Reclaiming Vitality: How Testosterone Therapy in Menopause Is Changing Women’s Lives

Introduction

Menopause is a natural stage in a woman’s life. It marks the end of monthly periods and the ability to have children. This usually happens between the ages of 45 and 55. During menopause, the ovaries stop making the same amount of hormones they once did. The main hormones affected are estrogen and progesterone. Many people know about these changes. But fewer people talk about another hormone that also drops during this time — testosterone.

Testosterone is often thought of as a male hormone. This is because men have much higher levels than women. However, women also make testosterone. In fact, the ovaries and adrenal glands in women produce small amounts of this hormone throughout life. Testosterone plays an important role in female health. It helps with energy, mood, muscle strength, and sexual desire. As women grow older, testosterone levels drop along with estrogen and progesterone. This drop can lead to symptoms that affect daily life.

Many women going through menopause report feeling tired, losing muscle tone, gaining weight, and losing interest in sex. Some feel less mentally sharp or emotionally balanced. These symptoms are often blamed on low estrogen alone. But research now shows that low testosterone may also be a cause. This has led to more attention on how testosterone therapy might help during and after menopause.

In the past, hormone replacement therapy (HRT) focused mainly on estrogen and sometimes progesterone. These therapies can help with hot flashes, night sweats, and vaginal dryness. But they do not always improve low energy, poor libido, or loss of muscle strength. Because of this, doctors and scientists have begun to look more closely at testosterone therapy for women.

Testosterone therapy means adding back a small amount of testosterone to the body. The goal is to bring levels closer to what they were before menopause. The therapy can be given in several ways. These include gels, creams, patches, injections, or tiny pellets placed under the skin. Some of these methods are used off-label, which means they are not yet approved for women in many countries. Still, the use of testosterone in menopausal women is growing.

Several medical groups, such as the International Menopause Society and the Endocrine Society, have reviewed studies on this topic. They now agree that testosterone therapy can be helpful for certain symptoms. Most of the support is for treating a condition called hypoactive sexual desire disorder, or HSDD. This means having little or no interest in sex that causes distress. But doctors are also studying whether testosterone can help with other issues like low mood, fatigue, and reduced muscle mass.

Not everyone agrees on when or how testosterone should be used in women. Some experts worry about safety, side effects, and the lack of long-term data. Others say that women should not be left to suffer if treatment could help. As with any medical treatment, careful testing and follow-up are needed. Blood tests can show if testosterone levels are too low or too high. Doctors can also look at symptoms and check for changes over time.

Interest in testosterone therapy for women has been growing for the last 10 to 15 years. More studies are being done to understand how it works, who it helps, and what risks it may carry. Women are also becoming more aware of how hormones affect their health, not just during menopause but across the lifespan. Many now ask about all their options—not only estrogen but also testosterone.

This article explores how testosterone therapy is changing the way menopause is treated. It answers the most common questions people have about this hormone and its use in women. The goal is to explain what is known, what is still being studied, and how this therapy may support women’s health and quality of life in midlife and beyond.

What Is Testosterone Therapy for Women?

Testosterone is a hormone that is found in both men and women. Men have much more of it, but women still need it for their health. In women, testosterone is made by the ovaries and adrenal glands. It plays an important role in energy levels, sex drive, mood, memory, and building muscle and bone strength.

As women age, especially during and after menopause, testosterone levels naturally drop. Some women may notice symptoms like fatigue, low sex drive, and mood swings. These symptoms may be caused by low testosterone levels.

Why Is Testosterone Therapy Used in Women?

Testosterone therapy is a treatment that gives the body extra testosterone. It is used when a woman’s natural testosterone levels are low, and she has symptoms that affect her quality of life. The goal of this therapy is to raise testosterone levels back to a normal range for women and reduce symptoms like:

• Low sex drive

• Tiredness or low energy

• Depression or irritability

• Loss of muscle strength

• Difficulty focusing or remembering things

Doctors may recommend testosterone therapy for women in perimenopause (the time before menopause) or postmenopause (after periods have stopped). It may also be used for younger women with certain hormone problems, such as those caused by early menopause or ovary removal.

How Is Testosterone Given?

There are several ways to take testosterone. The most common methods are:

• Creams and gels: These are rubbed on the skin, usually on the inner thighs or upper arms. The hormone enters the bloodstream through the skin.

• Patches: These stick to the skin and slowly release testosterone over time.

• Pellets: Small, solid pellets are placed just under the skin, usually in the buttocks or hip. They release a steady amount of testosterone for three to six months.

• Injections: A doctor or nurse may give a shot in a muscle, such as the thigh or buttock, every few weeks.

• Oral tablets: In some places, pills are available, but they are not common for women due to possible liver risks.

Each method has its pros and cons. The best option depends on the patient’s needs, preferences, and health condition.

How Is the Dose Different for Women?

The amount of testosterone used in women is much lower than the dose used in men. Women only need a small amount to see results. Taking too much can lead to side effects such as:

• Acne

• Hair growth on the face or chest

• Oily skin

• Voice deepening

Doctors carefully monitor testosterone levels through blood tests to make sure the dose is right. Most doctors aim to keep testosterone within the normal range for women—not men.

