How Testosterone Therapy Can Support Women’s Health in Postmenopause

Introduction

Menopause is a natural stage of life that marks the end of a woman’s menstrual cycles. It usually happens between the ages of 45 and 55, though it can occur earlier or later. Doctors say a woman has reached menopause when she has gone 12 months in a row without a period. After this point, she enters what is called postmenopause. Postmenopause is not just about the end of periods. It also brings changes to hormone levels in the body. Estrogen and progesterone, the two main female hormones, fall to very low levels. Testosterone, another important hormone, also drops with age. These shifts can have a big effect on health and quality of life.

Most people know that estrogen is important for women’s health, but not as many realize that women also need testosterone. Testosterone is often thought of as the “male hormone,” but women make it too—just in smaller amounts. In fact, testosterone is produced in a woman’s ovaries and adrenal glands. Even though the levels are much lower than in men, testosterone still plays a major role in energy, mood, sexual health, muscle strength, and bone protection. When levels drop too low, women may notice symptoms that affect daily living.

Postmenopause is a time when these changes become clear. Many women experience fatigue, lower sexual desire, weight gain, mood swings, and changes in thinking or memory. Bone loss, muscle weakness, and a slower metabolism may also appear. Some of these issues are connected to the decline in estrogen, while others may be linked to falling testosterone. Because of this, more women and healthcare providers are asking: could testosterone therapy help improve health after menopause?

Testosterone therapy means giving the body extra testosterone to bring levels back to a healthier range. The goal is not to make a woman’s body act like a man’s, but to restore balance. Treatment can come in many forms, such as creams, gels, injections, patches, or tiny pellets placed under the skin. Each option has different pros and cons, but the main idea is the same: support the body with a hormone it is no longer making enough of.

Over the last 20 years, research on testosterone therapy for women has grown. Studies suggest that in some women, treatment may improve energy, mood, sexual function, and even physical strength. At the same time, experts stress that therapy must be done carefully. Too much testosterone can cause side effects, such as acne, hair growth on the face, or changes in the voice. Doctors recommend that treatment should always stay within the normal female range. That is why blood tests and medical supervision are important parts of safe therapy.

Public interest in testosterone therapy is rising. Many women search online for answers to their questions: Is it safe? Will it help with fatigue? Can it improve weight control? What are the risks? These are important questions, and clear information is not always easy to find. Some websites may oversimplify, while others may give conflicting advice. This can make it confusing for women who are simply trying to understand their options.

The goal of this article is to give a clear and balanced overview of testosterone therapy for postmenopausal women. It will explain what testosterone is, why it matters in women’s health, and how therapy is used. It will look at the possible benefits and risks, who may be a good candidate, and what the latest research shows. It will also cover practical issues, such as how therapy is given, how it is monitored, and what women should know before considering treatment.

By the end, readers will have a full picture of how testosterone therapy may support women’s health in postmenopause. The information here is not meant to replace medical advice but to provide knowledge that can help women talk with their healthcare providers. Each woman’s situation is unique, and decisions about treatment should be made with a trusted medical professional.

Postmenopause can be a challenging time, but it is also an opportunity to focus on long-term health and well-being. Hormone therapy, including testosterone, is one option that may help some women live with greater energy and vitality. Understanding the facts is the first step toward making informed choices. This article aims to answer the key questions women are asking, using clear language and up-to-date medical knowledge.

What Is Testosterone Therapy for Women?

When most people hear the word “testosterone,” they often think of men. Testosterone is commonly known as the “male hormone.” But the truth is, women also make testosterone, though in much smaller amounts than men. In women, testosterone is produced in the ovaries and adrenal glands. Even though levels are lower, it plays a very important role in energy, mood, bone strength, sexual health, and muscle function.

As women reach menopause and then move into postmenopause, natural testosterone levels decline further. Some women may experience symptoms linked to this drop, such as low sexual desire, fatigue, or reduced muscle strength. In such cases, doctors may recommend testosterone therapy to restore hormone levels to what is considered normal for women.

What Exactly Is Testosterone Therapy?

Testosterone therapy is a medical treatment where a woman receives small, carefully measured doses of testosterone. The goal is not to give women the same amount of testosterone as men. Instead, it is to bring levels back to the healthy range for women. This is called physiologic replacement—restoring the body to a natural balance, not pushing it beyond.

The therapy can be given in different forms. Each type of treatment has its own benefits and challenges.

Forms of Testosterone Therapy

1. Creams and Gels
   • These are applied to the skin, usually on the arm, thigh, or abdomen.

   • The hormone passes through the skin and enters the bloodstream.

   • The dose can be adjusted easily, and it avoids the need for needles.

   • One challenge is making sure the cream does not rub off on someone else by accident. For example, contact with a child or partner soon after application could expose them to the hormone.

2. Patches
   • Similar to nicotine patches, these stick to the skin and release testosterone slowly.

   • They provide steady levels, but they are not always available in doses made for women.

   • Skin irritation at the patch site can sometimes occur.

3. Injections
   • Testosterone can be injected into the muscle every few weeks.

   • Injections often cause hormone levels to rise quickly, then slowly drop until the next dose. This can create ups and downs in how a person feels.

   • Because of this, injections are less commonly used for women than for men.

4. Pellets
   • Tiny pellets containing testosterone can be placed under the skin, usually near the hip or buttock, during a short office procedure.

   • These release hormone slowly over several months.

   • The advantage is not having to apply a cream or take frequent doses.

   • The disadvantage is that once the pellet is placed, the dose cannot easily be adjusted until the next procedure.

5. Oral Tablets
   • In some countries, oral testosterone tablets exist.

   • However, they are not widely recommended for women because they can stress the liver and may cause unwanted side effects.

   • In the United States, there are no FDA-approved oral testosterone products for women.

How Is Testosterone Therapy Different from Estrogen Therapy?

