Injectable testosterone for women: separating real benefits from TikTok hype

What did @i_am_sarah_leigh actually say?

She's three weeks into injectable testosterone at 5mg twice weekly, and she's tracking her own body with reasonable care. She reported early bloating that resolved, new acne (bigger and harder than her facial ones, which she linked to her cycle), no clear increase in hair shedding, improved emotional regulation, and a noticeable libido bump. She also mentioned her baseline testosterone was 17, and that her doctor considers 60 to 150 the optimal range for women. She's below her prescribed dose by choice and has a lab draw coming up.

To her credit, she's not selling anything. She flags that she had a hysterectomy eight years ago but still has her ovaries, which is clinically relevant context. She's not claiming testosterone fixed her life. She's logging observations.

Does the science back this up?

Mostly, yes, on the side effects. The timeline and type of symptoms she describes are consistent with what the literature shows for low-dose testosterone in women, though the evidence base is smaller than most people realize.

Bloating and water retention in the first weeks of testosterone therapy are well-documented. Testosterone aromatizes to estradiol, and early fluctuations in both androgens and estrogens can cause transient fluid retention. The fact that it resolved around week three is consistent with the body adapting to a new hormonal baseline.

On acne, the connection is real. Testosterone stimulates sebaceous gland activity via androgen receptors in the skin. A 2019 systematic review by Nolan and colleagues in the Journal of the American Academy of Dermatology confirmed androgens as a primary driver of acne, particularly the deeper, more painful nodular type, which is what she described on her back.

Her libido observation is also well-supported. A 2019 meta-analysis by Islam and colleagues in The Lancet Diabetes and Endocrinology found testosterone therapy improved sexual function in postmenopausal women compared to placebo across multiple trials. Her ovaries are still cycling, so she's not technically postmenopausal, but the libido mechanism is similar.

Hair loss is the one area where the science is murkier and she appropriately hedged. Androgenic alopecia in women is real, but at doses this low, the risk is not well-quantified in prospective trials.

What did they get wrong (or right)?

She got more right than wrong, and her uncertainty is actually one of the more honest things about this video.

One area worth pushing back on: she describes her emotional regulation improvement as possibly being due to testosterone, which may be true, but three weeks is genuinely too early to attribute mood changes to the therapy with confidence. Testosterone's effects on mood in women are not consistently demonstrated in randomized trials at low physiologic doses. The 2019 Islam meta-analysis found benefits for sexual function but not clear mood improvement. She does acknowledge it could be her circumstances, which is the right call.

Her reference range of 60 to 150 ng/dL as "optimal for women" is worth scrutinizing. Reference ranges for female testosterone vary widely by lab, age, and assay method. The Endocrine Society does not endorse a universal "optimal" target for women on testosterone therapy. Some clinicians use this range; others do not. Calling it universally optimal overstates the clinical consensus.

Her starting level of 17 ng/dL is genuinely low relative to most female reference ranges, so the decision to treat is not unreasonable on its face. But the framing of a single number as definitive is an oversimplification.

What should you actually know?

Low-dose testosterone for women is an area of real clinical interest and genuine evidence gaps at the same time. The Global Consensus Position Statement on testosterone for women, published in 2019 across multiple journals by Wierman and colleagues, supports its use specifically for hypoactive sexual desire disorder in postmenopausal women, and only when hormone levels are brought to physiologic premenopausal range, not above it.

The safety data beyond two years is thin. Long-term cardiovascular and breast cancer risk data in women using testosterone is not well-established, a point that does not get nearly enough airtime on social media.

If you're considering testosterone therapy, the relevant questions are not just whether your level is "low" on a number line, but what symptoms you have, what other hormones look like, and what your individual risk profile is. A lab number without clinical context is not a treatment plan. The creator is working with a doctor and tracking labs, which is the floor of responsible practice here, not a ceiling.