Is Testosterone Therapy Approved for Women?

In the United States, the FDA has not approved testosterone therapy for use in women, except for very rare conditions. Even so, many doctors still prescribe it for menopausal symptoms. This is called off-label use. Off-label use means the medicine is not officially approved for a specific purpose, but doctors use it because studies and expert guidelines support its safety and usefulness.

In some other countries, such as Australia, a testosterone product made just for women is available by prescription.

What Are Compounded Testosterone Products?

Because there are no FDA-approved products for women in the U.S., many doctors use compounded testosterone. Compounded drugs are made by special pharmacies to match a doctor’s order. They may come as creams, gels, or pellets. These products allow for personalized doses, but they are not regulated as strictly as regular prescription drugs. That means quality can vary between pharmacies.

Doctors who use compounded testosterone monitor their patients closely. They check hormone levels, symptoms, and side effects to make sure the treatment is safe and helpful.

Why Do Women Need Testosterone During Menopause?

Testosterone is often thought of as a male hormone, but it also plays an important role in the female body. Women produce much smaller amounts of testosterone than men, but this hormone is still essential for many key functions. It helps with sex drive, energy levels, mood, bone strength, and muscle mass. As women reach menopause, their testosterone levels drop along with estrogen and progesterone. This decline can lead to a number of symptoms that affect health and quality of life.

The Role of Testosterone in Women

Before menopause, women produce testosterone mainly in the ovaries and adrenal glands. It is involved in many areas of the body and works with other hormones to maintain balance. Some of its most important roles in women include:

• Sexual function: Testosterone helps support libido, or sexual desire. It also plays a role in arousal and response to sexual activity.

• Mood regulation: It supports mental health by helping balance mood and may reduce the risk of anxiety and depression.

• Energy and motivation: Healthy levels of testosterone may help improve stamina, drive, and motivation.

• Muscle and bone health: Testosterone helps the body build and maintain muscle mass. It also plays a role in keeping bones strong and healthy.

Although testosterone is often overlooked in women, its influence is broad and affects many systems in the body.

How Testosterone Levels Change With Age

Testosterone levels in women are highest in their 20s. These levels begin to drop gradually with age. By the time a woman reaches menopause, her testosterone level may be half or less than what it was at her peak. Unlike estrogen, which can fall quickly during menopause, testosterone tends to decrease more slowly. However, the drop can still be enough to cause noticeable changes.

Menopause marks the end of a woman’s natural reproductive years and usually happens between the ages of 45 and 55. During this time, the ovaries stop making most of the body’s estrogen and also reduce testosterone production. For some women, this shift leads to a collection of symptoms that are not fully improved by estrogen therapy alone.

Symptoms That May Be Linked to Low Testosterone

Low testosterone in women can cause a variety of symptoms. These may overlap with other hormonal changes, but some signs are more specific to testosterone deficiency. Common symptoms include:

• Reduced sexual desire: Many women report a drop in interest in sex. This is often one of the most common and noticeable effects of low testosterone.

• Low energy or fatigue: A lack of motivation or persistent tiredness can occur, even with enough rest.

• Mood changes: Some women feel more anxious, irritable, or depressed. Others may have trouble focusing or experience a sense of mental "fog."

• Loss of muscle tone or strength: As testosterone levels drop, the body may lose muscle mass and gain fat, especially around the abdomen.

• Decreased bone density: Lower testosterone levels can weaken bones over time, which may raise the risk of osteoporosis.

Because these symptoms are often vague, they may be blamed on stress, aging, or other causes. However, for some women, low testosterone is a key factor.

Why Testosterone Matters in Menopause Care

In the past, treatment for menopause focused almost only on estrogen and progesterone. These hormones are important, but they do not address all symptoms. For example, estrogen can help hot flashes and vaginal dryness, but it may not improve low libido or lack of energy in every case. Testosterone therapy may help fill this gap.

When testosterone is low and symptoms are present, adding testosterone to hormone therapy may help some women feel more like themselves again. It is not a cure-all, but it can be one part of a larger approach to menopausal care. Research is still growing, but some studies show that carefully monitored testosterone therapy can improve quality of life in certain women.

Testosterone is a natural part of the female hormone system. As levels drop during menopause, some women experience real and difficult symptoms. For those affected, testosterone therapy may offer relief when other treatments fall short.

What Are the Benefits of Testosterone Therapy in Menopausal Women?

During menopause, hormone levels change. Most people know about the drop in estrogen and progesterone. But testosterone also goes down. This hormone is often called the "male hormone," but women have it too. In fact, women need small amounts of testosterone for their health. When levels get too low, it can cause certain problems. Testosterone therapy may help some women feel better. It is not for everyone, but for those with low levels and certain symptoms, it can bring real benefits.

Improved Sexual Function and Libido

One of the main reasons women try testosterone therapy during or after menopause is to help with sexual problems. Some women lose interest in sex or have trouble feeling aroused. This can happen because of hormone changes. A condition called hypoactive sexual desire disorder (HSDD) is sometimes linked to low testosterone. It is a condition where a woman has little or no interest in sex, and it causes her distress.