Many women are familiar with estrogen therapy, which is a common treatment for symptoms of menopause such as hot flashes, night sweats, and vaginal dryness. While estrogen helps relieve those issues, it does not always improve energy, muscle health, or sexual desire. This is where testosterone therapy can sometimes play an additional role.

Estrogen and testosterone work differently in the body:

• Estrogen protects bone, skin, and heart health, and helps with body temperature control.

• Testosterone helps support energy, motivation, sexual function, and muscle strength.

In some cases, doctors may prescribe both estrogen and testosterone together, depending on a woman’s symptoms and health history.

Key Differences Between Men’s and Women’s Therapy

It is important to understand that testosterone therapy for women is not the same as it is for men. Men often need higher doses because their bodies naturally make much more testosterone. For women, the goal is to restore hormone levels only to what is natural and healthy for females. Too much testosterone can cause side effects such as acne, extra body hair, or a deeper voice. That is why therapy must always be carefully prescribed and monitored by a healthcare professional.

Testosterone therapy for women is a way to replace a hormone that declines with age. It can be given through creams, gels, patches, injections, or pellets. Unlike estrogen therapy, which mainly targets hot flashes and bone health, testosterone therapy focuses on energy, sexual function, and muscle strength. Most importantly, therapy for women is carefully tailored to give only small doses—enough to restore balance, not to reach male levels.

Why Consider Testosterone Therapy After Menopause?

Menopause is a natural stage in a woman’s life. It usually happens between ages 45 and 55, when the ovaries stop releasing eggs and menstrual periods end. After this transition, women enter postmenopause. During this stage, levels of important hormones such as estrogen, progesterone, and testosterone drop to very low levels. Most people are familiar with estrogen decline, but many do not realize that testosterone also decreases with age.

Although testosterone is often thought of as a “male hormone,” it is also made in smaller amounts in women’s ovaries and adrenal glands. Testosterone plays a role in energy, muscle strength, mood, and sexual health. In fact, women produce three to four times more testosterone than estrogen before menopause. After menopause, testosterone levels fall even more, and this change may contribute to symptoms that affect quality of life.

For this reason, doctors and researchers have studied whether testosterone therapy can help some postmenopausal women. Below, we will look at the main reasons why a woman may consider this type of treatment.

The Natural Decline of Testosterone with Age

Testosterone production in women begins to decline gradually in the late 20s or early 30s. By the time a woman reaches menopause, her levels may be half of what they were at a younger age. After the ovaries stop working, testosterone levels drop even further.

This slow but steady decline means that many women do not notice the change right away. Instead, they may experience symptoms over time, such as feeling more tired, losing interest in sex, or noticing changes in mood or body composition. These symptoms are often blamed only on low estrogen, but in some cases, low testosterone may also play a role.

Symptoms Linked to Low Testosterone

When testosterone is very low, women may notice one or more of the following:

• Fatigue and Low Energy: Many women say they feel “worn out” or lack the energy they used to have. This can make daily activities more difficult.

• Low Libido and Sexual Problems: Testosterone is important for sexual desire and arousal. Low levels can lead to reduced interest in sex, fewer orgasms, or discomfort during intimacy.

• Mood Changes: Some studies suggest that low testosterone may be linked to feelings of sadness, lack of motivation, or irritability.

• Muscle Weakness and Loss of Strength: Testosterone helps maintain lean muscle. Lower levels may lead to weaker muscles and less endurance.

• Changes in Body Composition: Women with low testosterone may notice more body fat, especially around the waist.

• Cognitive Effects: Although research is still ongoing, low testosterone may affect concentration, memory, or mental clarity.

These symptoms can overlap with those caused by low estrogen, thyroid problems, or aging in general. That is why it is important for women to speak with a healthcare provider before assuming testosterone therapy is the answer.

Goals of Testosterone Therapy in Postmenopausal Women

The main goal of testosterone therapy is not to return hormone levels to those of a 20-year-old woman, but to restore them to a healthy range for adulthood. Therapy may be considered when symptoms are affecting quality of life and blood tests show low levels of testosterone.

Possible goals of therapy include:

• Restoring Vitality: By improving energy and reducing fatigue, therapy may help women stay active and engaged in daily life.

• Supporting Sexual Health: This is the most well-documented benefit. Many women report stronger sexual desire, better arousal, and more satisfying intimacy.

• Improving Mood and Motivation: Some women notice improvements in mood stability and motivation, although research results are mixed.

• Preserving Bone and Muscle Health: Testosterone helps build muscle and may also support bone density, lowering the risk of osteoporosis and fractures.

• Enhancing Overall Well-Being: When energy, sexual health, and physical strength improve, women may feel more confident and capable.

Postmenopause is a stage of life that brings big hormonal changes. While much attention is given to estrogen loss, testosterone decline can also have a major impact. Symptoms like low energy, sexual problems, muscle weakness, and mood changes may be connected to low testosterone.

Considering testosterone therapy is not about “anti-aging” or turning back the clock. Instead, it is about finding balance and improving quality of life. Therapy may help restore vitality, support sexual function, and strengthen bones and muscles.

It is important to remember that testosterone therapy is not right for everyone. Some women may benefit, while others may not notice much change. The decision should always be made with a healthcare professional who can review symptoms, run blood tests, and provide safe medical guidance.

What Are the Benefits of Testosterone Therapy in Postmenopausal Women?

Testosterone is often thought of as a “male” hormone, but it is also very important in women’s health. Even though women naturally have much lower levels than men, testosterone plays key roles in sexual function, energy, mood, muscle strength, and bone health. After menopause, many women experience a drop in testosterone that can lead to troubling symptoms. In these cases, carefully managed testosterone therapy may help.

This section looks at the main benefits of testosterone therapy in postmenopausal women based on research and medical evidence.

Improved Sexual Desire and Function

One of the best-studied benefits of testosterone therapy for women after menopause is its effect on sexual health. Low testosterone is linked to low sexual desire, difficulty with arousal, and reduced satisfaction during sex. These problems can cause distress and impact relationships.

