Testosterone has long been stereotyped as the alpha male hormone. It was long thought (and still is, in some circles) as a key factor as to what makes a person a man versus a woman. But as our understanding of gender has evolved, so too has our knowledge about testosterone.

See, in reality, testosterone is one of the body’s main sex hormones—for everyone. And it can have major health implications (good and bad) for people who don’t identify as men. Here, leading hormone experts explain everything you need to know about testosterone, including the role it plays in women’s bodies and what happens when it’s out of balance.

The role testosterone plays in women and people with uteruses

“Testosterone is one of the most well-known sex hormones in the body, along with estrogen and progesterone,” says integrative doctor and hormone expert Arianna Sholes-Douglas, MD. It is crucial for the development of the penis and testes, sperm, and even muscles and bones. While people with uteruses generally have much lower levels of testosterone overall than people with testes, the Big Three sex hormones all work together, she says; if one is out of balance, it will affect the levels of the others.

Testosterone is important for sex drive and desire in people with uteruses; too little, and someone might have a harder time feeling aroused or in the mood. “The medical community has known for a long time that low testosterone is connected to diminished sexual desire in both men and women,” fertility expert Norbert Gleicher, MD says. While Dr. Sholes-Douglas says that while the reason for the connection isn’t clear, what doctors do know is that when testosterone levels dip, so can sex drive.

Because the sex hormones work so closely together, Dr. Sholes-Douglas says the adrenal glands (which are important for regulating metabolism, stress, and blood pressure) gets stressed when testosterone levels dip too low. “It makes estrogen and progesterone work harder to compensate, and this stresses the body out,” she says. “This could lead to the trouble sleeping, which in turn could lead to irritability,” she says.

Of course an imbalance the other way—too much testosterone—creates its own problems. “Too much testosterone is the main cause of female anovulatory infertility [when the ovaries do not release an egg during a menstrual cycle] and is the central characteristic of polycystic ovary syndrome,” says Sara Gottfried MD, the author of The Hormone Cure, The Hormone Reset Diet, and Brain Body Diet. “Signs of it include irregular cycles, hair loss or rogue hairs on the chin and elsewhere, cysts on the ovary, weight gain, and breakouts.” Too much testosterone can also potentially impact metabolism, Dr. Gottfried adds: “We also know that having high androgens, including testosterone, is linked to insulin resistance, making women feel foggier and experience strong cravings for carbs.”

Dr. Gottfried says it’s normal for both testosterone and progesterone to decline during perimenopause and menopause. “Once the ovaries begin reducing the production of estrogen, testosterone begins to drop,” she says. This is one reason why menopausal women may struggle more with weight management than they had at a younger age. “It might make fat glue to your body so you don’t see sufficient effects despite regular strength building workouts; it’s hard to build muscle,” she says. 

Dr. Sholes-Douglas says stress can impact testosterone levels, too. “If you are under a lot of stress, then your progesterone, estrogen, and testosterone levels can all go down,” she says, adding this can cause a cyclical problem as when the body is under stress, it (again) leads to sleep problems, which makes stress worse.

How to keep testosterone levels in check

Unsurprisingly, a big one is managing stress. “Write a nightly gratitude list of three big wins, practice forgiveness, and intentionally connect with those you love,” Dr. Gottfried suggests. “Focusing on the positive has been shown to lower cortisol by 23 percent and raise DHEA, the precursor to testosterone.” In other words: this isn’t just “feel good” advice; it’s vital to your hormones. Other ways to help manage stress: exercise (even if you hate it), eat foods that promote stable blood sugar levels (and thus a more even mood), and incorporate some Ayurvedic-inspired techniques into your routine. Dr. Gottfried also suggests limiting your exposure to certain synthetic chemicals (like plastics and pesticides) as much as possible as they disrupt estrogen levels, which in turn causes a (drumroll) testosterone imbalance.

As far as medical treatment goes, Dr. Sholes-Douglas says there are no FDA-approved testosterone raising drug for women (aside from hormone therapy for female-to-male transitions). “This is a big problem to me because it shows that people still don’t understand the importance of testosterone in women,” she says. (There are prescriptions available for drugs that raise both estrogen and testosterone, but not just testosterone.) As a workaround, she uses the above-mentioned DHEA, a hormone produced in the adrenal glands which the body converts into testosterone and other sex hormones. She says that, if needed, she injects DHEA vaginally in patients, as the clitoral area is most responsive to testosterone. DHEA is also, however, available as a supplement in capsule form, which Dr. Gleicher often recommends to women with low libido. (He specifically formulated one called Vivo.)

As these experts make clear, testosterone’s role in the body is just as important as estrogen or progesterone. While age, stress, and other factors (such as PCOS) can all affect its levels, the good news is there are ways to manage it and bring your body back to balance.

What you eat also affects your hormones. Check out the video below for tips on hormone-balancing foods:

Plus, how exercise affects your hormones. And here’s how to know if you should get your hormone levels checked.