Does low testosterone really cause depression in women?

What's this video probably claiming?

Based on the caption, this creator is telling her audience that low testosterone in women can masquerade as depression and anxiety, particularly in perimenopause and midlife. She's framing her own experience as a diagnostic revelation: she thought she had depression, got her hormones tested, and started testosterone replacement therapy (TRT). The implication is that if you're a woman suddenly experiencing mood symptoms in midlife, you may be misdiagnosed, and the real culprit could be a hormonal deficit rather than a psychiatric condition. This is a narrative that's gained significant traction in the wellness-TikTok ecosystem, and it contains enough partial truth to be genuinely confusing for the 70,000-plus people who've seen it.

What does the science actually show?

The relationship between testosterone and mood in women is real but complicated. Testosterone levels do decline with age, dropping roughly 50% between ages 20 and 45 (Davis et al., 2005, Journal of Clinical Endocrinology and Metabolism). Some observational data suggests low androgen levels correlate with depressive symptoms, fatigue, and reduced wellbeing in perimenopausal women. A randomized controlled trial by Davis et al. (2008, Menopause) found transdermal testosterone at 300 mcg/day improved mood and sexual function in surgically menopausal women versus placebo. However, the evidence for testosterone treating depression as a primary indication is much weaker. A 2019 Cochrane-adjacent systematic review by Islam et al. (Journal of Clinical Endocrinology and Metabolism) found benefits for sexual function were consistent but mood effects were modest and inconsistent across trials. The FDA has not approved any testosterone formulation for women in the United States for any indication, including depression.

Where does the social media noise diverge from clinical reality?

Here's where the video likely oversimplifies. The creator's framing, that new-onset depression in midlife could "very well be" your hormones, skips over a long list of alternative explanations. Perimenopause is also characterized by estrogen and progesterone fluctuations, sleep disruption, and cortisol dysregulation, all of which independently drive mood symptoms. Attributing depression specifically to testosterone, rather than to the broader hormonal milieu, is a significant leap. There's also a real diagnostic risk here. Women who self-advocate for testosterone testing and receive TRT without proper psychiatric evaluation may delay treatment for genuine depressive disorders, which have well-established, evidence-backed treatments. The SWAN study (Bromberger et al., 2011, Archives of General Psychiatry) found that perimenopausal women had a twofold increased risk of clinical depression compared to premenopausal women, and that risk was not simply explained by androgen levels.

What should you actually know?

If you're a woman in midlife experiencing new-onset depression or anxiety, getting a full hormonal panel is a reasonable part of a workup. But it's one data point, not a diagnosis. Testosterone reference ranges for women vary significantly between labs, there is no universally agreed-upon threshold for "low" testosterone in women, and symptoms don't reliably correlate with serum levels. The Endocrine Society's 2014 clinical practice guideline specifically states there is insufficient evidence to recommend testosterone therapy for women with mood disorders. If you're working with a telehealth provider, any testosterone prescription should come after a thorough clinical history, not just a lab value. TRT in women, typically dosed at 0.5 to 2 mg/day topically, carries real side effects including acne, hair loss, and voice changes at higher doses. A TikTok testimonial is not a treatment plan.