Testosterone Therapy for Women

Produced in the ovaries and adrenal glands, testosterone contributes to sexual motivation, arousal and a host of other bodily functions still under investigation.

“Testosterone is not just a male hormone,” said Sharon Winer, MD, MPH, a reproductive endocrinologist at Cedars-Sinai. “Women make it, too. And when testosterone levels begin to drop with age, testosterone therapy may help boost libido in women with low sexual desire.”

Why Testosterone Should Be Part of the Menopause Conversation

‍As women enter menopause, many face an exhaustive list of symptoms—fatigue, insomnia, shifting moods, brain fog, and a sudden or gradual loss of interest in sex. Menopause hormone therapy can provide meaningful relief. But for some women, it’s off the table due to medical reasons, or it’s insufficient to address dwindling sexual desire.

That gap has prompted growing interest in another hormone: testosterone.

“After age 30, women gradually produce less testosterone,” said Bryan Jick, MD, a menopause specialist at Cedars-Sinai. Unlike estrogen and progesterone, which drop sharply during the menopausal transition, testosterone declines slowly and steadily over time.

For some women, that gradual drop may impact sexual desire and satisfaction. When the change becomes distressing—diagnosed as hypoactive sexual desire disorder (HSDD)—clinicians may consider testosterone therapy as a potential treatment option.

“Testosterone is really about libido,” said Winer. “There’s evidence it can help some patients with HSDD. Beyond that, we just don’t have consistent evidence to promise benefits in women.”

Which Symptoms Testosterone Therapy Can—and Can’t—Address

Research shows that in continuously monitored, low doses that keep blood levels within the premenopausal female range, testosterone therapy can improve sexual desire and sexual satisfaction in women diagnosed with HSDD. But it’s not a panacea for every perimenopause or menopause complaint.

“Testosterone is really about libido,” said Winer. “There’s evidence it can help some patients with HSDD. Beyond that, we just don’t have consistent evidence to promise benefits in women.”

Although some patients report improvements in mood, energy, cognition and performance, the global position statement on the use of testosterone therapy for women concluded that “there are insufficient data to support the use of testosterone for the treatment of any other symptom or clinical condition, or for disease prevention.”

While testosterone therapy is widely prescribed for men, the benefits for women haven’t been sufficiently investigated. Research is underway to explore the effects of testosterone supplementation in women, including its impact on bone density, muscle strength, body composition, anemia, mood and energy.

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Dosing and Delivery for Testosterone Therapy

‍‍In the United States, an FDA-approved formulation of testosterone specifically for women does not exist. Instead, clinicians prescribe testosterone off label based on medical studies, adapting existing products or working with compounding pharmacies to achieve lower doses.

“Prescribing off label is legal and common in expert hands,” said Jick. “But it requires shared decision-making and careful follow-up.”

Before starting therapy, clinicians often measure baseline testosterone levels and present appropriate therapeutic options to address HSDD including:

• ‍Male topical solutions: The most prescribed form, testosterone gels and solutions are applied directly to the skin—usually at about one-tenth of the dose prescribed for men. “That can be tricky,” Jick said. “The products are designed for male dosing, so patients have to carefully adjust the amount to avoid accidentally using too much.” ‍
• Compounded gels and creams: Some clinicians prescribe compounded formulations of low-dose testosterone cream or gel for their patients to apply to the skin. Compounded drugs are not regulated by the FDA in the same way as approved drugs[SW1] , so sterility, dosing and quality may vary.
• ‍Pellets: Pellet therapy in women is uncommon and controversial. Clinicians insert small, compounded testosterone pellets under the skin, where they slowly release the hormone over several months. While convenient, there are significant concerns around the safety and efficacy of pellets—and about inconsistent dosing. Side effects of testosterone pellets include abnormal bleeding, hair growth and acne. “If levels end up higher than expected, you can’t adjust dosing or remove the medication,” Jick said. “That’s one reason many clinicians prefer topical approaches.”

“No matter which form you choose, the goal is to keep your testosterone levels in the premenopausal range, which requires ongoing monitoring,” said Winer.

Other prescription treatments for HSDD include flibanserin, a daily oral medication, and bremelanotide, an injectable medication used on demand before sexual activity.

Is Testosterone Therapy Safe?

‍Unfortunately, there is no long-term safety data for testosterone therapy in women. Short-term studies show no increased risk of cardiovascular disease and even hint at a potential protective effect against breast cancer—but the evidence is still evolving.

“When prescribed at low doses and carefully monitored, testosterone therapy is generally well tolerated,” said Winer. “However, combining testosterone with other androgen-boosting supplements—such as dehydroepiandrosterone, or DHEA—can potentially increase the risk of side effects.”

Even at appropriate doses, some women who receive testosterone therapy may experience common side effects, including:

• Acne
• Excessive sweating
• Body odor
• Increased facial or body hair

Severe side effects, usually associated with blood levels above the female physiologic range, include:

• Scalp hair thinning
• Voice deepening
• Clitoral enlargement

Women who are pregnant or breastfeeding—and those with active liver disease, hormone-sensitive conditions, uncontrolled hyperlipidemia or severe acne—should avoid testosterone therapy. Patients with hormone-sensitive cancers should discuss the risks and benefits with their healthcare team.

When Testosterone Therapy Makes Sense

Low libido is rarely caused by a single factor. Sleep problems, mood changes, genitourinary syndrome of menopause, relationship dynamics and stress can all play a role in sexual desire and satisfaction. But if low sexual desire persists, despite addressing relationship, psychological and medical contributors, testosterone therapy may be an appropriate solution.

“Improvements with testosterone therapy can take weeks to months to kick in,” said Winer. “During that time, we monitor symptoms while periodically checking hormone levels to ensure they remain in the premenopausal range. But if a patient doesn’t notice improvement after about six months, I suggest discontinuing therapy.”

If low sexual desire continues to be a concern, it’s important to talk with your doctor about the full range of available options. When sexual dysfunction is managed with the right tools—menopause hormone therapy, vaginal estrogen and, for select patients, testosterone therapy—many women report improved sexual satisfaction and quality of life.

“Testosterone isn’t a cure-all,” Winer says. “But with careful selection, female-appropriate dosing and regular follow-up, low-dose therapy can make a meaningful difference for the right patient.”