Do androgens in women affect sexual function, mood, energy, and muscle maintenance?

Androgens serve as crucial biological regulators in women, particularly around the menopausal transition, affecting multiple physiological domains including sexual function, muscle maintenance, mood, and physical energy.

Clinical and effectiveness evidence

• Sexual function: High-quality evidence demonstrates that transdermal testosterone, titrated to female physiologic ranges, significantly increases satisfying sexual events, improves desire, and reduces distress in postmenopausal women with hypoactive sexual desire disorder (HSDD). Intravaginal DHEA (prasterone) also significantly improves Female Sexual Function Index (FSFI) scores, enhancing lubrication, arousal, and reducing pain.
• Muscle mass and strength: Testosterone directly supports muscle tissue; a physiological dose can acutely increase muscle protein fractional synthesis rate (FSR) by approximately 50% in postmenopausal women, leading to dose-dependent increases in muscle cross-sectional area. In contrast, DHEA supplementation does not consistently improve fat-free mass.
• Mood and energy: Clinical trials do not consistently support using testosterone as an antidepressant or a treatment for subjective fatigue. While it may modestly improve physical aerobic endurance in active women, general vitality is not reliably altered.

Mechanistic explanations

• Myofiber receptor activation: Bioavailable testosterone directly binds to nuclear-localized androgen receptors (AR) in skeletal muscle, driving myofiber protein synthesis and contractile mechanics.
• Neurosteroid conversion: Androgens act as precursors for local estradiol and GABAergic neurosteroids (such as allopregnanolone), indirectly modulating GABA_A receptors and downstream serotonin pathways to affect mood networks.
• Mitochondrial bioenergetics: Androgens interact with mitochondrial pathways to support cellular respiration, physical endurance, and erythropoiesis.

Bottom line

• While androgens, especially bioavailable testosterone, directly sustain muscle protein synthesis and clinical sexual function (specifically in HSDD), their contributions to female mood and general energy are primarily indirect, complex, and lack robust therapeutic support for systemic replacement.