Clinical studies show that testosterone therapy can:

• Increase sexual desire and thoughts about sex.

• Improve arousal and responsiveness.

• Make sexual activity more enjoyable and satisfying.

• Reduce pain during intercourse in some women, often when used alongside estrogen.

In fact, the strongest medical evidence for testosterone therapy in women is in the treatment of hypoactive sexual desire disorder (HSDD). This condition describes women who have a persistent lack of interest in sex that causes personal distress. Multiple large studies and reviews confirm that testosterone therapy can significantly improve symptoms of HSDD in postmenopausal women.

More Energy and Vitality

Many women report feeling more energetic and motivated when testosterone levels are balanced. Fatigue is a common complaint after menopause, often linked to hormone changes, sleep disruption, and aging. While not every woman experiences an energy boost, studies suggest that testosterone therapy may help:

• Reduce constant tiredness.

• Improve overall vitality.

• Support motivation to engage in daily activities and exercise.

These effects are subtle and vary between women. Still, when fatigue is linked to low testosterone, restoring hormone levels may help improve day-to-day quality of life.

Better Mood and Cognitive Function

Testosterone also affects the brain. Research shows that low testosterone in women may be linked to mood changes such as irritability, low motivation, or mild depression. Some studies also suggest connections between testosterone and cognitive functions like memory and attention.

Testosterone therapy has been shown in some women to:

• Improve overall mood stability.

• Reduce feelings of sadness or frustration.

• Increase motivation and mental focus.

The evidence is mixed, and not all women see changes, but the potential benefits on emotional well-being make testosterone therapy an area of ongoing study. For some, restoring hormone balance can help them feel more like themselves again.

Stronger Bones and Muscles

Bone density and muscle strength naturally decline after menopause. Estrogen loss plays a major role, but testosterone is also important for keeping bones and muscles strong.

Research suggests that testosterone therapy may:

• Support muscle growth and maintenance.

• Improve physical strength and endurance.

• Help preserve bone density, lowering the risk of fractures over time.

This is especially valuable because postmenopausal women face a higher risk of osteoporosis and related fractures. While estrogen therapy remains the main treatment for bone health, adding testosterone may give extra support for muscle and skeletal strength. Stronger muscles also help protect bones by improving balance and reducing falls.

Current Consensus from Medical Organizations

Medical groups recognize the potential benefits of testosterone therapy, but they also caution that it should be prescribed carefully. The International Menopause Society (IMS) and the Endocrine Society agree that the only clearly proven use of testosterone therapy in women is for postmenopausal women with diagnosed low sexual desire that causes distress.

Other possible benefits, like more energy, better mood, or stronger bones, are promising but not yet proven by large long-term studies. That means women may experience these improvements, but doctors cannot yet guarantee them as standard outcomes.

Healthcare providers usually recommend testosterone therapy only when:

• A woman has clear symptoms of low testosterone, such as low sexual desire.

• Other causes of the symptoms have been ruled out.

• Blood tests and clinical evaluation confirm low testosterone levels.

Testosterone therapy in postmenopausal women may offer several important benefits. The strongest and most proven effect is an improvement in sexual desire and function, especially for women struggling with hypoactive sexual desire disorder. Other benefits may include more energy, better mood, and support for muscle and bone strength.

These positive effects can improve overall quality of life for some women. However, responses vary, and ongoing medical monitoring is essential. While research is encouraging, more studies are needed to fully understand long-term benefits and risks.

Is Testosterone Therapy Safe for Women?

When women think about hormone therapy after menopause, safety is often the first question that comes to mind. Testosterone is usually linked with men, but women also make it in small amounts. As women age, testosterone levels naturally drop. This can cause symptoms like tiredness, low interest in sex, or weaker muscles. Some doctors may suggest testosterone therapy to help with these issues. But is it safe? Let’s look closely at what the research says, how dose and method matter, and what possible risks women should know about.

Understanding “Safe Use”

It is important to understand that testosterone therapy for women is not the same as the high-dose testosterone or anabolic steroids sometimes misused by athletes. Medical testosterone therapy for women uses much smaller, carefully measured doses designed to bring hormone levels back to what is considered normal for a healthy premenopausal woman. This is called physiologic replacement.

When testosterone is given at these controlled levels, many studies show that it can be safe and helpful. The problems usually arise when testosterone is taken in high amounts or without medical supervision.

What Studies Show

Several clinical trials have tested testosterone therapy in postmenopausal women. The strongest evidence is for improving sexual desire and satisfaction. These studies, often lasting 6–24 months, generally report few serious side effects when the hormone is given in proper doses. Some women notice mild effects like acne or extra hair growth, but these are usually manageable and go away if the dose is lowered.

Long-term safety is less clear. There are still not enough studies lasting 5, 10, or 20 years to know every possible risk. Because of this, many doctors recommend testosterone therapy only for women who have clear symptoms and who do not find relief from other treatments.

Possible Side Effects

Even though therapy is usually well tolerated, side effects can happen. They depend on the dose, how the hormone is given, and a woman’s own sensitivity.

Mild side effects may include:

• Acne or oily skin: Testosterone can stimulate oil glands in the skin.

• Hair growth: Some women notice extra hair on the face or body.

• Changes in mood or energy: This can be positive or negative, depending on the individual.

Moderate side effects are less common but can occur with higher doses or long-term use:

• Voice deepening: This may not reverse after stopping therapy.

• Clitoral enlargement: Rare at medical doses but possible.

• Hair thinning on the scalp: Similar to male-pattern baldness in some cases.

Serious but rare concerns include:

• Liver strain: Especially when testosterone is taken in oral pill form, which is not recommended for women.

• Changes in cholesterol: Some studies suggest possible effects on “good” and “bad” cholesterol, which could raise heart risk over time.

• Breast and uterine tissue effects: There is still debate about whether testosterone therapy raises the risk of certain cancers. Current evidence does not show a clear link, but more research is needed.

