When most people hear "testosterone therapy," they think of men. But women produce testosterone too—from the ovaries and adrenal glands—and it plays important roles in libido, energy, mood, muscle mass, and bone health. During menopause, testosterone levels decline, and for some women, the effects are significant enough to warrant treatment.
Testosterone therapy for women is one of the most under-discussed topics in menopause care. Here is what you need to know.
How Testosterone Works in Women
Women produce approximately one-tenth to one-twentieth the testosterone that men do, but it is biologically active and important. Testosterone in women supports:
- Sexual desire (libido): Testosterone is a key driver of sexual motivation in women. Estrogen supports arousal and vaginal health, but testosterone drives desire.
- Energy and vitality: Many women with low testosterone report persistent fatigue that does not respond to sleep or lifestyle changes.
- Muscle mass and strength: Testosterone supports lean muscle maintenance, which becomes increasingly important for metabolic health and fall prevention as women age.
- Bone density: Works alongside estrogen to maintain bone strength.
- Mood: Some evidence suggests testosterone contributes to overall sense of wellbeing and mental clarity.
How Testosterone Changes During Menopause
Unlike estrogen, which drops dramatically at menopause, testosterone declines gradually throughout a woman's adult life. By the time a woman reaches menopause, her testosterone levels are approximately 50% of what they were in her 20s.
The decline accelerates after menopause because the ovaries—which continue producing some testosterone even after they stop producing estrogen—gradually reduce output. Women who have had their ovaries surgically removed (bilateral oophorectomy) experience an immediate and significant drop in testosterone.
Additionally, oral estrogen therapy can further reduce available testosterone by increasing sex hormone-binding globulin (SHBG), which binds testosterone and makes it less active. This is one reason why transdermal estrogen is generally preferred—it has less impact on SHBG.
Symptoms of Low Testosterone in Women
Low testosterone in women can manifest as:
- Persistent low libido that does not improve with estrogen therapy or relationship/psychological interventions
- Unexplained fatigue that persists despite adequate sleep and thyroid function
- Loss of motivation and drive
- Reduced muscle mass and strength despite regular exercise
- Low mood or decreased sense of wellbeing
- Reduced physical stamina
It is important to note that these symptoms overlap with other conditions (depression, thyroid disease, adrenal insufficiency, iron deficiency). A thorough evaluation is necessary before attributing them to testosterone deficiency alone.
What the Evidence Says About Testosterone Therapy for Women
The strongest evidence for testosterone therapy in postmenopausal women is for Hypoactive Sexual Desire Disorder (HSDD)—clinically significant low sexual desire that causes personal distress.
Libido
A 2019 systematic review and meta-analysis published in The Lancet Diabetes & Endocrinology analyzed data from 36 randomized controlled trials involving over 8,400 postmenopausal women. The findings were clear: testosterone therapy significantly improved sexual desire, arousal, orgasm frequency, and satisfaction compared to placebo.
Other Potential Benefits
The evidence for benefits beyond sexual function is less robust but suggestive:
- Bone density: Some studies show improvement, but data is limited.
- Muscle mass: Small improvements in lean body mass have been reported.
- Energy and mood: Some women report significant subjective improvement, but placebo-controlled data is mixed.
- Cognitive function: Limited and inconclusive evidence.
How Testosterone Is Dosed for Women
There is no FDA-approved testosterone product specifically designed for women. All testosterone use in women is off-label. This does not mean it is inappropriate—many well-established medical treatments are used off-label—but it does mean that products must be adapted.
Options include:
| Delivery Method | Typical Female Dose | Source | Cost Range |
|---|---|---|---|
| Compounded testosterone cream | 0.5–1 mg/day (applied to skin) | Compounding pharmacy | $40–120/month |
| Male testosterone gel (diluted) | 1/10th of male dose | Commercial product (off-label) | $30–80/month (with GoodRx) |
| Testosterone pellets | ~25–50 mg pellets (inserted every 3–4 months) | Provider office procedure | $200–500 per insertion |
| Compounded testosterone troches | 0.5–2 mg/day (sublingual) | Compounding pharmacy | $40–100/month |
Critical safety point: Female testosterone doses are a fraction of male doses. Using male-strength products without proper dose adjustment can cause virilizing side effects (acne, facial hair, voice deepening). Always work with a provider experienced in female testosterone prescribing.
Monitoring and Safety
Appropriate monitoring for women on testosterone therapy includes:
- Baseline labs: Total testosterone, free testosterone, SHBG, CBC, lipids, liver function
- Follow-up labs: Total and free testosterone at 6–8 weeks, then every 6–12 months
- Target range: The goal is to restore testosterone to the normal premenopausal range (typically 15–70 ng/dL for total testosterone), not to supraphysiological levels
- Watch for virilization: Acne, hair growth in male patterns, voice changes, clitoral enlargement. These are dose-dependent and generally reversible if caught early.
Safety Profile
Based on available evidence (primarily from the systematic review mentioned above):
- No increased cardiovascular risk was found in trials lasting up to 2 years
- No increased breast cancer risk was identified, though long-term data beyond 2 years is limited
- Mild side effects include acne (most common), increased facial hair growth, and oily skin—all dose-related and manageable
- No significant adverse effects on lipids or liver function at physiological replacement doses
The International Menopause Society and the Global Consensus Position Statement on Testosterone for Women both support the use of testosterone therapy for postmenopausal women with HSDD at physiological replacement doses, with appropriate monitoring.
Who Should Consider Testosterone Therapy?
Testosterone therapy is worth discussing with your provider if:
- You are postmenopausal (or in late perimenopause) and experiencing persistent low libido that causes you distress
- You are already on estrogen therapy and libido has not improved
- Psychological, relationship, and other medical causes of low desire have been evaluated and addressed
- You had surgical menopause (oophorectomy) and experienced a sudden drop in sexual desire
Who Should Avoid Testosterone Therapy?
- Women with hormone-sensitive cancers (active or recent)
- Women with polycystic ovary syndrome (PCOS) or existing hyperandrogenism
- Pregnant or breastfeeding women
- Women with significant liver disease
- Women seeking testosterone for general "anti-aging"—the evidence does not support supraphysiological dosing for longevity purposes
How to Find a Provider Who Prescribes Testosterone for Women
Because testosterone therapy for women is off-label, not all providers are comfortable prescribing it. Your best options:
- NAMS-certified menopause practitioners: Searchable at menopause.org. These providers are trained in the full range of menopausal hormone therapies.
- Telehealth HRT platforms: Winona, Hone Health, and Ivím Health all offer testosterone as part of their women's hormone therapy programs.
- Reproductive endocrinologists: Specialists who understand female hormonal physiology.
The Bottom Line
Testosterone is not a miracle hormone, but for the right patient—typically a postmenopausal woman with distressing low libido that has not responded to estrogen therapy alone—it can be genuinely transformative. The evidence for its efficacy is strong, the safety profile at physiological doses is reassuring, and the biggest barrier to access is not medical but structural: the absence of an FDA-approved female testosterone product.
If low desire is affecting your quality of life and your sense of self, do not accept "that's just what happens with age" as an answer. Ask about testosterone. The science supports you.
Want to explore your full HRT options? See our guide to HRT benefits and risks, or compare online HRT providers that include testosterone therapy for women.