Studies show that testosterone therapy can improve sexual desire, pleasure, and satisfaction in some women. It may also help with arousal, response to touch, and the ability to reach orgasm. This can help women feel more confident and improve their relationships. Experts usually recommend low doses to avoid side effects and to bring testosterone back to a normal range.

Increased Energy and Reduced Fatigue

Many women in menopause feel tired all the time. Even after getting enough sleep, they may still feel drained. This kind of fatigue can affect work, exercise, and mood. Low testosterone levels might be one cause.

Some women who use testosterone therapy report feeling more energetic and alert. They may have more stamina to do daily tasks and physical activities. Though this benefit is not as well-studied as the sexual effects, it is often mentioned by women in clinical settings. Doctors sometimes consider testosterone therapy when other causes of fatigue have been ruled out.

Better Mood and Mental Clarity

Hormones can affect the brain. Changes in hormone levels during menopause may cause mood swings, sadness, or even depression. Some women also notice they have trouble thinking clearly. They may forget things or feel mentally "foggy." This is sometimes called brain fog.

Testosterone plays a role in how the brain works. It may affect mood, focus, and memory. Some studies show that low testosterone can be linked to depression or mood disorders. When testosterone therapy is given at the right dose, some women report feeling more stable and clear-headed. They may feel more motivated and focused. However, this is not a cure for clinical depression, and therapy should always be done under medical care.

Muscle Strength and Body Composition

Testosterone helps maintain muscle mass and strength. It also supports healthy bones. As women age and go through menopause, they naturally lose muscle. At the same time, fat levels often increase, especially around the belly. This change in body shape can affect balance, physical ability, and self-esteem.

Testosterone therapy may help reduce this muscle loss. It can help the body use protein better, which is important for building muscle. In some studies, women using testosterone had stronger muscles and less body fat than those not using it. Exercise and diet are still important, but hormone therapy can support these efforts.

Bone Health and Osteoporosis Prevention

Bones become thinner and weaker with age, especially after menopause. Estrogen loss is a main cause of this. But testosterone also plays a part. Healthy levels of testosterone can help bones stay strong. Low levels may raise the risk of osteoporosis—a condition that makes bones easy to break.

Some research suggests that testosterone therapy can support bone health in women. It may help increase bone mineral density when used along with estrogen or on its own. Stronger bones lower the risk of fractures from falls or injury.

Testosterone therapy is not a one-size-fits-all solution. But for women with low levels and the right symptoms, it may offer real benefits. Sexual health, energy, mental clarity, strength, and bone health are areas where improvement is possible. Treatment must be guided by a healthcare provider who checks hormone levels and watches for side effects. Safe and effective use depends on proper monitoring and the right dose for each person.

Is Testosterone Therapy Safe for Women?

Safety is one of the most common concerns when it comes to testosterone therapy for women. Many people associate testosterone with men, so they may worry about what it does in a woman’s body. But women naturally make testosterone, just in smaller amounts. During menopause, testosterone levels drop even more, and some women develop symptoms linked to low testosterone. While some studies show that therapy may help improve these symptoms, it is important to also understand the risks.

Short-Term Side Effects

Most women tolerate testosterone therapy well when it is given in the right dose and under medical care. However, some side effects can happen, especially if the dose is too high or the body reacts differently. Some of the more common short-term side effects include:

• Acne or oily skin: Testosterone can increase oil production in the skin, which may lead to breakouts, especially on the face or back.

• Increased facial or body hair: Some women may notice darker or thicker hair in places like the chin, upper lip, or chest. This is known as hirsutism.

• Scalp hair thinning: High levels of testosterone may lead to hair loss on the scalp, similar to male-pattern baldness in men.

• Voice changes: In rare cases, a woman’s voice may deepen if testosterone levels get too high or are used for too long.

• Mood changes: Some women may feel more irritable, restless, or anxious. However, others may feel more energized or clear-headed. Each person may respond differently.

These side effects are usually mild and may go away once the dose is lowered or stopped. Regular check-ups can help prevent or manage these problems early.

Long-Term Safety and Health Risks

There is still much to learn about the long-term effects of testosterone therapy in women. Most of the research has been done over months or a few years, not decades. This means doctors are still watching for possible risks over time. However, current data from studies suggest that when testosterone is used in low, female-appropriate doses, the risk of serious side effects is low.

Some concerns that researchers continue to study include:

• Heart health: High doses of testosterone in men can raise cholesterol levels and increase the risk of heart disease. So far, studies in women using low doses have not shown a clear increase in heart problems, but it is still an area that needs more research.

• Liver function: Oral testosterone taken in pill form can affect the liver. This is why most doctors avoid pills and use gels, creams, or patches instead, which bypass the liver.

• Breast cancer: Some early concerns linked testosterone to an increased risk of breast cancer. However, newer studies have not confirmed this link in women using testosterone at low doses. In fact, some research suggests testosterone may even protect breast tissue, but more data is needed before drawing conclusions.

Monitoring and Safety Checks

Doctors who prescribe testosterone therapy usually follow safety steps to make sure it is working and not causing harm. These steps include:

• Blood tests: Before starting therapy, blood tests are done to measure testosterone levels. Doctors also check hormone levels while on treatment to keep testosterone within a safe range.