Importance of Supervision

The key to safety is medical supervision. Women should not buy testosterone products online or from unregulated sources. Instead, therapy should be prescribed by a qualified healthcare provider who:

1. Confirms low testosterone symptoms.

2. Checks blood levels before treatment.

3. Chooses the right dose and form (usually gel, cream, or patch).

4. Monitors blood tests and side effects regularly.

Follow-up visits allow doctors to adjust the dose if needed and reduce the chance of side effects.

Differences Between Delivery Methods

• Topical gels or creams: Often safest because the hormone is absorbed through the skin and avoids the liver.

• Patches: Provide steady hormone levels but may cause skin irritation.

• Pellets (implanted under the skin): Release testosterone slowly but are harder to adjust if side effects appear.

• Injections: Less commonly used for women because they may deliver too much hormone at once.

• Oral pills: Usually avoided, since they can stress the liver and affect cholesterol.

Individual Risk Factors

Not every woman is a good candidate for testosterone therapy. Women with a history of hormone-sensitive cancers (like breast or uterine cancer), serious liver disease, or high cardiovascular risk may be advised against it. For others, the benefits may outweigh the risks, especially when therapy is closely monitored.

Testosterone therapy can be safe for many postmenopausal women when used at the right dose, with the right delivery method, and under the care of a healthcare professional. Most side effects are mild and can be managed by adjusting the dose. The biggest unknown is the long-term safety beyond a few years. This is why ongoing monitoring and open discussion with a doctor are essential.

How Does Testosterone Therapy Compare to Estrogen Therapy?

When women reach menopause, the levels of both estrogen and testosterone in the body fall. These two hormones play different but connected roles in women’s health. Because of this, doctors often consider how estrogen therapy and testosterone therapy can work separately and together to relieve symptoms. Understanding the differences and possible overlap helps women make safer, informed choices.

The Role of Estrogen in Postmenopause

Estrogen is the main hormone that declines at menopause. This drop leads to many of the symptoms women often notice, such as:

• Hot flashes and night sweats.

• Vaginal dryness and discomfort during sex.

• Bone loss, which increases the risk of osteoporosis.

• Changes in skin elasticity and thickness.

Estrogen therapy has been used for decades to manage these symptoms. In many women, it is considered the first-line treatment because it directly addresses the sudden loss of estrogen.

However, estrogen therapy does not fully solve every health concern. While it helps with hot flashes, vaginal dryness, and bone protection, it may not improve sexual desire, muscle strength, or energy in the same way testosterone can.

The Role of Testosterone in Postmenopause

Testosterone is sometimes called the “male hormone,” but women also produce it in their ovaries and adrenal glands. In fact, before menopause, women make three to four times more testosterone than estrogen each day. After menopause, the ovaries stop producing both hormones, and testosterone levels drop by almost half.

Low testosterone in women has been linked to:

• Reduced sexual desire and lower arousal.

• Fatigue and loss of vitality.

• Decreased muscle strength and bone density.

• Possible changes in mood, such as lack of motivation or reduced confidence.

Testosterone therapy, when given in low doses meant for women, can help restore some of these functions. It is not meant to replace estrogen, but to add another layer of support where estrogen alone may not be enough.

Estrogen Therapy vs. Testosterone Therapy

While both therapies can support women’s health, they target different symptoms.

Estrogen therapy helps most with:

• Hot flashes and night sweats.

• Vaginal dryness and painful sex.

• Bone strength and protection against fractures.

Testosterone therapy helps most with:

• Sexual desire and satisfaction.

• Energy and feelings of vitality.

• Muscle mass and possibly lean body weight.

Because of these differences, many women benefit from a combined approach, where estrogen treats certain menopausal symptoms while testosterone addresses others.

When Testosterone Is Considered in Addition to Estrogen

Doctors may recommend testosterone therapy in addition to estrogen for women who still struggle with certain issues despite being on estrogen therapy. For example:

• A woman on estrogen who still has very low sexual desire may improve with testosterone.

• Someone who feels persistent fatigue or loss of motivation may benefit from a testosterone boost.

• A woman concerned about bone and muscle loss may use testosterone as an added support.

It is important to note that testosterone is not given to every postmenopausal woman. Instead, it is reserved for those who meet specific medical criteria, especially those diagnosed with hypoactive sexual desire disorder (HSDD).

Combination vs. Single-Hormone Approaches

• Single-hormone approach: Some women take only estrogen or only testosterone, depending on their symptoms. For instance, a woman suffering mainly from hot flashes may need only estrogen. A woman whose main complaint is low libido may consider testosterone.

• Combination approach: Other women take both. This combination is useful when multiple symptoms are present, and one hormone alone does not provide enough relief.

Combination therapy requires careful monitoring to balance the benefits while minimizing risks. Doctors usually start with low doses and adjust based on the woman’s response.

Estrogen and testosterone each play unique roles in women’s health after menopause. Estrogen focuses on hot flashes, vaginal health, and bone protection. Testosterone is more effective for sexual desire, energy, and muscle support. Some women may need only estrogen, while others may need a combination of both. Working with a knowledgeable healthcare provider is essential, since hormone therapy must be tailored to each woman’s symptoms, medical history, and personal health goals.

Who Is a Candidate for Testosterone Therapy?

Not every woman going through postmenopause is a good fit for testosterone therapy. Doctors look at a woman’s health history, symptoms, and sometimes blood test results before deciding if this treatment is right. In this section, we will go step by step through who may benefit, how doctors decide, and who should not use testosterone therapy.

Why Careful Selection Matters

Testosterone therapy can bring benefits, but it is not risk-free. Too much testosterone can cause unwanted side effects such as acne, hair growth, or voice changes. It can also make certain health conditions worse. That is why careful selection is important. Doctors want to find the women who will benefit most with the least risk.

Common Reasons Women Consider Testosterone Therapy

Postmenopausal women may be considered for testosterone therapy if they experience:

• Low sexual desire or interest that causes distress or affects relationships. This is one of the most studied reasons.

