Female TRT and REDs: what fitness creators get right and wrong

What did @coachdarianbates actually say?

The creator argued that women with low testosterone, particularly athletes, bodybuilders, or those on hormonal birth control, should consider testosterone replacement therapy when symptoms like fatigue, fat gain, or muscle loss appear. They named 40 ng/dL as a threshold worth acting on, said women "feel and perform best" between 50 and 75 ng/dL, and suggested starting doses around 3 to 5 milligrams per week. They also claimed testosterone is "bioidentical and is the only androgen with long-term safety data in women."

To their credit, they opened with a caveat: address underlying issues like undereating and overtraining first. That's a reasonable and often ignored starting point. But the specific numbers they threw out, presented with clinical confidence, deserve closer scrutiny.

Does the science back this up?

Partially, but the confidence level in this video exceeds what the evidence actually supports. Women do produce testosterone, and low levels are associated with reduced libido, fatigue, and muscle loss. That part is not controversial. What is contested is the specific numeric thresholds the creator cites as if they are established clinical standards.

The Endocrine Society's 2014 clinical practice guidelines on androgen therapy in women explicitly stated there is insufficient evidence to recommend testosterone therapy for most indications beyond hypoactive sexual desire disorder (HSDD). A 2019 global consensus position statement in the Journal of Clinical Endocrinology and Metabolism (Wierman et al.) supported testosterone only for HSDD, while noting that "data are insufficient to support use for any other indication." The creator's framing around performance optimization in athletes is far outside that evidence base. The claim that birth control drops testosterone by "around 50%" is in the right ballpark; studies like Zimmerman et al. (2014, Journal of Sexual Medicine) showed combined oral contraceptives significantly reduce total and free testosterone, though the exact percentage varies by formulation.

What did they get wrong (or right)?

The "under 40 ng/dL warrants consideration" threshold is presented as established fact. It is not. There is no universally agreed clinical cutoff for female testosterone deficiency. Reference ranges vary widely across labs and assays, and the accuracy of immunoassay-based testosterone testing in women, who have much lower levels than men, is genuinely poor. Davis et al. (2019, Lancet Diabetes and Endocrinology) noted that mass spectrometry is required for reliable low-level testosterone measurement in women, something most standard blood panels do not use.

The creator also says testosterone is "the only androgen with long-term safety data in women." This is broadly accurate in context. DHEA has some data but less robust evidence for clinical use, and anabolic steroids used in bodybuilding have well-documented risks with no comparable safety profile. Giving credit where it is due, the advice to train naturally for three years before considering any pharmacological enhancement is sensible, though it will likely be ignored by the audience most drawn to this content.

Calling 3 to 5 mg/week a starting dose is a clinical recommendation this platform cannot endorse and should not replicate. Dosing is a conversation between a patient and a licensed prescriber with access to labs and full health history.

What should you actually know?

If you are experiencing symptoms like the ones described, persistent fatigue, muscle loss, changes in body composition, those are worth investigating with a healthcare provider. They are not automatically signs of low testosterone, and testosterone is not automatically the fix. Thyroid dysfunction, iron deficiency, sleep disorders, and hypothalamic amenorrhea (which the creator does mention) can all produce identical symptoms.

The creator is right that hormonal birth control can suppress androgens, and this is an underappreciated clinical issue. But the leap from "your labs show low testosterone" to "start TRT" skips several diagnostic steps that matter. Women considering testosterone therapy should seek evaluation from an endocrinologist or a hormone specialist using validated testing methods, not a general testosterone panel run through a telehealth platform optimizing for conversion.

• There is no FDA-approved testosterone product for women in the United States as of 2024. Prescribing is off-label, which does not make it wrong, but it does mean the regulatory safety review that exists for men's products does not exist here.
• Long-term data on testosterone use in premenopausal women specifically for athletic performance is essentially nonexistent. The safety claims made in this video for that population are not evidence-based.