Subcutaneous Testosterone Injections and Androgens in Women Combined with Integrative Chiropractic Care

Abstract

Testosterone is often called a "male hormone," but it is also a normal and important part of female physiology. Women generally have much lower testosterone levels than men, yet testosterone and other androgens interact with receptors throughout the reproductive system, muscles, bones, brain, skin, and other tissues. They also serve as building blocks for estradiol. Research continues to explore how female androgen physiology affects sexual health, muscle, bone, metabolism, and healthy aging.

Subcutaneous testosterone injections place medication into the fatty tissue beneath the skin rather than deep into a muscle. This route can be practical and easier to self-administer, but there is an important evidence gap: most direct research supporting subcutaneous testosterone injections comes from men or testosterone-based gender-affirming care. Randomized studies of testosterone treatment in women have mainly used transdermal therapy. Therefore, testosterone treatment for women requires careful assessment, female-physiologic dosing, monitoring, and medical oversight. This article also explains how medical hormone evaluation may be coordinated with integrative chiropractic care, functional medicine, rehabilitation, and musculoskeletal care.

Testosterone Is a Normal Female Hormone

Androgens are a family of hormones that includes testosterone, androstenedione, dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S), and dihydrotestosterone, or DHT. Everyone produces androgens. Women simply produce them in much smaller amounts than men (Cleveland Clinic, 2024).

Recent research challenges the simple idea that estrogen is the "female hormone" while testosterone belongs only to men. Testosterone is a normal female sex steroid, and circulating testosterone concentrations can exceed estradiol concentrations during much of adult female life (Davis & Wahlin-Jacobsen, 2015; Faucett et al., 2026).

The uploaded whitepaper makes the same important point: testosterone is a normal and physiologically active hormone in women, not an abnormal "male" hormone that appears only in disease.

Women still have far less testosterone than adult men. One review describes endogenous testosterone concentrations as about 10 to 15 times lower in females than males, which helps explain major differences in muscle mass, strength, and physical performance while still allowing testosterone to perform important functions in women (Hunter, 2024).

Where Do Female Androgens Come From?

Female androgen production is more complex than simply saying "the ovaries make testosterone."

The body uses several sources:

Ovaries: Produce testosterone and androgen precursors.
Adrenal glands: Produce DHEA, DHEA-S, androstenedione, and other precursors.
Peripheral tissues: Fat, skin, muscle, and other tissues can locally convert precursor hormones into active testosterone, DHT, or estradiol.

In reproductive-age women, the ovaries and adrenal system both contribute to circulating androgen activity, while peripheral conversion adds another important source (Davis & Wahlin-Jacobsen, 2015).

The intracrine diagram on page 3 of the supplied whitepaper helps explain this process. Androgen precursors enter peripheral tissues, where enzymes convert them into testosterone, DHT, or estradiol based on that tissue's needs. Some hormone activity therefore occurs locally and may never be fully reflected by a blood testosterone measurement.

This explains why you can't always understand female androgen physiology from a single lab number.

Testosterone Can Also Become Estrogen

Testosterone has two major pathways of action.

First, testosterone can directly activate the androgen receptor. These receptors are found in many tissues, including skeletal muscle, bone, the nervous system, reproductive tissues, and adipose tissue.

Second, the enzyme aromatase can convert testosterone into estradiol. In this way, some effects associated with testosterone may actually occur after local conversion into estrogen (Davis & Wahlin-Jacobsen, 2015).

DHT represents another pathway. The enzyme 5-alpha-reductase converts testosterone into DHT, a more powerful androgen in certain tissues.

This network helps explain why female testosterone cannot be viewed separately from estrogen, DHEA, SHBG, metabolism, and tissue-specific enzyme activity.

What Happens to Androgens as Women Age?

Female testosterone does not usually fall suddenly at menopause.

Instead, the androgen system tends to decline gradually with age. DHEA and DHEA-S begin decreasing years before menopause. Natural menopause therefore does not cause the same abrupt testosterone decline as estrogen does (Hatzilabrou, n.d.; Thomas, 2022).

A different situation occurs when both ovaries are surgically removed. Bilateral oophorectomy abruptly removes an important ovarian source of androgen production, producing a much sharper change than natural aging.

This difference matters because menopause alone should not automatically be interpreted as testosterone deficiency.

Why Testosterone Blood Testing Can Be Difficult in Women

Female testosterone concentrations are low enough that some routine laboratory methods struggle to measure them accurately.

Liquid chromatography-tandem mass spectrometry, or LC-MS/MS, is generally more reliable at the low concentrations found in women than many standard immunoassays (Faucett et al., 2026).