• Persistent fatigue or low energy, especially when other causes like thyroid problems or anemia have been ruled out.

• Loss of muscle strength or bone density not explained by other conditions.

• Mood changes, irritability, or brain fog that do not respond well to other treatments.

These symptoms may overlap with natural aging, but when they are strong and ongoing, testosterone therapy may be part of the conversation.

The Role of Blood Tests

Doctors may order blood tests to measure testosterone levels. However, this is not always straightforward. Normal testosterone ranges for women are very low compared to men. Levels also vary during the day and can change from person to person. Because of this, blood tests are usually not enough by themselves.

Instead, doctors use blood results together with symptoms. For example, if a woman has very low measured testosterone and also reports loss of sexual interest, therapy may be considered. But if levels are normal and symptoms point to another cause, testosterone may not be recommended.

Who Is Most Likely to Benefit

Based on current research and medical guidelines, women most likely to benefit from testosterone therapy include:

• Postmenopausal women with Hypoactive Sexual Desire Disorder (HSDD): This condition means ongoing lack of sexual desire that causes distress. Studies show testosterone can help improve sexual interest and satisfaction in these women.

• Women who have had both ovaries removed (surgical menopause): Their hormone levels often drop sharply, and symptoms may be stronger.

• Women who tried estrogen therapy but still have low sexual desire: Sometimes testosterone is added to estrogen when estrogen alone does not help.

Who Should Not Use Testosterone Therapy

Some women should avoid testosterone therapy because it can worsen their condition or increase health risks. These include:

• History of breast cancer or other hormone-sensitive cancers: Testosterone can sometimes convert into estrogen in the body, which may fuel cancer growth.

• Liver disease: The liver processes hormones, and added testosterone can place stress on it.

• Severe heart or blood vessel disease: There is still concern about the effect of testosterone on cholesterol and cardiovascular risk.

• Pregnant or breastfeeding women: Although rare in postmenopause, testosterone should not be used during pregnancy or nursing.

• Women with unexplained vaginal bleeding: This must be checked before starting any hormone therapy.

Doctors also avoid giving testosterone if a woman’s symptoms may be better explained by depression, thyroid problems, or medication side effects.

The Importance of Medical Supervision

Some women try to buy testosterone creams or supplements without a prescription. This is not safe. Non-prescription or “bioidentical” products sold online or in spas may contain unregulated amounts of testosterone. Too much can cause long-term side effects such as voice changes or clitoral enlargement that may not go away.

Medical supervision ensures:

• The dose is correct for women (much smaller than men’s doses).

• Blood levels are checked regularly.

• Other causes of symptoms are ruled out.

• Treatment is adjusted if side effects occur.

The Decision-Making Process

The process of deciding if a woman is a candidate usually includes:

1. Detailed health history – cancer risks, liver function, heart health.

2. Review of symptoms – especially sexual desire, mood, energy, and bone/muscle strength.

3. Physical exam – looking for signs of hormone imbalance.

4. Blood tests – sometimes used as a guide, but not the only factor.

5. Shared decision-making – doctor and patient discuss benefits, risks, and personal goals.

Not all women in postmenopause should take testosterone therapy. The best candidates are those with clear symptoms such as low sexual desire that cause distress, especially if confirmed by low blood levels. Women with certain health conditions should not use it. Medical supervision is essential to keep treatment safe and effective.

How Is Testosterone Therapy Administered and Monitored?

When women start testosterone therapy after menopause, one of the most important questions is how the treatment is given and how doctors make sure it is safe. Unlike estrogen, which has many well-studied forms for women, testosterone treatments were first designed for men. This means doctors must carefully adjust the dose, the delivery method, and the follow-up plan to make sure women get safe and steady benefits.

This section explains the different ways testosterone can be given, how doctors decide on the right dose, and what kind of monitoring is needed to protect health.

Delivery Methods of Testosterone Therapy

There are several forms of testosterone therapy available. Each one has advantages and challenges.

1. Topical Gels and Creams

• These are applied directly to the skin, usually on the arms, thighs, or abdomen.

• The hormone is absorbed slowly into the bloodstream through the skin.

• This method allows flexible dosing because the amount can be adjusted by the size of the application.

• Women must be careful not to spread the gel or cream to children, partners, or pets through skin contact.

2. Transdermal Patches

• These patches stick to the skin and release testosterone steadily over time.

• They are easy to use but may cause skin irritation in some people.

• Patches provide more stable hormone levels compared to creams or gels, which may rise and fall during the day.

3. Injections

• Testosterone injections are given into the muscle or under the skin.

• Injections can be weekly, biweekly, or monthly depending on the type of testosterone used.

• They may cause levels to spike right after the shot and drop before the next dose, which can lead to mood or energy swings.

• Injections require either a doctor’s visit or training to self-inject.

4. Implants (Pellets)

• Tiny pellets are placed under the skin, often in the hip or buttock area, using a small medical procedure.

• The pellets release testosterone slowly for three to six months.

• This method is convenient because it avoids daily use, but once placed, the dose cannot be adjusted until the next procedure.

• There is a small risk of infection or pellet movement.

5. Oral Tablets or Capsules

• Oral testosterone is not widely recommended for women because it can affect the liver when processed in the digestive system.

• Some countries allow oral forms, but doctors usually prefer safer delivery methods like gels or patches.

Typical Dosing for Women

One of the most important parts of therapy is getting the dose right. Women’s bodies need only a small fraction of the testosterone that men need. Giving too much can cause side effects like acne, excess hair growth, or changes in the voice.

• Doses are usually designed to restore testosterone to the normal female range, not the male range.

• Therapy starts with a low dose, and the doctor adjusts it based on symptoms and blood test results.

• Compounded formulations (special mixes made in pharmacies) are sometimes used when commercial products are not available in the right strength for women. However, these should only be obtained from reliable pharmacies that follow safety standards.

