Disclaimer: The medications discussed in this article may include compounded preparations from a licensed 503A compounding pharmacy. Compounded medications have not been reviewed or approved by the FDA and are not the same as commercially available FDA-approved products. This content is for educational purposes only and does not constitute medical advice or establish a provider-patient relationship. Please consult a licensed healthcare provider for personalized clinical guidance.
Women produce testosterone in the ovaries and adrenal glands throughout life, and before menopause they make more testosterone by weight than estrogen. It is not a male hormone that women happen to have a little of. It is a core part of female physiology, and its decline through the 40s and 50s produces symptoms that estrogen replacement alone does not fix.
This article covers what testosterone does in women, what the clinical trials show about replacing it, the side effects, and the regulatory status, which is different from testosterone therapy for men.
What Testosterone Does in the Female Body
Testosterone contributes to sexual desire and arousal, energy, mood, muscle mass and strength, and bone density. Levels peak in a woman’s 20s and decline gradually, with a further drop after surgical menopause when the ovaries are removed. Natural menopause produces a smaller decline because the ovaries continue producing some testosterone after estrogen production stops.
The symptom most consistently tied to low testosterone in women is low sexual desire. Fatigue, reduced motivation, and difficulty maintaining muscle are commonly reported, though the evidence linking them specifically to testosterone is weaker.
What the Trials Show
The best evidence comes from a 2019 systematic review and meta-analysis in The Lancet Diabetes and Endocrinology that pooled 36 randomized controlled trials with 8,480 participants. Compared with placebo or estrogen alone, testosterone significantly increased sexual desire, arousal, orgasm, pleasure, and the frequency of satisfying sexual events in postmenopausal women, and reduced sexual distress.[1]
The same analysis found no significant effect on body composition, muscle or bone measures, or cognition, though the authors noted that few women contributed data for those outcomes. The analysis also found that oral testosterone worsened cholesterol profiles while transdermal forms did not, which is why cream and lotion are the preferred routes.[1]
Those findings underpin the 2019 Global Consensus Position Statement on testosterone therapy for women, endorsed by the Endocrine Society, the Menopause Society, and others. The consensus supports testosterone for postmenopausal women with low sexual desire that causes distress, at doses that keep blood levels within the normal premenopausal female range. It found insufficient evidence to recommend testosterone for any other indication.[2]
That last line matters. If you are offered testosterone for weight loss, energy, or “optimization” as a primary goal, the evidence does not support it.
Side Effects
The side effects of testosterone in women are dose-related and largely reflect levels pushed above the female range. The meta-analysis found that women on testosterone were more likely to report acne and increased hair growth, with no serious adverse events recorded across the trials.[1]
At higher-than-physiologic doses, the effects become more concerning: voice deepening, enlargement of the clitoris, and scalp hair thinning. Voice changes may not reverse after stopping. These are the reason our providers check levels before starting and recheck them after the first cycle, keeping doses low and adjusting from measured results rather than symptoms alone.
Weight is worth addressing directly because the question comes up constantly. The meta-analysis recorded a small overall increase in weight with testosterone treatment.[1] Testosterone is not a weight loss therapy for women and should not be presented as one.
Regulatory Status
There is no FDA-approved testosterone product for women in the United States. Every prescription for a woman is off-label, whether it is a fraction of a product approved for men or a compounded cream, lotion, or injection prepared by a 503A pharmacy. Compounded testosterone has not been reviewed by the FDA for safety or effectiveness.
Testosterone is also a Schedule III controlled substance, which places additional requirements on how it is prescribed and dispensed, including through telehealth.
None of this means testosterone for women is inappropriate. The international consensus exists precisely because the evidence supports its use for a specific indication. It does mean you should expect your provider to say the words “off-label” out loud and explain what that means.
Who Is a Candidate
Our providers consider testosterone for women who are postmenopausal, have low sexual desire that bothers them, have had other contributors addressed (vaginal discomfort, mood, relationship factors, medications that suppress desire), and have no contraindications such as hormone-sensitive cancer. Testosterone is often added to an estrogen and progesterone protocol rather than used alone, and the provider decides between cream, lotion, and injection based on the individual.
Our hormone replacement therapy for women program includes testosterone as one option within a broader evaluation, not as a standalone product.
References
Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754-766. PubMed: 31353194
Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660-4666. PubMed: 31498871
This article is for educational purposes only and does not constitute medical advice or establish a provider-patient relationship. Please consult a licensed healthcare provider for personalized guidance.
Angela Kifer, NP, is a licensed provider at Precision Telemed. This article has been reviewed for clinical accuracy.
