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Most testosterone panels give women numbers that are either unreliable at female levels or answering a different question. Here is what total testosterone and SHBG actually tell you, why free testosterone is shakier than it looks, and what a test before treatment is really for.
If you have had testosterone tested, you have probably had the experience of receiving a number, being told it was normal, and learning nothing useful. Or the opposite: being told it was low, and being handed a prescription on that basis alone.
Both are misreadings, and they come from applying a test designed around male physiology to a woman.
Two online services prescribe testosterone to women
Midi: 24 states and DC, a compounded cream, visits billable to most PPO plans (Medicare patients pay out of pocket). Hone Health: 33 states for women's hormone care, from $65 test, then $155/mo membership + medication. Compare them
The Midi link is not paid: we earn nothing if you choose Midi. The Hone Health link is a partner link: we may earn a commission, at no extra cost to you.
Women have far less testosterone in circulation than men, and many standard laboratory assays were built and validated for the male range. Down at female levels those assays get less reliable, which means the number you are handed carries more uncertainty than the confident single figure on the page suggests.
This has a practical consequence worth knowing: a difference between two results is not always a real change in you. Some of it is the measurement.
It also explains something that frustrates women constantly, which is being told their level is "normal" when they feel anything but. Female reference ranges are wide, they are typically built from populations across a range of ages, and sitting inside a wide range says very little about whether this is a normal level for you.
This is the workhorse and the number worth paying attention to. It measures everything in circulation, bound and unbound.
Its main value is not diagnosis. It is the baseline you compare against later. A pre treatment total testosterone gives you the reference point that makes every subsequent test interpretable, and without it you are permanently guessing whether treatment moved anything.
Once you are on treatment, total testosterone is the number that tells you whether you are inside the female physiologic range or have drifted above it. That is genuinely the safety question, because the side effects women worry about most are the ones associated with levels above the normal female range.
Free testosterone is the fraction not bound to proteins, and in theory it is the biologically active part, which makes it sound like the more meaningful number.
In practice it is the shakier one. Most labs do not measure it directly; they calculate it from total testosterone and SHBG. That calculation inherits all the uncertainty of a total testosterone measured at low female concentrations, and then adds its own. Direct free testosterone assays exist but have their own reliability problems at these levels.
None of that makes it useless. It makes it a supporting number rather than one to make decisions on by itself, and it is worth being sceptical of any provider who bases a prescription on a calculated free testosterone alone.
Two online services prescribe testosterone to women
Midi: 24 states and DC, a compounded cream, visits billable to most PPO plans (Medicare patients pay out of pocket). Hone Health: 33 states for women's hormone care, from $65 test, then $155/mo membership + medication. Compare them
The Midi link is not paid: we earn nothing if you choose Midi. The Hone Health link is a partner link: we may earn a commission, at no extra cost to you.
Sex hormone binding globulin is the protein that binds testosterone and takes it out of circulation. It is often left off panels, and it explains more than any other single number.
The reason it matters for menopausal women in particular: oral estrogen raises SHBG substantially. If you take estrogen as a pill, more of your testosterone gets bound, and the amount available to your tissues falls even if the total looks unremarkable. Transdermal estrogen, meaning patches and gels, does not do this to anything like the same degree because it bypasses the first pass through the liver.
Oral estrogen can raise SHBG and lower free testosterone, but testosterone or SHBG results do not diagnose HSDD or predict that changing the estrogen route will improve desire. If low desire is the concern, that is a question for a clinician's full assessment, not the lab result on its own.
Thyroid status and liver function also move SHBG, which is part of why a testosterone number read in isolation is so often misleading.
Here is the part that surprises people. Guidance in this area does not support diagnosing anything from a testosterone level in women. There is no threshold below which a woman is officially deficient and above which she is fine. The decision to try testosterone rests on symptoms, most robustly on distressing low sexual desire after menopause, not on a number.
So a pre treatment test is not there to qualify you. It is there to do two things: give you a baseline for comparison, and rule out an unexpectedly high starting level, which would make adding more a bad idea and point towards looking for another explanation.
That is a less satisfying answer than "your level is low, this is why you feel like this", but it is the accurate one, and it protects you from providers who use a number inside a wide reference range as a sales tool in either direction.
Total testosterone is the number that matters, mainly as a baseline and later as a safety check. SHBG explains the discrepancies and is the one most likely to be missing. Free testosterone is supporting evidence rather than a decision maker. And no number on the page diagnoses you, because symptoms are what the decision actually rests on.
If you are working out whether to pursue treatment at all, our guide to testosterone therapy for women covers the symptom picture the evidence best supports.
Get testosterone prescribed online
There is no FDA-approved testosterone product for women in the US, so it is prescribed off-label. The evidence supports it for one use: low sexual desire that bothers you (HSDD), after a clinician has assessed you. These online services prescribe it to women. Each covers different states, so check yours first.
Midi Health
A low-dose compounded testosterone cream from a virtual menopause clinic. Midi says most women have two video visits, with baseline blood tests, before a prescription, and only if a clinician decides it is appropriate.
The cream starts at $100 for a 90-day supply. Visits can be billed to insurance (Midi is in-network with most PPO plans) or cost $250 for the first visit self-pay; Medicare is self-pay only.
That evidence comes from trials of standardized, non-compounded testosterone used on the skin at doses that keep levels in the normal female range. The same international consensus does not recommend compounded testosterone, like Midi's cream, because its efficacy and safety have not been shown; it suggests small doses of an approved men's product instead, with blood levels checked. Ask any provider which product you would get and how your levels will be monitored.
Offered in 24 states and DC: AZ, CA, CO, DC, DE, FL, IA, IL, IN, KS, MA, MD, ME, NC, NJ, NM, NV, NY, OH, OR, PA, TX, UT, VA and WA.
Not a paid link: we earn nothing if you choose Midi.
Hone Health
Prescribes testosterone to women online, after a blood test.
From $65 test, then $155/mo membership + medication.
33 states for women's hormone care.
Partner link: we may earn a commission, at no extra cost to you.
Neither covers your state, or you would rather see someone in person? Find a clinic near you or compare online options.
Some links above are partnerships. If you start care through them, we may earn a commission at no extra cost to you. Partners we can earn from may be shown first in some lists, but commission never changes the facts we report about any provider.
The information on FindMyHRT is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have read on this website.
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