Monitoring Protocols

Starting testosterone therapy is not a “one-and-done” treatment. Careful monitoring is needed to make sure the hormone levels stay safe and the benefits outweigh any risks.

1. Blood Tests

• Blood tests check testosterone levels to confirm they are within the normal female range.

• Doctors often test before starting therapy, then again after a few weeks or months, and then every 6–12 months.

• Other labs may include cholesterol, liver function, and sometimes blood counts, since hormones can affect these systems.

2. Symptom Tracking

• Monitoring is not just about numbers. Doctors also ask about energy, mood, sexual health, and physical changes.

• A symptom diary can help women notice patterns or side effects early.

3. Side Effect Monitoring

• Doctors look for unwanted signs such as acne, oily skin, increased body hair, or voice changes.

• If these occur, the dose may be lowered or the delivery method changed.

• Long-term risks, such as effects on the heart, liver, or breast tissue, are still being studied, which is why ongoing follow-up is important.

Importance of Follow-Up Care

Regular follow-up visits are key to safe therapy. Women should see their healthcare provider every few months in the beginning, then at least once or twice a year. During these visits:

• Lab results are reviewed.

• Symptoms are discussed.

• Adjustments to dose or method can be made.

• Other health issues are checked to make sure testosterone therapy is not interfering.

Testosterone therapy for postmenopausal women can be given in several ways: creams, gels, patches, injections, or implants. Each method has benefits and drawbacks, and the best choice depends on lifestyle, medical history, and doctor recommendation. Because women need only small doses, careful adjustments and frequent monitoring are essential. Blood tests, symptom checks, and regular follow-ups help keep the treatment safe and effective.

What Are the Risks and Side Effects of Testosterone Therapy?

When thinking about any hormone treatment, it is important to understand both the possible benefits and the possible risks. Testosterone therapy can improve certain symptoms in postmenopausal women, but it can also bring side effects. These effects depend on the dose, the form of the medicine, and how carefully it is monitored.

Doctors usually aim to give a physiologic dose, meaning a level of testosterone similar to what healthy women naturally produce. Problems are more likely when the dose is too high or when the therapy is not supervised. Below is a detailed look at the possible risks and side effects.

Mild and Common Side Effects

The most common effects are mild and often improve if the dose is lowered or the method of treatment is changed.

• Acne and oily skin: Testosterone can increase oil production in the skin, leading to pimples, especially on the face, chest, or back. This is more likely if levels rise above the normal female range.

• Increased body hair: Some women notice more hair on the face, chest, or arms. This is called hirsutism. The change is usually gradual and depends on sensitivity of hair follicles.

• Thinning scalp hair: At higher doses, testosterone can trigger hair loss at the temples or crown, similar to male-pattern baldness.

These side effects are generally mild at medical doses but may be bothersome for some women.

Moderate or Less Common Side Effects

Some changes are less common but more serious if they occur. They are also more likely at higher doses or with long-term use.

• Voice deepening: Testosterone can thicken the vocal cords. This may cause a deeper or hoarser voice. Unlike acne or hair growth, this effect is usually permanent even if therapy is stopped.

• Clitoral enlargement: The clitoris may grow slightly larger. At low doses, this is uncommon, but if it happens, the change does not fully reverse.

• Mood or behavior changes: While testosterone may improve mood and energy, too much can sometimes lead to irritability, restlessness, or aggressive feelings. Careful monitoring helps prevent this.

Cardiovascular and Metabolic Concerns

Because testosterone influences cholesterol, blood pressure, and blood vessels, doctors are cautious about heart risks. Research so far shows mixed results:

• Cholesterol changes: Some studies suggest that testosterone can lower HDL cholesterol (the “good” cholesterol) while not always raising LDL (the “bad” cholesterol). Doctors usually track cholesterol levels during treatment.

• Blood pressure and clot risk: Unlike estrogen, testosterone has not been strongly linked to blood clots. But data is limited, and women with existing heart disease may need closer monitoring.

• Diabetes and weight: There is some evidence that testosterone may help with muscle mass and insulin sensitivity, but too much hormone can have the opposite effect.

For women with diabetes, high blood pressure, or heart disease, therapy must be prescribed with caution.

Liver and Hormone Balance Risks

• Liver effects: In the past, oral testosterone pills caused liver problems because the hormone had to be broken down by the liver. Today, most doctors avoid oral forms and use gels, creams, or implants instead. These newer forms do not stress the liver in the same way.

• Hormone imbalance: If testosterone levels are too high, some of the hormone may be converted into estrogen by the body. This can create unwanted side effects like breast tenderness or irregular bleeding.

Long-Term and Unknown Risks

One of the biggest questions in women’s health is what happens with testosterone therapy after many years of use. Research has not yet followed large groups of women over decades, so some answers are unknown.

• Cancer risk: There is not enough evidence to say if testosterone increases or decreases the risk of breast or uterine cancer. Current studies suggest that short-term use at low doses does not raise the risk, but more research is needed.

• Brain and memory: Testosterone may help mood and focus, but its long-term effects on memory, dementia, or brain health remain unclear.

• Overall survival: No large study has yet shown whether testosterone therapy helps women live longer or raises overall health risks in the long term.

The Importance of Monitoring

Because of these possible risks, medical supervision is essential. A safe approach usually includes:

1. Baseline testing – checking hormone levels, cholesterol, and liver function before starting.

2. Regular follow-ups – blood tests every few months in the first year, then at least once a year.

3. Symptom check – adjusting the dose if acne, hair growth, or mood changes appear.

4. Ongoing evaluation – stopping therapy if serious side effects develop.

Testosterone therapy can improve health and quality of life for many postmenopausal women, but like any hormone treatment, it carries risks. Most side effects are mild and manageable if therapy is carefully monitored. The more serious effects are rare when doses are kept in the normal female range. Long-term safety is still being studied, so open communication with a healthcare provider is essential before starting and during therapy.

What Does the Latest Research Say About Testosterone in Postmenopause?

