Synopsis: This article exposes how testosterone—the most abundant hormone in women’s bodies at 10-20 times higher levels than estradiol—gets systematically overlooked by mainstream medicine using reference ranges so broad (10-95 ng/dL) that detecting hormonal imbalances becomes “essentially impossible” when research shows optimal upper limits should be 28 ng/dL. Women with barely detectable testosterone presenting with exhaustion, brain fog, vanishing libido, and unexplained weight gain get dismissed as depressed and handed antidepressants rather than comprehensive testing of free testosterone, SHBG, DHEA, and cortisol that reveals the complete picture, while optimization to functional ranges rather than mere normalization produces dramatic relief in 60% of women within 4-6 weeks through personalized delivery methods matched to individual SHBG levels and lifestyle preferences.
Top 5 Questions Answered:
- Why is testosterone the most overlooked hormone despite being the most abundant in women’s bodies?
- How do commercial lab reference ranges make detecting testosterone deficiency “essentially impossible”?
- What’s the difference between “normal range” testosterone and optimal levels that restore quality of life?
- Why do women with low testosterone get misdiagnosed as depressed and prescribed antidepressants?
- How does high SHBG impact bioavailable testosterone and determine which delivery method works best?
You’re exhausted. Your brain feels foggy. Your libido has vanished. You’ve gained weight despite eating clean.
You go to your doctor. They run labs. Everything comes back “normal.”
You’re told maybe you’re depressed. Here’s an antidepressant.
This is the reality for countless women experiencing testosterone deficiency. And it’s a problem that mainstream medicine has failed to address.
The Hormone Everyone Overlooks
Here’s what most people don’t know: testosterone is actually the most abundant hormone in women’s bodies—not estrogen. Throughout a woman’s lifespan, testosterone levels are 10-20 times higher than estradiol levels.
Yet when women experience hormonal symptoms, the conversation almost always centers on estrogen.
“What surprised me the most was how overlooked this entire area of women’s health is,” says Somer Schreiber-Small, FNP-C, APRN, a board-certified nurse practitioner specializing in hormone optimization at Synchronicity Health. “I would see woman after woman come into my office exhausted, frustrated, feeling like they were just getting older, and struggling with brain fog. Many of them have been told by their doctors that nothing was wrong because their labs were normal.”
The truth is more complicated. Mainstream medicine hasn’t caught up with the science on testosterone in women. Most providers aren’t even checking it. And when they do, they’re using outdated reference ranges that don’t reflect what’s optimal for quality of life.
The Problem With “Normal” Lab Results
When Schreiber-Small reviews a woman’s lab work, she’s not just looking to see if the numbers fall within range. She’s looking for what’s optimal.
“The reference range for women is often extremely broad,” she explains. “It might go from 10 to 45, depending on the lab. So if a woman comes in with a level of 4, she’s technically in range, but that doesn’t mean she feels good.”
A level that low often correlates with fatigue, decreased muscle tone, low libido, and mood changes.
Research confirms this diagnostic gap. A landmark study found that when commercial laboratories use an upper limit of 95 ng/dL for testosterone, detecting hormonal imbalances becomes “essentially impossible.” The study established that the upper limit for a well-characterized reference population should be 28 ng/dL—dramatically different from what most labs report.
This means women with documented hormonal issues fall within “normal” ranges provided by commercial laboratories. The condition goes undetected in most affected women.
“Most mainstream providers aren’t trained to make that connection,” Schreiber-Small notes. “They see normal and move on. It’s not just testosterone either. It’s sex hormone binding globulin, free testosterone, DHEA, cortisol—because they all play into how much hormone is actually available for the body to use. If you don’t look at the whole picture, you miss why the patient feels the way she does.”
When Women Are Told It’s All in Their Head
The symptoms of androgen deficiency are subtle. They affect sexual desire, satisfaction, and mood. And they’re commonly mistaken as signs of underlying depression.
This leads to referrals for counseling and psychotherapy when hormone measurements would be more appropriate.
“This is such an important moment because most women come to me feeling dismissed or even gaslit,” Schreiber-Small says. “The first thing I do is validate their experience. I say, you’re not crazy and you’re not imagining this. Your symptoms are real.”
She walks patients through their labs side-by-side, showing them where their levels fall on the range and explaining the difference between normal and optimal.
“I’ll often say something like, your number is in range but it’s at the very bottom. This might be considered normal but this is where women usually feel tired, gain weight, and lose their libido.”
The analogy she uses resonates: “It’s like being told your gas tank has fuel, but it’s just enough to keep the car from stalling.”
Once women see the data and connect it to their own experience, it’s empowering. The goal isn’t to make them perfect on paper. It’s to restore their quality of life.
What Happens When You Optimize Instead of Normalize
When testosterone levels are optimized rather than just kept within “normal” range, women notice changes quickly.
“The very first thing women notice is that their brain fog lifts and their energy comes back,” Schreiber-Small explains. “I’ve had patients tell me, I slept all night and I woke up this morning and didn’t need three cups of coffee, I just felt good.”
For some, the first shift is mood—they feel calmer, less irritable. Others notice they’re sleeping better or that their libido starts to return.
Most women feel changes within four to six weeks. By three months, it’s like night and day.