• Liver and cholesterol tests: Since testosterone can affect the liver and cholesterol levels, doctors may order tests every few months, especially in the first year.

• Symptom tracking: Patients are often asked to keep track of changes in their symptoms, energy, mood, skin, or hair. This helps the doctor adjust the dose if needed.

• Regular visits: Follow-up visits are important for ongoing safety. Most side effects can be managed if found early.

Importance of Proper Dosing

One key factor in safety is the dose. Women need much lower doses of testosterone than men. Using products made for men can lead to overdose, even if only a small amount is applied. That is why doctors often use compounded creams or gels made for women or apply very small doses of men’s products under close supervision.

Testosterone should never be used without medical advice. Over-the-counter or unregulated hormone products may not be safe or accurate. Proper medical care ensures the correct dose and keeps treatment within safe levels.

Testosterone therapy can be safe for women when used at the right dose and monitored by a qualified healthcare provider. While short-term side effects like acne or hair changes can occur, most are mild and manageable. There is no strong evidence linking low-dose testosterone to serious health risks in women, but long-term studies are still ongoing. Regular check-ups and lab tests are essential to keep treatment safe and effective.

How Is Testosterone Therapy Prescribed and Monitored?

Testosterone therapy for women is a medical treatment that must be carefully prescribed and monitored by a healthcare provider. Since testosterone is not approved for use in women in many countries, including the United States, it is often used “off-label.” This means that doctors may prescribe it based on clinical judgment and available evidence, but it is not officially approved by regulatory agencies for that specific use. Even so, many specialists now offer testosterone therapy as part of hormone treatment for women going through menopause.

Diagnosing Testosterone Deficiency

Before starting testosterone therapy, doctors usually evaluate a woman's symptoms and check her hormone levels. Women may report low sex drive, fatigue, mood swings, difficulty concentrating, or a loss of muscle strength. These can sometimes be linked to low testosterone, especially during and after menopause. However, these symptoms can also have other causes, so it is important to rule out other conditions first.

A blood test is used to measure testosterone levels. Doctors often order a "total testosterone" test and sometimes also a "free testosterone" test. The levels can vary throughout the day, so the timing of the blood draw may be important. Usually, the test is done in the morning when hormone levels are highest. Since normal testosterone levels in women are much lower than in men, the lab results must be interpreted carefully. What counts as "low" can depend on the woman’s age, symptoms, and general health.

Choosing the Right Form of Testosterone

There are different ways to take testosterone. The most common forms for women are:

• Creams or gels applied to the skin

• Patches that release hormone slowly

• Injections, usually given every few weeks

• Pellets placed under the skin that release testosterone over time

Each method has pros and cons. Creams and gels are easy to apply but must be used daily. Patches are also convenient but can sometimes cause skin irritation. Injections are not needed as often, but they can cause hormone levels to rise and fall more sharply. Pellets offer steady hormone release but require a small procedure to insert them under the skin.

Doctors usually start with a very low dose to reduce the risk of side effects. The goal is to bring testosterone levels back to a healthy range for women, not to reach levels seen in men. Often, the dose is adjusted over time based on how the woman feels and how her blood levels change.

Monitoring During Treatment

Regular follow-up is very important during testosterone therapy. Doctors usually check blood levels of testosterone every 3 to 6 months after starting treatment. These tests help make sure the levels are in a safe and effective range. If levels are too high, the dose may need to be lowered.

Besides checking testosterone, doctors may also monitor:

• Lipid levels (cholesterol and triglycerides)

• Liver function tests

• Blood cell counts (to watch for thickening of the blood)

• Hormone levels including estrogen if using combination therapy

Some doctors may also check for signs of side effects. These can include acne, unwanted hair growth, voice changes, or changes in mood. If any of these appear, the dose may be lowered or the method of treatment may be changed.

Role of Medical Specialists

Testosterone therapy in women is usually managed by specialists in hormone health. These may include:

• Gynecologists with training in menopause care

• Endocrinologists (hormone specialists)

• Healthcare providers in hormone clinics

Specialists are more likely to understand the correct testing, dosing, and follow-up needed. They can also provide up-to-date information based on the latest research and clinical guidelines.

Because testosterone is not approved for women in many countries, some providers use compounded products. These are custom-made by pharmacies based on a doctor’s prescription. Compounded hormones are not regulated as strictly as approved drugs, so careful monitoring is especially important when using them.

Prescribing and monitoring testosterone therapy for menopausal women involves several important steps. First, the provider must confirm that symptoms and blood levels support the diagnosis. Then, a low dose of testosterone is chosen and adjusted over time. Regular follow-up testing helps make sure the therapy stays safe and effective. Working with a knowledgeable healthcare provider is key to getting the best results and avoiding problems.

What Symptoms Might Improve With Testosterone Therapy?

Many women going through menopause experience a range of symptoms that affect their quality of life. These symptoms often include low energy, mood changes, decreased sexual desire, and changes in body composition. While these are commonly linked to falling estrogen levels, testosterone also plays a role. When testosterone levels drop, symptoms can become more noticeable. Testosterone therapy is being used more often to help ease these symptoms.