Testosterone therapy for women after menopause is still a growing field of study. While estrogen therapy has been studied for decades, testosterone research is much newer. Over the last 15 to 20 years, clinical trials and systematic reviews have helped us better understand how testosterone works in postmenopausal women. The results show some clear benefits, but there are also gaps in knowledge. Below, we look at the main areas where research has focused: sexual function, general health benefits, safety, and what global regulators say.

Key Findings from Large Trials and Reviews

One of the strongest areas of research is sexual health. Multiple large studies and reviews have shown that testosterone therapy can help women after menopause who suffer from low sexual desire or hypoactive sexual desire disorder (HSDD).

• In randomized controlled trials, women who received testosterone reported more sexual thoughts, greater arousal, and more satisfaction with sexual activity compared to women who received placebo.

• A 2019 global position statement, led by the International Menopause Society and several other professional groups, concluded that testosterone therapy is effective for treating HSDD in postmenopausal women.

• Importantly, these improvements were seen even when women were already using estrogen therapy, which suggests testosterone has a unique role beyond estrogen.

When researchers pooled results from many trials in a meta-analysis, the benefits were clear. On average, women reported one to two additional satisfying sexual experiences per month compared to placebo. While that might sound small, it was a meaningful change for women who had been struggling for years.

Evidence for Sexual Function Improvement

Most of the research evidence focuses on sexual function. This is the only use of testosterone therapy that is broadly supported by medical guidelines today. Testosterone appears to:

• Increase sexual desire and interest.

• Improve arousal and responsiveness.

• Enhance pleasure and satisfaction during intimacy.

These effects are strongest when testosterone is prescribed at physiologic doses—meaning doses that restore testosterone to normal female levels, not the much higher levels used in men. At these doses, women often feel improvements without developing masculine side effects.

Other Potential Benefits Under Study

Research on non-sexual benefits is less complete. Some studies have suggested that testosterone might:

• Improve mood and well-being: A few trials found reductions in anxiety, irritability, and depressive symptoms, but the evidence is mixed. Larger, longer studies are still needed.

• Support bone health: Because testosterone contributes to bone strength, researchers are looking at whether therapy can reduce osteoporosis risk. Early results are promising but not conclusive.

• Help with muscle mass and strength: Small studies show increases in lean body mass, which may help reduce frailty after menopause.

• Boost energy and reduce fatigue: Many women report this anecdotally, but the scientific evidence is limited.

Right now, medical groups agree there is not enough strong evidence to recommend testosterone therapy for these general health benefits. More long-term studies are needed.

Safety Findings So Far

Safety is one of the biggest questions in testosterone research. The results so far are cautiously reassuring:

• Short-term use of physiologic doses appears safe. Studies lasting up to two years show no major increase in serious side effects.

• Common mild side effects include acne, oily skin, or increased body hair.

• More serious changes, such as voice deepening or clitoral enlargement, are rare when doses are carefully managed.

However, many questions remain. Most studies are short (often less than two years) and involve relatively small numbers of women. This means we do not yet know the long-term effects on heart health, stroke, breast cancer, or dementia risk. Researchers stress the need for ongoing monitoring and longer trials.

Regulatory Perspective

The U.S. Food and Drug Administration (FDA) has not yet approved a testosterone product specifically for women. In practice, doctors often prescribe testosterone “off-label” using lower doses of products made for men, or they use compounded creams and gels from specialty pharmacies.

By contrast, in some countries—such as Australia and parts of Europe—there are testosterone formulations designed for women. For example, Australia approved a transdermal cream in 2020 for use in postmenopausal women with low sexual desire.

Global guidelines, such as the 2019 international consensus statement, support prescribing testosterone for women with HSDD. But they also caution against using it for other purposes until stronger evidence is available.

Gaps in Knowledge

Despite progress, there are still important gaps in research:

• We do not know the long-term safety of testosterone therapy in women, especially over 5–10 years.

• More studies are needed on non-sexual benefits like cognition, mood, and metabolic health.

• There is little research on women with a history of hormone-sensitive cancers, who may have different risks.

• The best dose and delivery method for women is still being refined, since many current products are adapted from male formulations.

Research over the last two decades shows that testosterone therapy can reliably improve sexual desire and satisfaction in postmenopausal women with HSDD. This is the main use that is backed by strong evidence and supported by global guidelines. Other possible benefits—like better mood, stronger bones, or higher energy—are still under study and not yet confirmed.

Safety data so far is reassuring for short-term use, but long-term studies are needed before broader recommendations can be made. Regulatory approval varies worldwide, and in many places women still rely on off-label or compounded formulations.

Practical Considerations: Access, Cost, and Regulation

When women think about starting testosterone therapy after menopause, the conversation often goes beyond health benefits and risks. Real-world issues such as how to get the treatment, how much it costs, and whether it is regulated also matter a lot. These practical factors can affect whether women decide to start therapy, how they continue it, and how safe it is over the long term.

Access to Testosterone Therapy

Access to testosterone therapy for women is not the same everywhere. In many countries, there are only a few approved options for women, and sometimes none at all. Most testosterone products are made for men, such as gels, injections, or patches at higher doses. When women need testosterone, doctors often prescribe lower doses of these same products, or they rely on special compounding pharmacies to make tailored formulations.

Compounding pharmacies can create creams, gels, or capsules at doses suitable for women. However, compounded medications are not regulated as strictly as standard commercial drugs. This means that strength and purity can sometimes vary. Because of this, some medical organizations recommend using approved commercial products whenever possible, even if that means adjusting male doses for female patients.

The lack of approved testosterone options for women can make access harder. Some doctors may not feel comfortable prescribing it, or pharmacies may not carry what is needed. For this reason, women often need to seek care from specialists, such as gynecologists or endocrinologists, who have more experience in hormone therapy.

Cost of Testosterone Therapy

The cost of testosterone therapy also varies widely. Several factors can influence the price:

• Type of product: Standard gels, patches, or injections may be less expensive if they are generic. Compounded medications can be more expensive because they are custom-made.

