Low testosterone in women: real condition, real hype problem

What did @drjolenebrighten actually say?

Brighten listed symptoms she links to low testosterone in women: "lack of motivation, losing muscle, difficulty gaining muscle, waking up feeling tired," and emotional fragility, specifically "feeling like you're really easy to cry." She made two specific clinical points: that free testosterone is the relevant marker to test because it is "biologically active," and that building muscle mass can improve testosterone levels. These are the actual claims worth examining.

The video is short and aimed at a general audience. Brighten is a naturopathic doctor who writes and speaks frequently on women's hormones. Her framing here is largely consistent with her broader clinical perspective on perimenopause and testosterone deficiency in women.

Does the science back this up?

Partially, yes, but the picture is messier than the video lets on. Testosterone does play a role in muscle protein synthesis and energy regulation in women, and declining levels in perimenopause are well-documented. The symptom list, however, overlaps heavily with low estrogen, thyroid dysfunction, depression, and iron deficiency anemia.

A 2019 review by Davis et al. in The Lancet Diabetes and Endocrinology confirmed that testosterone contributes to sexual function and potentially body composition in women, but the authors were careful to note the evidence for mood and fatigue symptoms specifically is less robust. The symptom overlap problem is real: a 2021 paper by Islam et al. in the Journal of Clinical Endocrinology and Metabolism found that many women with low testosterone scores on symptom checklists had normal free testosterone levels, pointing to confounding factors.

Brighten's point that free testosterone is the biologically active fraction is textbook endocrinology and correct. Most total testosterone circulates bound to sex hormone-binding globulin and albumin, leaving a small free fraction to act on receptors.

What did they get wrong (or right)?

The free testosterone testing recommendation is genuinely right. Clinicians who order only total testosterone in women are missing the picture. Credit where it is due.

What's more problematic is presenting this symptom cluster as reliably diagnostic of low testosterone without naming the differential. "Feeling like you're really easy to cry and you just don't have the gumption" describes perimenopause broadly, but it also describes subclinical hypothyroidism, low ferritin, perimenopausal estrogen fluctuation, and clinical depression. If someone watches this and assumes testosterone is the culprit without ruling those out, that is a real clinical risk.

The muscle-testosterone bidirectional claim, that improving muscle mass can help with testosterone, is interesting and has some support. Resistance training is associated with modest increases in androgen levels (Kraemer and Ratamess, 2005, Sports Medicine). However, presenting this as a direct intervention for low testosterone in women without context flattens a complicated relationship between exercise, body composition, and hormone regulation.

What should you actually know?

If you relate to these symptoms, the first step is a proper workup, not a single hormone test. A good clinician will order free and total testosterone, yes, but also thyroid panel, ferritin, estradiol, DHEA-S, and a mood screen before landing on any single cause.

Testing itself has a reliability problem in women. The Endocrine Society's 2014 clinical practice guideline explicitly noted that current assay methods for measuring testosterone in women are imprecise at the low concentrations typical in female serum. Mass spectrometry-based testing is more accurate than standard immunoassays, and many commercial labs still use immunoassays.

There is currently no FDA-approved testosterone product for women in the United States. Any testosterone therapy prescribed to women is off-label use. That does not make it inappropriate, but it does mean you need a clinician who understands dosing, monitoring, and the limited long-term safety data, particularly for cardiovascular and breast tissue outcomes. This is not a supplement you optimize on your own based on a TikTok symptom list.