Testosterone for Women: What We Know, What We Don't, and Who May Benefit
Some clinics market it as a solution for everything from fatigue to weight loss, while others refuse to prescribe it at all. The truth falls somewhere in the middle.
- 01Testosterone may be an appropriate treatment for carefully selected women with distressing low sexual desire, particularly after menopause.
- 02There is currently no FDA-approved testosterone product specifically for women in the United States, so treatment is considered off-label.
- 03The goal is to restore testosterone to normal physiologic levels for women — not to achieve male hormone levels.
- 04Low libido is rarely caused by one thing alone. Sleep, relationship factors, medications, vaginal dryness, thyroid disease, stress, and menopause all play important roles.
- 05Testosterone should be individualized, carefully dosed, and monitored for both effectiveness and side effects.
Is testosterone only a "male hormone"?
Not at all.
Women naturally produce testosterone too — just in much smaller amounts than men.
It plays a role in sexual desire, sexual arousal, mood, bone health, muscle function, and overall well-being.
As women age and transition through menopause, testosterone levels gradually decline.
For some women, that decline may contribute to changes in sexual desire.
For others, it may not.
That's one reason there isn't a simple blood test that tells us whether testosterone is the answer.
What does the research actually support?
The strongest research supports testosterone therapy for postmenopausal women with hypoactive sexual desire disorder (HSDD) — a persistent decrease in sexual desire that causes personal distress and isn't better explained by another medical condition or relationship concern.
Studies have shown that appropriately dosed testosterone can improve:
- Sexual desire
- Sexual arousal
- Sexual satisfaction
- Orgasm
- Sexual distress
For women struggling with these symptoms, the improvement can be meaningful.
It's important to have realistic expectations, though.
Testosterone isn't designed to dramatically change your personality or make you feel like you're in your twenties again.
The goal is improvement — not perfection.
Low libido is usually more than one hormone
One of the biggest misconceptions I see is the idea that low libido automatically means someone needs testosterone.
In reality, sexual desire is incredibly complex.
Before recommending testosterone, I also think about:
- Vaginal dryness or pain with intercourse
- Sleep quality
- Stress
- Relationship factors
- Depression or anxiety
- Medications, especially SSRIs
- Thyroid disorders
- Iron deficiency
- Estrogen deficiency
Sometimes treating one of those issues improves libido without testosterone.
Sometimes testosterone becomes one piece of a much bigger treatment plan.
Why is testosterone off-label?
Many patients are surprised to learn that there isn't an FDA-approved testosterone product specifically designed for women in the United States.
Because of that, testosterone therapy is considered off-label, meaning we're using an approved medication in a way that isn't specifically included in its FDA labeling.
Off-label prescribing is common throughout medicine and doesn't mean the treatment is inappropriate.
It simply means we rely on available evidence, clinical guidelines, and careful monitoring to guide treatment.
How is testosterone prescribed?
Because every woman is different, there isn't one approach that works for everyone.
Depending on the patient, I may recommend:
- Compounded testosterone cream
- Compounded testosterone injection
The decision depends on several factors, including:
- Your symptoms
- Your response to treatment
- Your ability to consistently apply a cream
- Lifestyle and personal preference
- Whether you're achieving the desired results
Some women do very well with topical therapy.
Others absorb creams differently or simply prefer an injectable option.
The goal isn't to use the same treatment for everyone — it's to choose the formulation that best fits the individual patient.
How do I monitor treatment?
Before starting therapy, we spend time talking about your symptoms and making sure testosterone is an appropriate option.
Depending on your history, laboratory testing may also be appropriate to establish a baseline and monitor treatment over time.
Once treatment begins, I follow up regularly to discuss:
- Changes in sexual desire
- Improvement in symptoms
- Side effects
- Whether dose adjustments are needed
The goal is always to use the lowest effective dose while keeping testosterone levels within the normal physiologic range for women.
More is not better.
What are the possible side effects?
When testosterone is prescribed at appropriate doses for women, most side effects are mild and dose-related.
Potential side effects include:
- Acne
- Increased facial or body hair
- Oily skin
Higher-than-intended doses may increase the risk of:
- Scalp hair thinning
- Voice deepening
- Clitoral enlargement
Some of these changes, particularly voice changes, may not be completely reversible.
That's one reason careful dosing and regular follow-up are so important.
What we still don't know
Medicine is always evolving.
While we have good evidence supporting testosterone for carefully selected women with low sexual desire, we still need more research regarding long-term safety beyond several years of treatment.
I believe it's important to be honest about what we know — and what we don't.
Every treatment decision should balance the available evidence with your symptoms, goals, and individual health history.
The bottom line
Testosterone isn't a miracle hormone.
It's also not something women should automatically avoid.
For carefully selected patients, it can be a valuable part of treating distressing low sexual desire when other contributing factors have been evaluated.
Like every aspect of menopause care, testosterone therapy should be individualized.
The right treatment isn't the same for every woman.
My goal is to understand the whole picture, explain your options, and help you decide whether testosterone belongs in your treatment plan.
References
- Islam RM, et al. Safety and efficacy of testosterone for women: A systematic review and meta-analysis of randomized controlled trials. Lancet Diabetes Endocrinol. 2019;7(10):754-766.
- Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660-4666.
- Parish SJ, et al. 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. J Sex Med. 2021;18(5):849-867.
- The Menopause Society. 2025 Hormone Therapy Position Statement. Menopause. 2025.
- American College of Obstetricians and Gynecologists. Compounded Bioidentical Menopausal Hormone Therapy. Reaffirmed 2023.
Related care
If this is what you're working through, read more about Menopause & Perimenopause Hormone Therapy.
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