Other measurements may include:

Total testosterone
SHBG
Calculated or measured free testosterone
DHEA-S
Androstenedione
Estradiol and other hormones when clinically indicated

SHBG is especially important because it binds testosterone. A woman may therefore have the same total testosterone as another woman while having a different amount of biologically available hormone.

The whitepaper emphasizes that current major guidelines do not support diagnosing a generalized female androgen deficiency syndrome from a single testosterone result. Laboratory measurements are better used as one part of the clinical picture and, when therapy is used, to help prevent excessive exposure.

What Does Testosterone Do in the Female Body?

Female androgen receptors are found throughout the body. Research is examining testosterone's relationship with:

Sexual desire and sexual function
Reproductive physiology
Skeletal muscle
Bone remodeling
Brain signaling
Fat metabolism
Cardiovascular physiology
Skin and hair biology

The 2026 review by Faucett and colleagues describes testosterone as an important part of normal female reproductive, muscular, skeletal, cardiovascular, and neurologic physiology.

However, an important difference exists between what endogenous testosterone normally does in the body and what giving additional testosterone has been proven to treat.

That distinction is essential.

Current clinical evidence does not establish testosterone therapy as a proven treatment for improving women's memory, general energy, weight loss, bone health, or overall muscle performance. Although these areas remain scientifically interesting, adequately powered treatment trials have not established them as routine indications (Kling, 2025).

The strongest evidence remains improvement of hypoactive sexual desire disorder, or HSDD, in appropriately evaluated postmenopausal women (Davis et al., 2019; Parish et al., 2021).

What Are Subcutaneous Testosterone Injections?

A subcutaneous, or SubQ, testosterone injection places testosterone into the fatty layer beneath the skin rather than deep inside a muscle.

Potential practical advantages may include:

A smaller needle
Easier self-administration
Less injection discomfort for some patients
Avoidance of deep intramuscular injections
The ability to administer measured doses

Research shows that testosterone cypionate and enanthate can be effectively absorbed through subcutaneous tissue. However, much of this research involves men with hypogonadism or patients receiving testosterone-based gender-affirming therapy rather than women receiving very low female-physiologic doses (Figueiredo et al., 2022; Spratt et al., 2017).

Clinicians should clearly explain this limitation to women considering this route.

Subcutaneous Testosterone in Women: What the Evidence Actually Says

Subcutaneous testosterone may be considered by a clinician in selected circumstances, but it should not currently be presented as the established or preferred testosterone route for women.

The supplied whitepaper specifically cautions that the evidence for subcutaneous injections is largely derived from male hypogonadism and related populations. Randomized evidence in women has primarily studied transdermal testosterone, and current guidelines do not establish subcutaneous testosterone injections as the standard route for women.

The International Society for the Study of Women's Sexual Health similarly recommends carefully dosed systemic transdermal testosterone for appropriately selected women with HSDD. Treatment should maintain testosterone within the physiologic premenopausal female range and monitor for androgen excess (Parish et al., 2021).

In the United States, FDA-approved testosterone products are approved for specific forms of male hypogonadism; there is currently no FDA-approved testosterone product specifically indicated for women.

Therefore, testosterone prescribing for women in the United States is generally off-label and requires informed, individualized medical decision-making.

Monitoring Matters More Than the Size of the Needle

Subcutaneous administration does not make testosterone a minor medication.

A woman receiving testosterone should be evaluated for excessive androgen exposure. Depending on the patient, clinicians may monitor symptoms, total testosterone, SHBG, metabolic markers, and other laboratory findings.

Signs of excessive androgen exposure may include acne, increased facial or body hair, scalp hair loss, or other androgenic changes. More significant androgen exposure may increase the risk of voice changes or other virilizing effects.

The goal should not be to raise testosterone as high as possible. Current guidance emphasizes maintaining exposure within a normal female physiologic range when therapy is medically appropriate (Davis et al., 2019).

Where Integrative Chiropractic Care Fits

Chiropractic care does not replace hormone evaluation or correct a true endocrine disorder.

Its role is different.

For a woman dealing with pain, stiffness, previous injury, reduced mobility, weakness, or difficulty exercising, integrative chiropractic care and rehabilitation may help improve the musculoskeletal environment that supports healthy activity.

Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, describes a clinical model that evaluates more than hormone numbers. His published approach considers movement, strength, sleep, nutrition, medications, cardiometabolic health, thyroid and other endocrine conditions, previous injuries, rehabilitation needs, and patient goals before deciding whether hormone treatment belongs in the plan.

