Testosterone therapy is often associated with men, but it’s increasingly recognized as a valuable option for women, particularly during perimenopause and menopause. While estrogen and progesterone have long dominated discussions about women’s hormone replacement therapy (HRT), testosterone plays a critical role in female health, influencing everything from sexual desire to bone strength and mental clarity. Despite lingering myths and misconceptions, growing evidence supports the use of low-dose testosterone therapy to improve quality of life for women experiencing hormone-related symptoms. Here’s why women should consider this treatment, backed by science and expert insights.
The Role of Testosterone in Women’s Health
Testosterone is not just a “male hormone.” Women produce testosterone in their ovaries and adrenal glands, and it’s essential for various physiological processes. In fact, young women’s ovaries produce three to four times more testosterone than estrogen daily. It contributes to:
-
Sexual Health: Testosterone supports libido, arousal, orgasm, and overall sexual satisfaction.
-
Bone and Muscle Health: It helps maintain bone density and muscle mass, reducing the risk of osteoporosis and frailty.
-
Cognitive Function: Testosterone influences mental sharpness, focus, and mood regulation.
-
Energy and Well-Being: Adequate levels combat fatigue, irritability, and low mood, common complaints during hormonal transitions.
However, testosterone levels in women peak in their 20s and decline gradually with age, dropping to about one-quarter of peak levels by menopause. Surgical procedures like oophorectomy (removal of ovaries) can cause a sudden drop, intensifying symptoms. These declines can lead to symptoms such as low libido, fatigue, brain fog, and reduced muscle strength, prompting many women to explore testosterone therapy.
Addressing Hypoactive Sexual Desire Disorder (HSDD)
One of the most evidence-based uses of testosterone therapy for women is to treat hypoactive sexual desire disorder (HSDD), a condition characterized by a persistent lack of sexual desire that causes distress. A 2019 systematic review of 36 randomized controlled trials (RCTs) involving 8,480 women found that testosterone significantly improved sexual desire, arousal, orgasm, and overall satisfaction in postmenopausal women with HSDD. On average, women using testosterone experienced one additional satisfying sexual event per month compared to placebo.
For women like Cate Hall, a 41-year-old from Berkeley, California, testosterone therapy was a game-changer. After experiencing a plummeting sex drive in her 40s, she started low-dose testosterone replacement therapy (TRT) in 2024 and noticed improvements within a week. Her story reflects a growing trend, with women reporting enhanced sexual well-being after starting therapy, often shared through social media and word-of-mouth, dubbed the “book club effect.”
Beyond Libido: Additional Benefits
While HSDD is the primary evidence-based indication for testosterone therapy, emerging research suggests broader benefits, though more studies are needed to confirm these effects. Testosterone may:
-
Support Bone Health: It helps maintain bone density, potentially reducing the risk of osteoporosis, a significant concern for postmenopausal women.
-
Enhance Muscle Mass and Strength: Testosterone supports muscle maintenance, aiding mobility and metabolic health.
-
Improve Mood and Cognition: Anecdotal reports and some studies suggest testosterone can alleviate brain fog, anxiety, and low mood, though randomized controlled trial (RCT) evidence is limited for these outcomes.
-
Protect Breast Health: Two long-term studies have shown a significant reduction in invasive breast cancer incidence among women using testosterone therapy, challenging myths about its risks.
These potential benefits are driving interest, with many women reporting improved quality of life after starting therapy. However, experts caution that claims about mood, cognition, and energy improvements are not yet fully supported by RCTs and should be approached cautiously.
Safety and Side Effects: What the Evidence Says
Safety concerns have historically deterred women from considering testosterone therapy, fueled by misconceptions that it causes masculinization or increases health risks. However, when administered in low doses to maintain physiological levels, testosterone is generally safe. A seven-year study on subcutaneous hormone-pellet therapy demonstrated long-term safety, with no significant adverse effects when levels were kept within the female physiological range.
