When most people hear “testosterone,” they immediately think of men’s health. But here’s something that might surprise you: before menopause, women’s ovaries produce three to four times more testosterone than estrogen every single day. Testosterone isn’t just a “male hormone”—it’s actually the most abundant biologically active hormone throughout a woman’s entire life.
Yet despite its crucial role in women’s health, testosterone therapy remains one of the most misunderstood and underutilized treatment options for menopausal women. If you’ve been struggling with symptoms that hormone replacement therapy alone hasn’t resolved, understanding testosterone’s role in your body could be the missing piece of your wellness puzzle.
Understanding Testosterone’s Role in Women’s Health
Testosterone isn’t optional for women—it’s essential. This hormone plays a vital role in multiple aspects of your physical and mental well-being, including bone density, muscle mass, cognitive function, mood, sexual function, and energy levels.
When menopause arrives, testosterone levels don’t drop as dramatically as estrogen does, but they do decline gradually. For some women, this decline happens more abruptly, especially after surgical removal of the ovaries. When testosterone levels fall too low, the effects can ripple through multiple areas of your life.
Women produce both functional estrogen receptors and functional androgen receptors, which means your body is designed to use both types of hormones. Testosterone works alongside estrogen to maintain your health, and in fact, it serves as the primary building block for estrogen production in your body.
Recognizing the Signs of Low Testosterone
Low testosterone in women can manifest in ways that significantly impact quality of life. The symptoms often overlap with general menopause symptoms, which is why they’re frequently overlooked or misattributed.
Common signs include:
Sexual health changes: The most well-documented symptom is hypoactive sexual desire disorder (HSDD)—a persistent lack of sexual interest that causes personal distress. Studies estimate that HSDD affects approximately one in ten women, with the highest prevalence in younger women who’ve undergone surgical menopause.
Physical symptoms: You might notice unexplained fatigue that doesn’t improve with rest, difficulty maintaining muscle mass even with exercise, decreased strength, and changes in bone density.
Cognitive and emotional changes: Brain fog, difficulty concentrating, memory challenges, mood changes, including irritability or anxiety, and a decreased sense of overall well-being are all potential indicators.
Other symptoms: Some women experience hot flashes, night sweats, joint pain, vaginal dryness, and urinary complaints.
It’s important to note that before considering testosterone therapy, you should work with your healthcare provider to rule out other factors that might be contributing to these symptoms, such as stress, relationship issues, thyroid problems, or other medical conditions.
The Benefits: What Research Tells Us
The evidence supporting testosterone therapy for women has grown substantially over the past decade. Here’s what we know works:
Sexual Function
The most robust evidence supports testosterone therapy for treating HSDD in postmenopausal women. Multiple studies show that testosterone can increase sexual interest, arousal, pleasure, and orgasmic function, while reducing sexual distress. On average, women using testosterone therapy report approximately one additional satisfying sexual event per month compared to those using a placebo.
This might not sound dramatic, but for women who’ve been struggling with a complete loss of desire that’s affecting their relationships and self-image, this improvement can be life-changing.
Bone and Muscle Health
Research indicates that testosterone may help maintain bone density and muscle mass, though more long-term studies are needed. For women at risk of osteoporosis, this potential benefit is worth discussing with your healthcare provider.
Cognitive Function and Mood
Studies suggest that both testosterone and estradiol can counter biochemical reactions in the brain associated with Alzheimer’s disease, potentially reducing beta-amyloid deposition and improving the brain’s ability to metabolize glucose. Many women also report improvements in mood, concentration, motivation, and energy levels when taking testosterone, though these benefits are considered secondary to the primary indication for sexual dysfunction.
Cardiovascular and Metabolic Health
When used transdermally (applied to the skin), testosterone doesn’t adversely affect blood pressure or lipid profiles. Some research even suggests it may have beneficial effects on lean body mass, glucose metabolism, and lipid profiles.
Safety Profile and Side Effects
One of the most important things to understand about testosterone therapy for women is that safety depends entirely on keeping hormone levels within the normal female range. When used appropriately, testosterone has been shown to be safe for over 80 years.
What We Know Is Safe
Transdermal testosterone (applied as a cream or gel) has no adverse effects on the liver, doesn’t increase clotting factors, and doesn’t negatively impact kidney function or blood cell counts. Research also shows no increased risk of breast cancer in the short term, and it doesn’t stimulate the endometrium. If you have breast, uterine, or ovarian cancer, or a strong family history of the same, you must speak to your doctor about whether hormone replacement therapy is right for you.