Low Sexual Desire and Sexual Function

One of the most common reasons women begin testosterone therapy is low sexual desire. This condition is often diagnosed as hypoactive sexual desire disorder (HSDD). It means a woman has a lasting lack of interest in sex, which causes distress or problems in her relationship. Estrogen can help with vaginal dryness and discomfort, but it does not always improve desire. Studies have shown that testosterone therapy can increase sexual thoughts, improve arousal, and boost satisfaction during sexual activity.

Testosterone may also help with the physical side of sexual function. Some women report less pain during sex, improved response to touch, and greater ease reaching orgasm. These effects may be due to changes in nerve sensitivity, blood flow, and lubrication.

Low Energy and Fatigue

Feeling tired all the time is a common concern during and after menopause. Even after getting enough sleep, some women feel drained and have a hard time getting through the day. Testosterone affects the body’s ability to produce energy and maintain motivation. Low testosterone levels can lead to persistent fatigue and slower recovery after physical activity.

Testosterone therapy may improve stamina and reduce this type of tiredness. Women who respond to the treatment often report having more energy to complete daily tasks, exercise, and stay active. While testosterone is not a cure for all types of fatigue, it may help when low hormone levels are part of the problem.

Mood Changes and Mental Clarity

Menopause is often linked to mood swings, irritability, anxiety, and mild depression. These changes may be due to hormone shifts, poor sleep, and life stress. Estrogen is known to help with some mood symptoms, but testosterone also affects mood and brain function.

Testosterone interacts with brain chemicals like dopamine and serotonin. These chemicals help control emotions and motivation. Some women with low testosterone feel mentally flat, unmotivated, or emotionally distant. This is sometimes called “emotional blunting.” Testosterone therapy may help restore emotional balance and bring back a sense of well-being.

In addition to mood, testosterone can support mental clarity. Many women complain of “brain fog” during menopause. They may feel forgetful, have trouble focusing, or lose track of tasks. While this can have many causes, low testosterone may play a role. Research shows that testosterone supports certain brain functions like memory, processing speed, and focus. After starting therapy, some women report sharper thinking and a better ability to concentrate.

Muscle Weakness and Body Composition

As women age, it becomes harder to maintain muscle mass and strength. This is partly due to hormonal changes. Testosterone helps build and maintain lean muscle. When levels drop, muscles can shrink and become weaker. This can lead to a slower metabolism and increased body fat, especially around the belly.

Testosterone therapy may help improve muscle tone and strength. It may also reduce body fat and support a healthier body shape. These changes may be small at first but can make a difference over time, especially when combined with regular exercise and healthy eating. While testosterone is not a weight-loss drug, it can help the body respond better to physical activity and rebuild muscle that was lost.

Testosterone therapy can help improve several symptoms linked to menopause. These include low sexual desire, fatigue, mood changes, mental fog, and muscle loss. Not every woman will experience the same benefits, and not all symptoms are caused by low testosterone. That is why careful testing and medical guidance are important before starting treatment. When used correctly and monitored by a healthcare provider, testosterone therapy can support better health and well-being during midlife and beyond.

Who Should Not Use Testosterone Therapy?

Testosterone therapy can help some women during and after menopause, but it is not right for everyone. Like any medical treatment, testosterone therapy has risks. Certain medical conditions, health histories, or personal factors may make testosterone therapy unsafe or less suitable. It is important to understand who should avoid this treatment and why doctors are careful when prescribing it.

Women with Hormone-Sensitive Cancers

Women who have had certain types of cancer, such as breast or uterine cancer, are usually not advised to use testosterone therapy. These cancers are called hormone-sensitive or hormone-receptor-positive cancers. This means that hormones like estrogen and possibly testosterone may help the cancer grow.

Even though testosterone is not the main hormone linked to these cancers, it can convert into estrogen in the body through a process called aromatization. This extra estrogen may affect cancer growth. Because of this, most doctors will not recommend testosterone therapy for women with a history of breast or endometrial cancer, unless it is carefully monitored and used only in very specific cases.

Women with Active or Uncontrolled Liver or Kidney Disease

Testosterone is processed through the liver. In women with liver problems, the body may not break down the hormone properly. This can cause testosterone to build up in the blood and lead to side effects.

Women with kidney disease may also have trouble handling hormone therapy. The kidneys help manage fluid and waste in the body. Some testosterone products, especially those given by injection or taken by mouth, can place extra stress on the liver and kidneys. That is why women with active or severe liver or kidney disease are usually advised to avoid testosterone therapy.

Women with Heart or Blood Vessel Problems

Testosterone may affect blood pressure, cholesterol, and red blood cell count. In women with heart disease, stroke, or other circulation problems, these changes could increase the risk of health issues.

Some studies suggest that testosterone might raise the risk of high blood pressure or cause an increase in blood thickness (called polycythemia). This could lead to a higher chance of blood clots, heart attack, or stroke, especially in women who already have heart conditions.

Doctors may still consider testosterone in women with mild heart disease, but only with regular check-ups and lab tests. Women with uncontrolled high blood pressure or recent heart attacks should usually not take testosterone.