Clinical studies support these observations. Research shows that 60% of women with testosterone insufficiency treated with testosterone experienced successful relief in vasomotor symptoms, insomnia, fatigue, decreased libido, and cognitive decline.
Why Personalization Matters More Than Protocol
There’s no one-size-fits-all approach to testosterone replacement therapy.
“I start with the whole picture,” Schreiber-Small says. “Symptoms, goals, lifestyle, lab results, and even preferences. For example, if a woman’s SHBG is high, she might need a higher dose or a different delivery method to make sure she’s getting enough bioavailable testosterone.”
Delivery methods include:
- Injections for women who prefer twice-weekly administration
- Topical creams for daily application
- Pellets for those who don’t want to think about it for several months
“At the end of the day, the goal is to use the lowest effective dose and the delivery method that keeps her symptoms under control, her levels optimized, and her life simple.”
This personalized approach stands in stark contrast to what many women experience elsewhere. Often, they’re given a birth control pill or patch that’s supposed to balance hormones but actually shuts down hormone production. Or they’re given a low dose that never brings them to optimal levels.
“Sometimes the delivery method wasn’t right for the woman,” Schreiber-Small notes. “The cream wasn’t absorbing well or a pellet was dosed too high or too low. Very often no one is rechecking labs or following up so adjustments weren’t made.”
The Birth Control Pill Isn’t Hormone Balance
Many women are put on birth control pills from a young age for everything from painful periods to irregular cycles to acne and mood swings.
But synthetic birth control pills don’t actually balance hormones. They shut down ovulation.
“For some women, that can make symptoms worse,” Schreiber-Small explains. “They might feel flat, gain weight, experience mood changes, or lose their libido. And when they come off the pill, their symptoms come back because the root cause was never addressed.”
This aligns with research showing that oral estrogen increases sex hormone-binding globulin (SHBG) levels, which can reduce free testosterone. This explains why some women on standard hormone therapy still don’t feel better.
“When I talk to women about this, I focus on education, not fear,” she says. “We talk about real root cause solutions—optimizing their natural production, or replacing what’s low with bio-identical hormones in a way that mimics the body’s own chemistry.”
Most women feel relieved because for the first time, someone is connecting the dots and offering options that don’t just mask symptoms.
When Everything Comes Together
Schreiber-Small recalls a patient in her 40s who came to her feeling like her life was falling apart. She was exhausted no matter how much she slept. She’d gained weight despite eating clean. Her libido had vanished, putting a strain on her marriage.
Her previous provider told her everything was normal and that maybe she was depressed. She was put on an antidepressant.
“When we ran a full panel, her testosterone was barely detectable. Her cortisol was dysregulated,” Schreiber-Small recalls. “I walked her through each number, what it meant and how it explained the way she was feeling.”
They started her on bioidentical testosterone and optimized her cortisol curve with lifestyle changes, following up closely to make adjustments.
Within six weeks, the patient said, “I feel like myself again. My energy is back, my mood is lighter and I’ve started losing weight.” Her relationship with her husband was closer than it had been in a long time.
“That’s why I do this work,” Schreiber-Small says. “Because when you connect the dots, you don’t just improve lab numbers. You give women their lives back.”
What You Can Do Now
If you’re experiencing unexplained fatigue, brain fog, low libido, difficulty building muscle, or mood changes, it’s worth having a conversation about comprehensive hormone testing.
Look for a provider who:
- Tests beyond just estrogen
- Evaluates free testosterone, not just total testosterone
- Considers SHBG, DHEA, and cortisol
- Focuses on optimal ranges, not just normal ranges
- Connects your lab results to your actual symptoms
At Synchronicity Health, we take a comprehensive approach to hormone optimization. We don’t just look at numbers on a page. We look at you—your symptoms, your goals, your life.
Your symptoms are real. You’re not imagining them. And you deserve answers that go beyond “everything’s normal.”
Ready to reclaim your vitality? Download our free guide on natural testosterone boosters and symptoms checklist, or schedule a consultation to discuss whether testosterone optimization might be right for you.
Because normal isn’t optimal. And you deserve to feel like yourself again.
Somer Schreiber-Small, FNP-C, MSCP, ABHRT
Hi, I’m Somer Schreiber-Small, FNP-C, MSCP, a Nurse Practitioner specializing in weight loss, hormone therapy, aesthetics, and functional medicine—but I’m also a woman who’s been where you are.
I know what it’s like to feel tired all the time, struggle with weight that won’t budge, battle brain fog, and feel like yourself one day and a completely different person the next. I’ve been there—frustrated, searching for answers, and told everything was “normal” when I knew deep down it wasn’t.
Like many women, I didn’t realize my symptoms were caused by hormonal imbalances until I dug deeper. Once I balanced my own hormones and lost over 65 pounds, everything changed. I had more energy, my mood stabilized, the weight finally came off, and I felt like myself again. That experience ignited my passion for helping other women take back control of their health.
Could It Be Your Hormones?
Hormonal imbalances can show up in so many ways, including:
❌ Unexplained weight gain (especially around the belly)
❌ Fatigue, no matter how much you sleep
❌ Brain fog and trouble concentrating
❌ Mood swings, anxiety, or depression
❌ Low libido and vaginal dryness
❌ Irregular periods or worsening PMS
❌ Hair thinning or… Read more