Manageable Side Effects
The most common side effects are generally mild and manageable:
- Acne or oily skin
- Increased hair growth at the application site
- Slight increase in body or facial hair
These effects are dose-dependent, meaning they’re more likely to occur if testosterone levels rise above the normal female range. When levels are kept within physiological ranges, more serious androgenic effects like voice deepening, male-pattern baldness, or clitoral enlargement do not occur.
What to Avoid
Oral testosterone preparations aren’t recommended for women because they can adversely affect lipid profiles. Similarly, testosterone pellets or injections that result in supraphysiologic (higher than normal) concentrations should be avoided.
How Testosterone Therapy Is Administered
In countries where testosterone products for women are approved (including Australia, the United Kingdom, New Zealand, and South Africa), the preferred method is transdermal application—typically as a cream or gel applied to the lower abdomen, buttocks, legs, or arms.
The U.S. Situation
In the United States, the FDA hasn’t approved any testosterone products specifically for women, though over 30 FDA-approved testosterone therapies exist for men. This doesn’t mean testosterone therapy is unsafe or inappropriate for women—it simply means it’s prescribed “off-label.”
When prescribed off-label, healthcare providers typically use male formulations at much lower doses (approximately 1/10th of a male dose) or work with compounding pharmacies to create female-appropriate preparations. The key is finding a knowledgeable provider who understands proper dosing and monitoring for women.
Finding the Right Dose
The goal of testosterone therapy isn’t to achieve a specific number on a lab test—it’s to relieve your symptoms while avoiding side effects. Your healthcare provider should use an individualized approach, adjusting your dose based on how you feel and monitoring for any signs of excess testosterone.
Monitoring and Professional Guidance
If you and your healthcare provider decide to try testosterone therapy, proper monitoring is essential for both safety and effectiveness.
Initial Assessment
Before starting treatment, your provider should:
- Measure your baseline testosterone levels
- Conduct a thorough assessment to rule out other causes of your symptoms
- Discuss your treatment goals and expectations
- Review your medical history for any contraindications
Ongoing Monitoring
After starting testosterone therapy, you should have your testosterone levels checked within 8-10 weeks, then every 6 months thereafter. Your provider should also regularly assess:
- Symptom improvement
- Signs of androgen excess (acne, excessive hair growth)
- Your overall response to treatment
If you haven’t experienced any benefit after 6 months of treatment, current guidelines recommend stopping therapy.
Who Should Avoid Testosterone Therapy
Testosterone therapy generally isn’t recommended for women with:
- Cardiovascular disease
- Liver disease
- Hormone-sensitive cancers (such as breast or uterine cancer)
- Current pregnancy or plans to become pregnant
Setting Realistic Expectations
So, should women use testosterone? All women should at least discuss it with their doctor! It’s crucial to understand what testosterone therapy can and cannot do. The only use supported by strong clinical evidence is treating HSDD—persistent, distressing low sexual desire—in postmenopausal women.
While some women report improvements in energy, mood, and cognition, these benefits aren’t yet well-supported by research. If you’re considering testosterone therapy primarily for fatigue or brain fog, have an honest conversation with your provider about the limited evidence for these uses and other approaches that you can try.
Also, remember that testosterone therapy works best as part of a comprehensive approach to menopausal health. Addressing lifestyle factors like sleep, stress management, nutrition, and exercise remains foundational to your well-being at every age.
Taking the Next Step Toward Hormonal Balance
Understanding your body’s hormonal needs during menopause empowers you to make informed decisions about your health. If you’re experiencing persistent symptoms that haven’t responded to other treatments, testosterone therapy might be worth exploring.
The path forward starts with finding a healthcare provider who:
- Understands the role of testosterone in women’s health
- Has experience prescribing and monitoring testosterone therapy for women
- Takes time to listen to your concerns and goals
- Can provide comprehensive, individualized care
At Roots of Health, Dr. Melissa McCarty specializes in helping women navigate the complexities of menopause and hormonal health. She takes a holistic, integrative approach that considers your unique symptoms, health history, and wellness goals.
Ready to explore whether testosterone therapy might be right for you? Schedule a consultation with Dr. Melissa McCarty to discuss custom hormone therapy options and other women’s health concerns. Taking control of your hormonal health is one of the most empowering steps you can take during menopause.
