"We can put satellites into space," Dr Helen O'Neill said, with the flat incredulity of someone who has said it many times, "but we cannot give a woman a properly made version of a hormone her own body produces and needs." Testosterone is not a men's hormone that women happen to have a little of. It is a women's hormone too, and the fact that there is no product designed for them is one of the quieter scandals in this whole conversation.
This is Part 4 of The Quiet Storm. It is the most technical instalment, and, because we are again talking about a prescription medicine used off-label, one where I will hold the science at arm's length and keep flagging what belongs to a clinician's judgement rather than a blog's. But the core facts are not complicated, and they are worth knowing.
The Third Line
Most menopause conversations plot two curves: estrogen and progesterone. There is a third the room rarely sees. Women produce testosterone in the ovaries and adrenal glands, and it declines gradually across adult life. When it runs low it can show up as flat energy, low mood, mental fog and a loss of drive, symptoms that overlap so completely with everything else in perimenopause that it is easy to miss the one hormone nobody thought to check.
Both women were careful about sequence, and it matters. Testosterone is not a first move. The advice that came through was: get the estrogen and progesterone right first, and only then, if symptoms persist and levels are genuinely low, look at testosterone. And if your levels are fine, leave it alone. Taken when it is not needed, it can bring unwanted effects such as voice changes or unwanted hair growth. This is emphatically not a "more is better" hormone. It is a "replace it only if it's missing" one.
If your levels are okay, don't touch it. But if they're genuinely low, and everything else is optimised, for some women, it's the missing link.
No Formula, So You Improvise
Here is the gap made concrete. In the UK there is no testosterone product licensed for women. So the women who are prescribed it, off-label, by a clinician, are typically given a men's preparation and told to use a fraction of it: a pea-sized measure, a portion of a sachet meant to last a fortnight, a dose eyeballed down from a formulation designed for a body producing many times more of the hormone. It works, in careful hands. But it is improvisation standing in for pharmacy, and it puts the burden of precision on the patient.
O'Neill's frustration doubled here, because the reference range itself, the very yardstick a doctor uses to decide whether you are "low", was, she argued, never built for women in the first place. She told the room that Hertility has published what she described as the largest study in the world redefining the female testosterone reference range, testing more women's testosterone in a day than the old ranges were ever calibrated on. I am reporting that as her claim; I have not independently verified the "largest in the world" framing. But the underlying problem is real and well documented: normal ranges for female testosterone have historically been thin, contested, and poorly suited to clinical decisions.
We can put satellites into space, but we can't give a woman an Earth-made version of a hormone she produces and needs. That should tell you something about whose problems get solved.
She also sketched the shape of the data: women split unevenly across the range, with meaningful numbers at both the very low and very high ends; a steady decline with age; and a strong influence from lifestyle, diet and genetics. It is not a single number that tells you who you are, it is, again, a line you can only read against your own baseline.
The Risk Nobody Talks About
And then the part of the conversation that made the room go quiet. Because testosterone gel is rubbed into the skin, it does not stay politely on the person who applied it. O'Neill described cases she called a crisis hiding in plain sight: a young woman turning up with sky-high testosterone whose source turned out to be her mother's gel, transferred through ordinary contact at home; a family dog falling ill after licking a treated arm; shared gym equipment carrying a residue from someone injecting or applying it. Skin, sweat and touch move the hormone from one body to another, including to children and pets, for whom the exposure can be genuinely harmful.
This is not a reason to fear the treatment; it is a reason to respect it. Applied to the right site, allowed to dry, covered, with careful hand-washing and no skin-to-skin contact until absorbed, the transfer risk is managed routinely. But it is exactly the kind of instruction that gets lost when a medicine is being improvised from a product built for someone else, which is precisely why the missing formula is more than an inconvenience.
Testosterone for women is unlicensed in the UK and prescribed off-label under specialist supervision; it is a prescription-only medicine and is not something to source or self-administer. This article reports views shared by Davina McCall and Dr Helen O'Neill at a public event, alongside independently sourced science; it is not medical advice. Testosterone should only be considered after estrogen and progesterone are optimised, only where levels are genuinely low, and only with a clinician who will monitor your blood levels. Transfer to children, partners and pets through skin contact is a real hazard and requires strict application and hygiene precautions. The claim that Hertility has published "the largest study in the world" redefining the female reference range is reported as stated by Dr O'Neill and not independently verified here. BODY HLTH does not prescribe or supply testosterone; our role here is editorial.
A hormone women need,
and no bottle with their name on it.
Testosterone is a women's hormone that declines with age and, for some, is the missing piece once estrogen and progesterone are handled. Yet there is no licensed female product, the reference range was barely built for women, and those who need it improvise from a man's dose, with a transfer risk that demands real care. The fix is not more hormone; it is better science, honest ranges, and a formula that finally has a woman's name on it.
Optimise the basics first, test against your own baseline, and treat this one with a specialist's caution, never a shortcut. Next, the series closes where it should: on backing your own body, and the people standing next to you while you do.
- 01Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the use of testosterone therapy for women. Journal of Clinical Endocrinology & Metabolism / Climacteric / Maturitas (joint publication). 2019. On the single evidence-based indication, the absence of licensed female preparations, and off-label use of male formulations.
- 02Reviews of female androgen physiology on testosterone production in the ovaries and adrenal glands and its gradual decline with age (rather than an abrupt menopausal drop).
- 03Literature on the limitations and poor standardisation of female testosterone reference ranges, supporting the case for better-calibrated ranges.
- 04Manufacturer and regulatory guidance on transdermal testosterone warns of secondary transfer to others through skin contact, with precautions on application site, drying, covering and hand-washing.
- 05The description of Hertility's dataset as "the largest study in the world" redefining the female testosterone reference range, and the accounts of transfer cases, were presented by Dr Helen O'Neill at the event and are reported here as her account, not independently verified.
- 06Quotations are drawn from the conversation between Davina McCall and Dr Helen O'Neill at The Longevity Show, Tobacco Dock, London, June 2026, and reflect views the speakers expressed there; clinical mechanisms are sourced independently to the literature above.