Testosterone for women
Women make testosterone too, and treating them with it has exactly one evidence-based use: low sexual desire that causes distress after menopause. The wider claims — more energy, better mood, a better life — come from uncontrolled studies, one of them a survey of women who had paid for treatment, and short-term heart safety looks reassuring, though long-term safety is uncertain.
Consider testosterone only for distressing low desire after menopause, diagnosed by a clinician rather than a blood test. Where no female product is approved, an approved male product at a female dose, with levels checked, is the reasonable route; avoid compounded "bioidentical" testosterone and pellets.
What it is and what it is for
Testosterone is a primary female sex hormone: women produce more testosterone than estrogen, by mass. The only use backed by randomised evidence is hypoactive sexual desire disorder (HSDD) — low sexual desire that causes distress — in postmenopausal women. The global consensus statement on testosterone in women, published in 2019, is emphatic that this is diagnosed by a full clinical and psychosocial assessment, never by a blood testosterone level, for which no diagnostic cutoff exists.[1]
Claims beyond libido rest on weak studies
The most-cited recent example is a retrospective study of 332 women aged 27–78 treated through a telehealth platform, in which 84.3% reported more energy and 89.7% a better quality of life.[2] The design explains those numbers better than the drug does:
- No placebo group, no blinding and no baseline symptom score: the outcomes come from one survey after treatment, given to women still on a drug they had paid for.
- Energy, mood and quality of life are exactly the symptoms where placebo responses in hormone trials are large.
- Two of the authors advise the telehealth provider whose patient data were analysed.
- The blood tests came from only 120 of the women, all from the shortest-treatment group, re-tested at 12 weeks. Total testosterone rose about two and a half times, from 16.8 to 42.3 ng/dL (0.58 to 1.47 nmol/L), which mainly confirms the drug was absorbed; triglycerides fell about 13%, with no control group to judge that against.
A single-practice chart review of 100 women given testosterone pellets over a decade found that the 78 who completed both questionnaires improved across all 11 categories of a menopause symptom scale. But symptoms were measured only twice, at the start and at roughly six months; there was no control group; side effects occurred in 58 of the 100 women; and two developed breast cancer while on therapy.[3]
Treat both as hypotheses, not effect sizes.
Safety: reassuring in the short term
A 2026 systematic review of 13 randomised trials in 2,628 women on testosterone through the skin for 8–52 weeks recorded no cardiovascular deaths. The same review rated the certainty about long-term safety low: these are short trials, not lifetime data.[4]
Mild acne and unwanted hair growth are dose-related and are managed by lowering the dose or with spironolactone.
The supply problem
The United States has no approved testosterone product for women. Where none is available, the global consensus calls off-label use of an approved male product "reasonable", provided blood levels stay in the normal female range and are checked regularly. It advises against compounded "bioidentical" testosterone wherever an approved product, including a male one, is available, for lack of evidence on effectiveness and safety, and against pellets outright, because they produce levels well above the female range.[5]
A licensed female product does exist elsewhere: a 1% cream registered in Australia in 2020 for HSDD after menopause. A patch was licensed in Europe for women whose menopause was caused by surgery and later withdrawn.[6]
What to do
- Bring distressing low desire after menopause to a clinician for a full assessment; a testosterone level alone cannot diagnose it.
- If treated, use an approved product — a female one where licensed, otherwise a male one at a female dose — with levels kept in the female range and rechecked.
- Skip compounded creams and pellets.
- Don't take testosterone for energy, mood or general wellbeing; the evidence for those is uncontrolled.
For menopause symptoms more broadly, see Menopausal hormone therapy; for men, see Testosterone therapy.
Further reading
- Davis SR et al. Global Consensus Position Statement on the Use of Testosterone Therapy in Women. JCEM 2019.[7]
- Viana DPDC et al. Cardiovascular mortality associated with testosterone therapy in cisgender women and transgender men: a systematic review. Front Endocrinol 2026.[8]
- Elggren CW et al. Testosterone Replacement Therapy in Women Is Associated with Improved Symptom Burden and Favorable Biomarker Changes: A Retrospective Observational Study. J Pers Med 2026 — uncontrolled, unblinded, industry-linked.[9]