufficiency creates an earlier deficit than the usual age-related slope (Davison et al., 2005; Soman et al., 2019)

The postmenopausal ovary is not silent. Its stroma can continue to make some testosterone for years after estradiol output has collapsed (Davis & Wahlin-Jacobsen, 2015).

Why one lab number rarely settles the question

Measuring female testosterone is challenging. Routine immunoassays were built for the much higher male range. Liquid chromatography–tandem mass spectrometry (LC-MS/MS) is more reliable. Most circulating testosterone is bound to sex hormone-binding globulin (SHBG), so free hormone can change when SHBG changes even if total testosterone stays the same (Rosner & Vesper, 2010).

What moves SHBG—and the free fraction:

• Oral estrogen and high thyroid hormone tend to raise SHBG and lower free testosterone
• Obesity and insulin resistance tend to lower SHBG and raise free testosterone
• Androgen excess, including polycystic ovary syndrome (also discussed as polyendocrine metabolic ovarian syndrome, or PMOS), also lowers SHBG (Luo et al., 2024; Teede et al., 2023)

Low SHBG is also a metabolic clue and has been linked to higher type 2 diabetes risk in women (Ding et al., 2009). Major guidelines do not diagnose androgen deficiency from a single value. A level can serve as a baseline and a safety assessment. It should not be the sole basis for diagnosis (Davis et al., 2019; Parish et al., 2021).

What the evidence supports—and what it does not

The clearest evidence is in sexual function. Higher endogenous testosterone tracks modestly with better desire (Maseroli & Vignozzi, 2022). In randomized trials, testosterone improved desire, arousal, orgasm, pleasure, and satisfaction and reduced sexual distress in postmenopausal women with low desire (Islam et al., 2019).

Androgen receptors are found in bone, muscle, fat, vessels, and the brain. That map is real. This is not the same as a proven benefit. Trials showing sexual-function gains have not firmly proven better body composition, bone, mood, or cognition to the same standard (Davis, 2025; Islam et al., 2019). Some tissue effects may also come from local conversion to estradiol.

Too much androgen is the other problem: acne, unwanted hair, cycle changes, and higher cardiometabolic risk in PMOS/PCOS (Teede et al., 2023). Risk can appear at both ends of the female range (Luo et al., 2024). The target is a physiologic band, not “more is better.”

International groups have not endorsed a broad “female androgen deficiency syndrome,” because no blood cutoff cleanly separates symptomatic women from normal variation (Davis et al., 2019; Wierman et al., 2014). The one consensus indication is hypoactive sexual desire disorder (HSDD) in postmenopausal women—low desire that causes distress—after relationship, mood, medicine, and genitourinary issues are addressed (Parish et al., 2021).

There is still no FDA-approved testosterone product for women in the United States. Prescribing remains off-label. Long-term heart and breast data in women are limited (Islam et al., 2019; Panay et al., 2024).

What subcutaneous testosterone injections are

A subcutaneous (SubQ) injection places testosterone into the fatty layer under the skin, usually in the abdomen or thigh, with a short, thin needle. An intramuscular (IM) injection goes deeper into muscle.

In men and in some gender-affirming care settings, weekly SubQ testosterone esters can reach therapeutic levels with smaller peaks and troughs, less pain, and easier self-use than some IM schedules (Figueiredo et al., 2022). That data should not be copied wholesale onto women.

• Women need much smaller doses
• Female physiologic ranges are far lower
• Randomized evidence in women is mainly transdermal, not SubQ (Davis et al., 2019)
• Guidelines do not establish a subcutaneous route for women and do not endorse compounded products as first-line (Parish et al., 2021)

If a clinician considers low-dose SubQ testosterone cypionate in oil, it is an individualized, off-label choice. The goal is to keep exposure within the premenopausal physiologic range, monitor for acne, hair changes, voice changes, or metabolic shifts, and document informed consent (Davis et al., 2019; Jimenez, 2026b).

If this route is used at all:

• Start low and titrate to symptoms plus labs, not to a male-range number
• Use the same assay method over time, ideally LC-MS/MS
• Recheck total testosterone, SHBG, and clinical signs after any dose or route change
• Do not treat menopause itself as an automatic indication (Wang et al., 2025)

Some practices offer compounded prefilled low-dose syringes. They are not FDA-approved for women. They are a delivery tool, not proof that therapy is indicated.

