Testosterone for women: what it can and cannot do

Women make testosterone too

The ovaries and adrenal glands produce testosterone throughout a woman's life, in much smaller amounts than in men. Levels decline gradually with age rather than dropping sharply at menopause, though removal of the ovaries causes a more abrupt fall. Testosterone contributes to sexual desire and has effects on many tissues.

That has led to the idea that topping it up will restore energy and vitality. When that idea was tested, the benefits turned out to be concentrated in one area.

The one well-supported use

In 2019, an international task force endorsed by the Endocrine Society, the International Menopause Society and other organizations published a global consensus position statement. It concluded that the only evidence-based indication for testosterone in women is hypoactive sexual desire disorder (HSDD) in postmenopausal women, meaning low desire that causes personal distress.

Even then, the diagnosis should follow a full assessment of physical, psychological and relationship factors. In trials, physiological doses produced modest improvements in desire, arousal and satisfying sexual events. It is a helpful option for some women, not a transformation.

What it has not been shown to do

The same statement found insufficient evidence to support testosterone for general wellbeing, mood, cognitive function, bone density or muscle mass and strength. It also concluded that evidence was insufficient for premenopausal women and recommended against DHEA for low desire.

If fatigue, brain fog or low mood is your main concern, testosterone is unlikely to be the answer, and those symptoms deserve their own evaluation.

Why a blood test cannot make the diagnosis

The consensus statement advises that a blood testosterone level should not be used to diagnose HSDD. Many standard tests are not accurate at the low concentrations found in women, levels do not track closely with symptoms and they do not predict who will respond.

Testing still has a role: a baseline level before treatment and follow-up levels during treatment help make sure you stay within the normal premenopausal range rather than drifting higher. MedlinePlus notes that testosterone testing in women is mostly used to look for signs of excess, such as unwanted hair growth or irregular periods.

Check these causes first

Addressing these often improves desire without testosterone, and it is an expected part of the assessment.

• Vaginal dryness or pain with sex from genitourinary syndrome of menopause, which local estrogen can treat
• Hot flashes and poor sleep from untreated menopause symptoms
• Medicines such as SSRIs and SNRIs, which commonly lower desire
• Depression, anxiety, stress and fatigue
• Relationship issues or a partner's sexual health
• Thyroid problems, low iron or other medical conditions

Desire changes are common and often multi-causal

Many women notice a shift in sexual desire through perimenopause and beyond. For some, desire becomes more responsive, arising after intimacy begins rather than spontaneously, which is a normal pattern rather than a disorder. A diagnosis of HSDD is made only when low desire is persistent and causes personal distress.

Talking openly about what has changed, and when, helps your clinician work out which factors matter most for you. Sometimes the answer is medical, sometimes it is about sleep, stress or the relationship, and often it is a mix.

Practical issues and risks

There is no FDA-approved testosterone product for women in the U.S. Clinicians typically prescribe a small fraction of a men's product, carefully dosed, and the consensus statement recommends against compounded testosterone, pellets and injections because they can produce levels well above the normal female range. Oral testosterone is not recommended because of its effects on cholesterol.

Side effects include acne and unwanted hair growth. At excessive doses, voice deepening, scalp hair loss and clitoral enlargement can occur, and some of these may not fully reverse. Long-term safety beyond about two years has not been established, and women with hormone-sensitive breast cancer need specialist advice.

What a trial looks like

If testosterone is appropriate, the consensus statement suggests checking levels at baseline and again three to six weeks after starting, then about every six months. If there is no benefit by six months, treatment should be stopped.

HealifyMD's hormone therapy plan for women focuses on estradiol, estriol vaginal cream and progesterone. If low desire is your main concern, your clinician will start with the causes above and discuss whether a referral or other option fits. HealifyMD's hormone therapy plan for women is $349 for the first month (including the evaluation and baseline labs), then $99/month, with estradiol, estriol vaginal cream and progesterone included in the hormone therapy program. Compounded hormones are not FDA-approved and are not equivalent to branded products. Other labs are priced separately, and your price is confirmed at the eligibility review.