What does this TikTok creator claim about testosterone?
@alixawinn tells women over 35 they should get testosterone levels checked regularly. She says doctors who refuse are wrong, and if your levels are "normal" but you feel bad, you need a new doctor.
She argues that normal isn't optimal. According to Winn, testosterone drops with age, and TRT can restore levels to where they were in your twenties when you "felt amazing." She promotes this as a simple solution to feeling better.
What does the research actually show about women's testosterone?
Women's testosterone levels do decline with age, dropping about 1-2% per year after age 30. But the clinical significance remains hotly debated among endocrinologists.
The largest randomized trial on testosterone therapy in postmenopausal women was published by Davis et al. in NEJM (2019). They found modest improvements in sexual function but no meaningful changes in mood, energy, or cognitive function in 850 women over 24 weeks.
The North American Menopause Society's 2017 position statement supports testosterone only for postmenopausal women with sexual dysfunction. They explicitly state there's insufficient evidence for other uses like energy or mood.
Where does Winn get it wrong about normal vs. optimal?
Winn's "normal isn't optimal" argument sounds compelling but lacks scientific backing. Reference ranges for women's testosterone are based on healthy populations, not arbitrary lab standards.
The Endocrine Society's 2014 clinical practice guideline notes that testosterone testing in women is unreliable due to assay limitations. Most commercial labs can't accurately measure the low levels found in women.
More problematically, there's no evidence that restoring testosterone to twenties levels improves outcomes. The Australian longitudinal study by Davison et al. (2005) found no correlation between testosterone levels and well-being in healthy women across age groups.
What are the real risks of testosterone therapy for women?
Winn glosses over significant safety concerns. The FDA has never approved testosterone therapy for women, meaning all use is off-label.
Long-term safety data is limited, but known risks include irreversible voice deepening, male-pattern baldness, and clitoral enlargement. The 2016 systematic review by Achilli et al. found these effects occurred even at "physiologic" doses.
Cardiovascular risks remain unclear. While some studies suggest neutral effects, others show concerning lipid changes. The lack of long-term data makes this essentially a large-scale experiment on women's health.
What should women actually know about testosterone testing?
Most women don't need routine testosterone testing. The American College of Obstetricians and Gynecologists doesn't recommend screening asymptomatic women.
If you're experiencing fatigue, low mood, or decreased libido, these symptoms have many potential causes. Thyroid disorders, vitamin D deficiency, sleep apnea, and depression are far more common culprits than low testosterone.
Before considering hormone therapy, work with a qualified healthcare provider to rule out these conditions. If you do pursue testosterone testing, ensure your lab uses a sensitive assay designed for women, not the standard male assays that many facilities use.