How integrative chiropractic care fits

Hormones do not exist outside the musculoskeletal system. Androgen receptors sit on muscle and bone. Women with midlife androgen decline often describe fatigue, slower recovery, joint stiffness, and lower exercise capacity alongside sexual and mood changes (Davis, 2025; Jimenez, 2026a). Chiropractic care does not replace hormone evaluation. It treats the mechanical side of the same person: spinal motion, posture, muscle balance, post-injury inflammation, and graded return to activity.

In clinical observation at Injury Medical Clinic PA in El Paso, Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, describes testosterone as one part of a wider plan, not a stand-alone energy shot. He notes that women have androgen receptors across muscle, bone, and brain; that levels often fall by the mid-forties compared with the mid-twenties; and that low-dose, monitored strategies may support libido, energy, and musculoskeletal integrity in selected patients when labs, symptoms, and safety checks line up (Jimenez, 2026a, 2026c). He also stresses that SubQ use in women is not the same as male testosterone replacement and should not be sold as routine wellness care (Jimenez, 2026b).

That review sits next to hands-on care:

• Spinal and extremity adjustments to restore joint motion
• Soft-tissue work and rehabilitation after auto injuries, work strain, or chronic back and neck pain
• Functional medicine review of sleep, gut, thyroid, iron, and metabolic drivers that also change SHBG and energy
• Personal injury and veteran care when trauma, delayed symptoms, or neuropathy are part of the picture

Hormone support, when used, helps tissue biology. Chiropractic and rehab help the person move, load, and recover.

Medical direction in a multidisciplinary El Paso clinic

Off-label hormone decisions need medical oversight. At Injury Medical Clinic PA (El Paso Back Clinic and related integrative sites) at 11860 Vista Del Sol, Suite 128, El Paso, Texas, Dr. Maria Guadalupe Cardenas, MD, board-certified in internal medicine (NPI #1164426749, Texas MD License #J2933), serves as Medical Director and Collaborative Physician. She brings more than 40 years of internist experience to screening, comorbidity review, and safety (El Paso Back Clinic, 2026).

This MD–DC–NP model is common in integrative and injury clinics:

• Dr. Cardenas provides internal medicine direction and collaborative oversight
• Dr. Jimenez provides chiropractic care, functional medicine framing, and dual-licensed nurse-practitioner evaluation
• Together they connect hormone questions to spinal care, rehabilitation, personal injury recovery, and follow-up rather than treating a lab value alone

That structure matters. No approved female product exists, the measurement is imperfect, and the proven indication is narrow. A team that can say “monitor and keep the dose physiologic” or “not indicated; treat sleep, pain, mood, and pelvic symptoms first” is safer than a single-hormone sales pitch.

Putting the pieces together

A careful visit starts with the story—desire, distress, energy, sleep, pain, injuries, medicines, and surgery—then an exam and labs used as a baseline, not a verdict. Other causes come first: relationship strain, depression, pain, vaginal dryness, thyroid disease, and medication effects. For many women, that means no testosterone. For some postmenopausal women with HSDD, a carefully dosed, monitored plan may be discussed. If SubQ is chosen, it stays small, measured, and reversible, while chiropractic care and rehab rebuild the capacity to move and recover.

Testosterone is a normal female hormone made in more than one place and used inside many tissues. It declines on a long slope. Blood tests tell only part of the story. The honest evidence base is strongest for distressed low sexual desire after menopause, not for menopause itself. Subcutaneous injections can offer steady delivery in other groups, but in women they remain an individualized, off-label option that must stay within a physiologic range. In El Paso, that is the working model between Dr. Cardenas and Dr. Jimenez: medical direction for safety, chiropractic and rehabilitation for movement and injury recovery, and a plan that treats physiology as a foundation rather than a marketing claim.

“Hormonal health is not a one-size-fits-all equation; it is about finding the exact physiologic balance that helps your body thrive. If you are experiencing symptoms of androgen imbalance, take a moment to note what you are feeling so we can evaluate your unique lab values and build a precise, individualized care plan together.”

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