Women Who Are Pregnant or Breastfeeding

Testosterone should never be used during pregnancy or while breastfeeding. This hormone can affect the development of a growing baby. Exposure to testosterone in the womb may cause changes in the baby’s genitals or other birth defects, especially in a female fetus.

Testosterone can also pass into breast milk. This could harm a newborn baby or affect milk production. Because of these risks, testosterone therapy is not safe during pregnancy or lactation.

Women with High Testosterone Levels or Androgen Sensitivity

Some women naturally have higher levels of testosterone or are very sensitive to androgens, which are male-type hormones like testosterone. In these women, adding more testosterone can lead to unwanted side effects such as acne, unwanted facial or body hair, scalp hair loss, or voice deepening.

Doctors check hormone levels before starting therapy. If testosterone levels are already high or if a woman shows strong side effects even at low doses, doctors may stop the treatment or lower the dose.

Mental Health or Substance Use Concerns

Testosterone may affect mood, especially in large doses. In rare cases, it can cause mood swings, anxiety, or aggressive behavior. Women with a history of mood disorders, such as bipolar disorder or severe depression, should be monitored closely.

Also, women with a history of substance use or hormone misuse might not be good candidates for testosterone therapy. Some forms of testosterone can be misused for performance or body image reasons. Careful monitoring is important in these cases.

Importance of Medical Supervision

Testosterone therapy is not one-size-fits-all. Before starting treatment, doctors take a full health history, perform blood tests, and assess for any health risks. Women should be open about their medical history and any symptoms they are having.

Regular follow-up visits are also needed. These visits help track hormone levels, look for side effects, and make sure the therapy is working safely.

Avoiding testosterone therapy when there are clear risks protects a woman’s long-term health and well-being. Other treatment options may be better in some cases. The decision to use or not use testosterone should always be based on medical advice.

Are There FDA-Approved Testosterone Products for Women?

Testosterone therapy has been used by women going through menopause to help with certain symptoms like low sexual desire, fatigue, and mood changes. While this treatment can be helpful, many people are surprised to learn that there are no testosterone products officially approved by the U.S. Food and Drug Administration (FDA) for use in women. This lack of approval makes testosterone therapy different from other hormone treatments like estrogen, which has many FDA-approved products.

What Off-Label Use Means

Even though the FDA has not approved testosterone for women, doctors can still prescribe it. This is called off-label use. Off-label means that a medicine is being used in a way that is not officially approved by the FDA. It does not mean the medicine is unsafe. Many medications are prescribed off-label every day for different conditions. In the case of testosterone, doctors may prescribe a lower dose of a product made for men or work with a compounding pharmacy to create a dose specifically for women.

Doctors who prescribe testosterone off-label do so based on medical research and their own clinical experience. Some medical societies, like the International Menopause Society and the Endocrine Society, support off-label testosterone therapy for certain women—especially those with hypoactive sexual desire disorder (HSDD), a condition where women have very low interest in sex that causes distress.

Compounded Testosterone Products

Because there are no FDA-approved testosterone products for women in the U.S., many women use compounded testosterone. Compounded medicines are made in special pharmacies based on a prescription written just for one person. The dose can be adjusted to meet a woman’s specific needs, which is important because women usually need much lower doses of testosterone than men.

Compounded testosterone can come in many forms:

• Creams or gels that are applied to the skin

• Troches or lozenges that dissolve in the mouth

• Pellets placed under the skin

• Injections

Although compounding allows for personalized treatment, these products are not regulated or tested by the FDA in the same way as standard medications. This means the quality and strength of the medicine can vary between pharmacies. For this reason, patients who use compounded testosterone need to be monitored carefully with regular blood tests and follow-up appointments.

Why There Are No FDA-Approved Products for Women

The main reason there are no FDA-approved testosterone products for women is that few companies have invested in the research and clinical trials needed to get approval. Clinical trials are expensive and take many years. Since women only need small doses of testosterone, companies may not see a large enough profit to make it worth the cost.

Another reason is that there has been less focus on testosterone in women in the past. For many years, most hormone therapy for menopause was centered around estrogen and progesterone. Only recently have researchers and doctors started paying more attention to the role of testosterone in women’s health.

There was one product approved in Australia called AndroFeme 1, a testosterone cream specifically made for women. It is available by prescription in that country and in a few others, but it is not yet approved in the United States. Some doctors in the U.S. may help patients get it through special pharmacy import services, but this is not common.

Pharmaceutical-Grade Testosterone for Men Used in Low Doses

In the U.S., some doctors prescribe testosterone products made for men, such as AndroGel or Testim, but at much smaller doses. These are FDA-approved for men with low testosterone, but not for women. Using a male product requires careful dose adjustment to avoid giving too much. This approach is supported by medical guidelines for women with HSDD, but only when used with proper monitoring.

Testosterone therapy for women in menopause is often prescribed without an FDA-approved product. Doctors may use compounded formulas or low doses of products made for men. While many women benefit from this therapy, careful monitoring is essential to make sure the dose is safe and effective. Ongoing research may lead to new options in the future, but for now, testosterone for women remains an off-label treatment in most countries, including the United States.