Chiropractic and rehabilitation strategies may therefore complement medical hormone care by helping patients:

Restore joint mobility
Reduce mechanical barriers to exercise
Improve movement patterns
Rebuild strength and stability
Progress toward resistance training
Recover from musculoskeletal or personal injuries

Resistance exercise is especially important because muscle tissue responds to both mechanical loading and hormonal signaling. Research continues to study how testosterone, androgen-receptor activity, and resistance training interact in women (Hunter, 2024).

A Multidisciplinary Approach at Injury Medical Clinic PA

At Injury Medical Clinic PA in El Paso, Texas, Dr. Jimenez's published care model combines chiropractic care, functional medicine, personal injury care, rehabilitation, musculoskeletal assessment, and medical coordination.

Dr. Maria Guadalupe Cardenas, MD, serves as Medical Director and Collaborative Physician. Clinic materials identify her as board-certified in internal medicine with more than 40 years of medical experience. Public provider records list her specialty as internal medicine and identify Texas medical license J2933.

This collaborative model allows the clinic to evaluate medical and musculoskeletal questions together. Dr. Cardenas provides internal medicine and medical oversight, while Dr. Jimenez contributes chiropractic, advanced-practice nursing, functional medicine, biomechanical, and rehabilitation perspectives. Clinic publications describe this arrangement as a way to coordinate medical evaluation with functional and structural recovery.

For hormone-related care, that approach may include reviewing medical history, symptoms, medications, laboratory findings, cardiovascular and metabolic risks, physical function, movement limitations, nutrition, sleep, exercise, and rehabilitation needs before building an individualized plan.

The Bottom Line

Testosterone is not exclusively a male hormone. It is a normal part of female biology and works through a complex network involving the ovaries, adrenal glands, peripheral tissues, androgen receptors, SHBG, DHEA, DHT, and estradiol.

Subcutaneous testosterone injections offer a practical delivery route, but evidence specifically supporting SubQ testosterone treatment in women remains limited. Current women's health guidelines have much stronger evidence for carefully dosed transdermal testosterone in selected women with HSDD.

The safest approach is not simply to "raise testosterone." It means understanding the patient's physiology, symptoms, risks, goals, musculoskeletal function, and overall health. When medical oversight, functional medicine, integrative chiropractic care, and rehabilitation are coordinated appropriately, each discipline can address the part of the patient's health that falls within its role.

"True healing happens when your body's structure and chemistry work in perfect harmony. If you are struggling with stubborn fatigue, muscle weakness, or slow injury recovery, note down what you are feeling so we can explore how balancing your hormones alongside specialized chiropractic care can help you truly thrive."

References

Cleveland Clinic. (2024). Androgens: Function, levels & related disorders.

Davis, S. R., Baber, R., Panay, N., et al. (2019). Global consensus position statement on the use of testosterone therapy for women. Journal of Clinical Endocrinology & Metabolism, 104(10), 4660–4666.

Davis, S. R., & Wahlin-Jacobsen, S. (2015). Testosterone in women—the clinical significance. The Lancet Diabetes & Endocrinology, 3(12), 980–992.

Faucett, K., Giles, L. A., & Sing, E. (2026). Testosterone: Vital to female physiology. Women's Health, 22. https://doi.org/10.1177/17455057261451831

Figueiredo, M. G., Gagliano-Jucá, T., & Basaria, S. (2022). Testosterone therapy with subcutaneous injections: A safe, practical, and reasonable option. Journal of Clinical Endocrinology & Metabolism, 107(3), 614–626.

Hatzilabrou, T. A. (n.d.). Testosterone and androgen physiology in women. Worldborne Medical, Clinical Frontiers: Androgen Series.

Horstman, A. M., Dillon, E. L., Urban, R. J., & Sheffield-Moore, M. (2012). The role of androgens and estrogens on healthy aging and longevity. Journal of Gerontology: Series A, 67(11), 1140–1152.

Hunter, S. K. (2024). Testosterone and androgen receptors in females: What is possible with resistance training? The Journal of Physiology.

Kling, J. M. (2025). Testosterone for the treatment of hypoactive sexual desire disorder in perimenopausal and postmenopausal women. Obstetrics & Gynecology, 146(3), 341–349.

Parish, S. J., Simon, J. A., Davis, S. R., et al. (2021). International Society for the Study of Women's Sexual Health clinical practice guideline for the use of systemic testosterone for hypoactive sexual desire disorder in women. The Journal of Sexual Medicine, 18(5), 849–867.

Thomas, L. (2022). The role of testosterone in women's health. News-Medical.

Jimenez, A. (2026). Subcutaneous testosterone for hormone balance therapy guide. DrAlexJimenez.com.

Jimenez, A. (2026). Women's hormonal health insights on testosterone deficiency. DrAlexJimenez.com.

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