• Insurance coverage: In many cases, insurance companies do not cover testosterone therapy for women because it is not FDA-approved specifically for female use in the United States. This means patients often have to pay out-of-pocket. In other countries, coverage may depend on local guidelines and regulations.

• Dosage and frequency: Higher doses or longer-acting options like implants may cost more up front, but could reduce the need for frequent refills.

On average, women might spend anywhere from $30 to $200 per month for testosterone therapy, depending on where they live and which formulation they use. Costs may add up over time, so this is an important factor to discuss with a healthcare provider before starting treatment.

Regulation and Approval

Regulation is another key issue in testosterone therapy for women. Currently, in the United States, there are no FDA-approved testosterone products made specifically for women. In 2019, an international task force recommended testosterone therapy only for women with postmenopausal hypoactive sexual desire disorder (HSDD), based on evidence of benefit. But the lack of approved products remains a challenge.

In other regions, such as Australia and parts of Europe, there have been testosterone products designed for women, though not always widely available. Regulatory agencies continue to review safety and effectiveness data, but progress is slow.

Because of limited approval, many women depend on “off-label” use. Off-label means that a drug approved for men is prescribed at a lower dose for women. This is legal but requires careful oversight to make sure the dose is safe and effective.

Importance of Evidence-Based Prescribing

Even with barriers in access, cost, and regulation, it is important that testosterone therapy is prescribed in an evidence-based way. This means:

• Using therapy only when there is a clear medical need, such as bothersome symptoms of low libido after menopause.

• Following established guidelines from professional medical groups.

• Choosing the safest and most reliable product available, whether that is a regulated male formulation or a compounded product when no alternative exists.

• Monitoring symptoms and blood hormone levels to avoid side effects from too much testosterone.

Women should be cautious about buying over-the-counter “hormone boosters” or supplements advertised online. These are often unregulated, may contain unknown ingredients, and can pose health risks.

Variations by Country and Region

The experience of getting testosterone therapy can look very different depending on where a woman lives. In countries where female-specific testosterone products are approved, access may be simpler and safer. In countries without approved options, reliance on off-label use or compounding is common. Costs and insurance policies also vary from one health system to another, making affordability an uneven issue worldwide.

Practical issues such as how to get testosterone therapy, how much it costs, and how it is regulated may shape a woman’s decision as much as health information does. While testosterone therapy may provide important benefits for postmenopausal women, limited approval and uneven access remain challenges. Women considering therapy should work closely with experienced healthcare providers to find the safest and most reliable options available to them.

Conclusion

Testosterone therapy is becoming an important topic in women’s health, especially for those in the years after menopause. Many people know about estrogen and progesterone, but testosterone is often left out of the conversation. This hormone, though present in smaller amounts in women compared to men, plays a vital role in overall health. When levels drop after menopause, some women may notice changes in energy, mood, muscle strength, and sexual health. Understanding how testosterone therapy may help, as well as its possible risks, allows women and their healthcare providers to make informed decisions.

One of the main points to remember is that testosterone therapy is not about creating high, male-like hormone levels. Instead, the goal is to restore balance and return the body to a healthy range. This is why medical supervision is so important. Low doses designed for women can support sexual desire, energy, and well-being without the negative effects that come from excess testosterone. Clinical studies have shown that when testosterone is prescribed carefully, many women report improvements in quality of life.

Another important lesson is that testosterone therapy does not work in the same way as estrogen therapy. Estrogen has long been used to manage hot flashes, night sweats, and bone loss after menopause. Testosterone is different. It is not usually the first hormone given, but it may be added when women still have symptoms that estrogen alone does not relieve. For example, some women find that even with estrogen, they still have very low sexual desire or ongoing fatigue. In these cases, testosterone therapy may be considered as an additional option.

It is also important to look at both the benefits and risks. The benefits can be meaningful. Women often notice higher energy levels, stronger muscles, and improved mood. Sexual desire and satisfaction may return after years of struggle. Some research also suggests that bone and brain health could benefit, although more studies are needed in these areas. On the other hand, there are real risks. If the dose is too high, women may develop oily skin, acne, or extra hair growth. Rare but serious effects include voice changes or enlargement of the clitoris, which may not reverse even if therapy is stopped. Long-term risks, such as effects on the heart, liver, or cancer development, are still being studied. This is why therapy must be monitored carefully, with regular check-ups and blood tests.

Access and regulation add another layer to the conversation. In some countries, there are approved testosterone products made specifically for women. In others, women may only have access through compounded prescriptions, which are not always regulated in the same way. Cost can also vary widely, and insurance coverage is not guaranteed. These factors can make it harder for some women to receive consistent and safe treatment. Because of this, it is best to work closely with a healthcare provider who has experience in hormone therapy and can guide patients through safe options.

The larger picture is that testosterone therapy is not a “one-size-fits-all” solution. Every woman’s health, history, and symptoms are unique. Some women may never need testosterone therapy, while others may find it life-changing. What matters is an open and honest conversation with a trusted healthcare professional. Decisions should be based on medical evidence, personal health goals, and regular monitoring.

Looking ahead, more research is needed. We still do not have large, long-term studies that answer every question about safety and effectiveness. Scientists are learning more about how testosterone affects the female brain, bones, metabolism, and heart. Over time, we will have clearer answers, and better, more tailored treatments will likely become available. For now, the knowledge we do have shows that testosterone therapy can be a helpful option for some women after menopause, as long as it is used responsibly.

In closing, testosterone is not just a “male hormone.” It is a natural and important part of women’s health too. For women in postmenopause who continue to struggle with fatigue, low desire, or loss of strength, testosterone therapy may offer real support. When guided by a qualified healthcare provider, it can be part of a safe and effective plan to improve overall well-being. Women should feel empowered to ask questions, explore options, and take an active role in their health decisions. Menopause is a new chapter of life, and with the right care, it can also be a time of renewed strength and balance.