How Does Testosterone Therapy Compare to Estrogen or Other Hormones?

During menopause, hormone levels drop. Estrogen, progesterone, and testosterone all decrease. Most hormone therapy for menopause focuses on estrogen and progesterone. These hormones help with hot flashes, night sweats, and bone loss. But many women also lose testosterone, which can cause other symptoms like low sex drive, tiredness, or loss of muscle. Testosterone therapy is now being studied and used more often to help with these problems.

Differences Between Estrogen and Testosterone

Estrogen is the main hormone that decreases during menopause. It helps control the menstrual cycle and supports the health of bones, skin, brain, and heart. When estrogen levels drop, many women get hot flashes, vaginal dryness, mood swings, and weak bones.

Testosterone is often thought of as a male hormone, but women also make small amounts of it. It plays a role in energy, mood, sexual desire, and keeping muscles strong. Testosterone levels begin to go down in women starting in their 30s, and by menopause, levels are often very low. Some women feel symptoms from this drop, even when they are already using estrogen therapy.

Estrogen and testosterone affect the body in different ways. Estrogen mainly helps with heat regulation, mood, sleep, and keeping the vagina and urinary tract healthy. Testosterone mainly affects sexual desire, strength, mental focus, and physical energy. When estrogen is not enough to improve problems like low sex drive or fatigue, doctors may suggest adding testosterone.

When Testosterone May Be Used Alone or With Estrogen

Some women take only testosterone, especially if they cannot use estrogen. This might be the case for women who have had certain cancers or blood clots. However, most women use testosterone along with estrogen and progesterone. This combination can help treat a wider range of symptoms.

Estrogen helps relieve the most common menopause symptoms, like hot flashes and night sweats. But if a woman still feels very tired, unmotivated, or has a low sex drive even with estrogen therapy, her doctor may check her testosterone levels. If levels are low, adding testosterone might help.

Research shows that testosterone is most helpful for women who have hypoactive sexual desire disorder (HSDD), a condition where a woman has little to no desire for sex that causes distress. Estrogen may help with vaginal dryness, but it may not be enough to bring back interest in sex. In those cases, adding testosterone can improve sexual desire and satisfaction.

Common Misunderstandings About Testosterone

Many people think testosterone is only for men. This is not true. Women’s bodies also need testosterone, just in much smaller amounts. When given in the right dose, testosterone therapy does not make women look or act like men. The goal is not to raise testosterone to male levels. It is to bring the hormone back into a normal female range.

Some worry that testosterone therapy might cause side effects like hair growth on the face, acne, or a deeper voice. These effects can happen if the dose is too high. That is why careful monitoring is important. When used correctly, most women tolerate testosterone well without major side effects.

Another common myth is that taking testosterone will replace the need for estrogen. This is not true. Estrogen and testosterone work in different ways. Estrogen is still needed for many menopause symptoms and for bone and heart health. Testosterone should not be used as a full replacement for estrogen therapy.

Understanding the Role of Each Hormone

It helps to think of estrogen, progesterone, and testosterone as working together like a team. Estrogen handles most of the classic menopause symptoms. Progesterone helps protect the uterus if a woman is still taking estrogen. Testosterone can fill in the gaps when energy, sex drive, or muscle strength are still low, even with other treatments.

Doctors will look at symptoms, blood tests, and health history to decide which hormones are needed. Some women may need only estrogen and progesterone. Others may benefit from adding testosterone. The best plan is the one that matches a woman’s symptoms and health needs.

Testosterone is not a “better” hormone than estrogen, and it does not replace it. Instead, it can be an added tool to help improve well-being when other therapies are not enough.

What Are the Long-Term Considerations of Testosterone Therapy?

Testosterone therapy is often used by women during and after menopause to help manage symptoms like low sex drive, fatigue, mood changes, and muscle loss. While many women report benefits from this therapy, there are important long-term considerations to think about before starting and while continuing treatment.

Ongoing Monitoring Is Essential

Long-term testosterone therapy should always be closely monitored by a healthcare provider. This includes regular blood tests to check hormone levels and to make sure testosterone stays within the normal range for women. Blood tests are often done every 3 to 6 months during the first year and then at least once a year after that.

Monitoring also includes checking for signs of side effects. Some of these may include unwanted hair growth (especially on the face), acne, oily skin, and voice deepening. Though these side effects are usually mild and can often be managed by adjusting the dose, it is important to catch them early.

Other tests may be needed to check liver function, cholesterol levels, and red blood cell counts. High testosterone levels can sometimes increase red blood cells or change cholesterol levels, which may raise the risk of heart problems. These risks are not yet fully understood, so ongoing testing helps reduce any long-term harm.

Lack of Long-Term Data in Women

Testosterone therapy has been studied in men for many years, but long-term studies in women are still limited. Most research on women has followed them for less than two years. Because of this, doctors do not yet know all the long-term effects testosterone might have on the female body when used for many years.

More research is still being done, especially to learn if testosterone therapy affects the risk of heart disease, breast cancer, or stroke over the long term. Until more is known, most medical experts recommend using the lowest effective dose for the shortest time needed. Regular follow-up visits help doctors decide whether to continue or change the treatment plan.