Transdermal testosterone (gels or creams) is preferred because it minimizes risks compared to injectables or pellets, which can lead to supraphysiological levels. Side effects are uncommon but may include acne or localized hair growth at the application site. Serious effects like voice deepening or excessive hair growth are rare if dosing is carefully monitored. Importantly, transdermal testosterone does not adversely affect blood pressure, lipid profiles, liver function, or endometrial health, and short-term data show no increased breast cancer risk.
However, testosterone therapy is not recommended for women with pre-existing cardiovascular disease or breast cancer without specialist consultation, as evidence in these populations is limited. Regular monitoring of testosterone levels is crucial to ensure they remain within the normal female range (typically below 20 ng/dL for women over 50).
Why No FDA-Approved Options for Women?
Despite over 30 FDA-approved testosterone therapies for men, none are approved for women in the United States, forcing doctors to prescribe off-label or use compounded formulations. This gap stems from historical misconceptions about testosterone’s role in women and a lack of large-scale, long-term studies on its safety and efficacy. In contrast, countries like Australia and England have licensed testosterone products for women, used safely for over 60 years.
The absence of FDA-approved options complicates access, as insurance coverage for off-label prescriptions can be challenging. However, a 2019 Global Consensus Position Statement, endorsed by major medical societies, provides clear guidance on safe prescribing practices, advocating for low-dose, transdermal formulations and regular monitoring.
Who Should Consider Testosterone Therapy?
Testosterone therapy is most appropriate for postmenopausal women with HSDD who have not responded to estrogen-based HRT alone. It may also be considered for perimenopausal women with low libido or those who have undergone oophorectomy, which causes a sharp testosterone drop. Before starting therapy, doctors typically:
-
Conduct a thorough evaluation to rule out other causes of symptoms, such as depression, relationship issues, or vaginal dryness.
-
Measure baseline testosterone and sex hormone-binding globulin (SHBG) levels to ensure therapy is warranted.
-
Ensure women are adequately estrogenized (e.g., no longer experiencing vasomotor symptoms) before adding testosterone.
Women experiencing symptoms like fatigue, low mood, or brain fog may be tempted to seek testosterone as a “feel-good” drug, but experts emphasize that it’s not a cure-all. Comprehensive assessment by a healthcare provider is essential to determine if testosterone is appropriate.
Debunking Myths
Misconceptions about testosterone therapy in women persist, often rooted in its association with male physiology. A 2013 review in Maturitas debunked several myths, clarifying that testosterone:
-
Is the most abundant biologically active hormone in women, not just men.
-
Does not cause masculinization when dosed correctly.
-
Is cardiac-protective and does not adversely affect the liver or increase clotting risks.
-
May support scalp hair growth and breast health, contrary to common fears.
These findings underscore the importance of evidence-based information to guide treatment decisions.
The Bottom Line
Testosterone therapy offers a promising option for women struggling with low libido, particularly those with HSDD, and may provide additional benefits for bone health and overall well-being. While not FDA-approved for women, low-dose, transdermal testosterone is safe when monitored carefully, with minimal side effects. Women considering this therapy should consult a healthcare provider to assess their symptoms, rule out other causes, and ensure personalized dosing.
As social media and patient advocacy fuel interest in testosterone therapy, it’s critical to separate hype from evidence. For women navigating the challenges of perimenopause or menopause, testosterone could be a key to reclaiming vitality and sexual wellness—but it’s not a one-size-fits-all solution. With ongoing research and growing acceptance, testosterone therapy may soon become a standard part of women’s health care, empowering women to thrive through midlife and beyond.
Disclaimer: Always consult a healthcare provider before starting any new supplement, especially if you have underlying health conditions or take medications.
The content contained in this article is for information purposes only, and is not meant to be a substitute or replacement for professional advice and medical consultation. It is just shared as information only, and with the understanding that Directional Force, LLC, (Directional Force) is not engaged in the provision or rendering of medical advice or services whatsoever. You unilaterally understand and agree that Directional Force shall not be liable for any claim, loss, or damage arising out of the use of, or reliance upon any content or information in this article or any article provided by Directional Force. Please seek professional medical advice prior to engaging in, or undertaking any of the content, exercises, advice, and workouts provided by Directional Force.
For more information, consult your healthcare provider or visit resources like the International Menopause Society or the Australasian Menopause Society.
