When most people hear the word testosterone, they think of men, muscle, or libido.
But that is far too simplistic.
Testosterone plays an important role in both male and female health, and for many women, it may be one of the most overlooked hormones in the entire conversation. At The Retreat Wellness + Aesthetics, we talk about testosterone often because it affects much more than sex drive. It can influence energy, motivation, mood, cardiovascular health, bone density, muscle mass, and overall quality of life. For many patients, restoring healthy testosterone levels is part of what helps them finally feel like themselves again.
This episode of The Retreat Radio breaks down one of the most confusing parts of hormone care: the many different forms of testosterone therapy, how they work, and why the “best” option depends on far more than convenience or what insurance happens to cover.
Why testosterone matters for women too
One of the most important takeaways from this episode is that testosterone is not just a male hormone.
In fact, testosterone is the most abundant hormone in the female body, just at much lower levels than in men. That means low testosterone in women can still have a very real impact, even if the conversation around women’s hormones is often dominated by estrogen and progesterone.
When testosterone is depleted, women may notice:
- lower energy
- low motivation
- poor recovery
- reduced libido
- lower mood
- loss of their usual spark for life
And yet, despite how important it is, women still face major gaps in care when it comes to testosterone therapy.
Why testosterone therapy for women is still so difficult to access
Here is one of the biggest frustrations in hormone medicine right now: there is still no FDA-approved testosterone product specifically for women in the United States.
That means providers often have to use products designed for men and prescribe them off label in women. It also means insurance coverage is usually much harder to obtain for female patients, even when symptoms and labs clearly support treatment. This is one of the reasons so many women either go untreated or get stuck with less effective options simply because they are easier to access.
That is not a small problem.
It is a major gap in care.
Why monitoring testosterone properly matters
Before even talking about treatment forms, it is important to understand that testosterone therapy should never be monitored with just a total testosterone alone.
That is one of the biggest mistakes in general practice.
At minimum, a more thoughtful testosterone workup should include:
- total testosterone
- free testosterone
- SHBG
- DHEA
- hematocrit/CBC
- estradiol
Why does that matter?
Because free testosterone is the portion the body can actually use. A patient can have a decent total testosterone and still feel terrible if free testosterone is low. SHBG can bind too much testosterone and reduce what is available. DHEA can help reveal whether low testosterone is really a precursor issue rather than a true testosterone production problem. And hematocrit matters because testosterone can increase red blood cell concentration, which may raise clotting or stroke risk if not monitored properly.
This is why good hormone care is never just “here is your prescription, see you later.”
Testosterone creams and gels
Transdermal creams and gels are one of the most common forms patients encounter, especially through insurance-based or conventional channels.
The problem is that they often come with limitations.
Absorption can vary significantly from one patient to another, which makes dosing less reliable. They also tend to be weaker in terms of achieving truly optimal levels, and there is an added concern with transference, especially around children or pets if the product is not applied and handled carefully.
For some patients, they may still have a place. But at The Retreat, they are generally not a preferred first-line option.
Oral testosterone
Oral testosterone is another option, and traditional forms like Kyzatrex can help maintain more even daily levels because they are taken every day.
That said, they come with tradeoffs.
Because oral medications have to pass through the digestive system and liver, much of the active medication can be broken down before it ever has its intended effect. That means oral testosterone can be less potent and more variable in outcome. If patients miss doses, their levels can also fall quickly.
There is, however, a newer category that is much more promising.
Liposomal oral testosterone
Liposomal oral testosterone is one of the more exciting developments in this space.
The liposomal technology helps protect the medication as it moves through the digestive tract and liver, which can improve absorption and preserve more potency. In practice, this may offer a helpful middle ground for patients who want steadier daily dosing but do not want injections.
It is still newer and dosing is still being refined, but it is becoming an increasingly useful option, especially for patients who strongly prefer to avoid needles.
Injectable testosterone
Injectable testosterone cypionate remains one of the most effective and reliable forms of therapy, and for many patients, it is the preferred method.
Why?
Because it is easier to control, easier to optimize, and generally produces the strongest, most consistent improvement in levels and symptoms.
At The Retreat, the approach is also more nuanced than the conventional “once weekly injection” model. Instead of one larger weekly dose, splitting the dose into two to three smaller injections per week helps reduce the dramatic peaks and valleys patients often feel with standard weekly protocols. That steadier rhythm may also help reduce issues like rising estrogen or hematocrit, especially in men.
For women, dosing is obviously much smaller, but the same principle applies: steadier levels often mean better outcomes.
Testosterone pellets
Pellets are often marketed as the convenient, set-it-and-forget-it option.
And while that sounds appealing, the clinical reality can be disappointing.
Pellets are inserted under the skin and slowly release testosterone over months. In theory, that sounds ideal. In practice, many providers have found that pellets can produce an early surge, followed by an awkward decline where patients are no longer optimized but are not yet ready for repeat placement. In men especially, pellets can be associated with issues involving hematocrit and estrogen fluctuations.
Another downside is that once the pellet is in, it is in. You cannot fine-tune it the same way you can with injections or oral therapy.
Some patients still do well with pellets, particularly certain women. But for many practices, including yours, pellets are no longer the preferred first recommendation.
Which form of testosterone therapy is best?
There is no one-size-fits-all answer.
The best method depends on:
- how well a patient absorbs medication
- how comfortable they are with injections
- whether they can remember a daily pill
- how their labs respond
- what side effects or risks need to be monitored
- what level of control and adjustability is needed
That is exactly why testosterone therapy should be individualized, carefully monitored, and built around the patient, not forced into a generic protocol.
The bottom line
Testosterone therapy can be life-changing for the right patient, especially when it is monitored properly and prescribed in the right form.
But this is not just about boosting libido or chasing a number on a lab report. It is about understanding how testosterone fits into the bigger hormone picture, how different delivery methods behave, and how to choose a strategy that actually supports long-term health and symptom improvement.
And for women especially, this conversation needs to keep growing.
Want the full breakdown? Listen to this episode of The Retreat Radio, where Heather walks through the different forms of testosterone therapy, how they compare, how to monitor them properly, and why women deserve better access to thoughtful, evidence-informed testosterone care.