Changes in Hormone Needs Over Time

As the body continues to age after menopause, hormone needs may also change. A woman who benefits from testosterone therapy in her 50s may find that her symptoms improve or change by her 60s. The dose that worked well before may no longer be needed or may need to be adjusted.

Testosterone is not a “forever” treatment for most women. Some may choose to stop the therapy after a few years once symptoms are better controlled. Others may want to continue if benefits are still clear and no serious side effects are present. This decision should be made with the help of a healthcare provider who can look at both risks and benefits over time.

Adjusting or Stopping Treatment

If testosterone therapy needs to be stopped, it is usually safe to do so without any special steps. However, some women may notice that their original symptoms return. For this reason, any decision to stop therapy should be carefully considered.

Dose adjustments may also be needed if side effects appear or if lab tests show that testosterone levels are too high. In some cases, switching to a different form of testosterone, such as a lower-dose cream or patch, can help manage symptoms better with fewer side effects.

Emotional and Mental Health Monitoring

Mood, memory, and motivation can also be affected by hormone changes. Testosterone may improve these areas for some women, but mental health should still be checked regularly. Anxiety, depression, and low mood can have many causes, and not all emotional issues during menopause are related to hormones. Keeping track of mental health over time is an important part of long-term care.

Informed and Ongoing Decision-Making

Testosterone therapy is a personal and medical decision that may need to be reviewed regularly. What works well for one stage of life may not be needed later on. The key to safe and effective long-term use is regular check-ups, clear communication with healthcare providers, and careful tracking of symptoms and test results.

Long-term success with testosterone therapy depends on staying informed, flexible, and focused on health goals. With proper guidance, it may continue to be a helpful tool for improving quality of life during and after menopause.

Conclusion

Testosterone therapy is changing how menopause is understood and treated. For a long time, most hormone treatments focused on replacing estrogen and progesterone. These two hormones do fall sharply during menopause, but testosterone also drops with age and is often overlooked. New research and clinical experience are now showing that testosterone plays an important role in women’s health—especially during and after menopause.

Testosterone helps with many body functions. It supports energy, mood, sexual desire, muscle strength, bone health, and mental sharpness. When testosterone levels fall, some women may feel tired, low in mood, and less interested in sex. They may also notice changes in their body such as muscle loss or slower thinking. Some of these symptoms can overlap with estrogen deficiency, but others may point more directly to low testosterone. For women who continue to struggle with symptoms even after starting estrogen, testosterone therapy may offer another way to improve their quality of life.

Studies show that testosterone therapy can help with several of these symptoms. The strongest evidence supports its use for low sexual desire that causes distress, also known as hypoactive sexual desire disorder (HSDD). Many women report improvements in their sex drive and satisfaction. Some also feel more energized and mentally focused. While research is still growing in these areas, the early results are promising. Clinical guidelines from trusted health organizations also support testosterone use in specific cases like HSDD when monitored carefully by a healthcare provider.

Safety is an important part of testosterone treatment. So far, research shows that it can be safe for most healthy women when used at the right dose and under medical care. Side effects are possible, such as acne, increased facial hair, or a deepened voice, but these are rare when blood levels stay in the normal female range. Regular blood tests are used to make sure testosterone levels are not too high. Providers may also check liver function and cholesterol levels to help prevent long-term problems. Each woman’s treatment is tailored to her needs, and any concerns are watched closely.

There are some women who should not take testosterone. This includes women with a history of hormone-sensitive cancers like breast or uterine cancer. Women with serious heart, liver, or kidney disease may also need to avoid this therapy. Pregnancy and breastfeeding are also times when testosterone is not safe. Careful screening and a full medical history help determine if treatment is a good fit.

Access to testosterone therapy can vary. In some countries, there are products made specifically for women, but in others, the treatment is considered “off-label.” This means doctors may use testosterone approved for men, but at lower doses. Sometimes women receive compounded medications from pharmacies, but these are not always regulated in the same way as commercial products. This situation may change in the future as demand grows and research continues.

It is also important to understand how testosterone fits with other hormones. It is not a replacement for estrogen and does not treat all menopausal symptoms. Many women use it alongside estrogen and sometimes progesterone. Each hormone has a role in the body, and the right balance depends on the woman’s age, health, and symptoms. Testosterone should not be viewed as a cure-all, but rather as one part of a full treatment plan.

Because long-term studies are still limited, ongoing monitoring is key. Women who start therapy usually have regular check-ups to see how they are responding and to catch any problems early. Researchers are still learning how long therapy should continue and whether benefits last over many years. These questions are important and are being studied in clinical trials.

As science continues to uncover more about the female body and hormones, testosterone therapy is becoming a more accepted part of care for women in menopause. It offers new hope for those who have symptoms that don’t improve with traditional treatment. While it is not right for everyone, it can be life-changing for some. Working with a healthcare provider who understands hormone therapy is the best way to decide if testosterone is a good choice. Careful use of this therapy may help women feel more like themselves again—stronger, more focused, and more connected to their lives.