Testosterone gets a lot of attention in menopause weight loss, and a lot of it runs ahead of the evidence. Women do make testosterone, levels fall with age, and it is reasonable to wonder whether replacing it would help with muscle, energy or stubborn weight. Here is what the research actually shows, what testosterone is and is not evidence-based for, and how to raise it with a provider.
Two online services prescribe testosterone to women
Midi: 24 states and DC, a compounded cream, visits billable to most PPO plans (Medicare patients pay out of pocket). Hone Health: 33 states for women's hormone care, from $65 test, then $155/mo membership + medication. Compare them
The Midi link is not paid: we earn nothing if you choose Midi. The Hone Health link is a partner link: we may earn a commission, at no extra cost to you.
What testosterone does in women
Women's bodies make testosterone in the ovaries and adrenal glands, and some of it is converted to estrogen. It acts on many tissues, including muscle, bone, the brain and sexual function. That is the body's own hormone at its normal levels; it does not follow that adding more as a treatment improves each of those things, which is the question the trials below were designed to answer.
What happens to testosterone with age
- Levels decline gradually from a woman's twenties onward, earlier and more slowly than estrogen
- Natural menopause does not cause a sudden drop
- Removing both ovaries (surgical menopause) causes a larger, abrupt fall
What the evidence shows for weight and body composition
The main reference is the 2019 Global Consensus Position Statement on testosterone therapy for women, endorsed by The Menopause Society, the Endocrine Society, the International Menopause Society and others, and based on a meta-analysis of 36 randomized trials involving about 8,500 women. At the physiological doses used for women:
- Muscle, body fat and strength: no statistically significant effect on lean body mass, total body fat or muscle strength
- Bone: no effect on bone density at 12 months
- General wellbeing: no effect
- Mood: no effect on depressed mood shown
- Memory and thinking: not enough evidence to recommend it
Some women report more energy, better mood or sharper focus on testosterone, and most trials were short, so "not shown" is not the same as "proven useless". But trials at safe doses have not confirmed those effects, so they are not reasons on their own to start it, and testosterone is not a weight-loss treatment.
What testosterone is evidence-based for
The consensus names one evidence-based use: hypoactive sexual desire disorder (HSDD) in postmenopausal women, meaning low sexual desire that causes distress and is not better explained by something else, such as relationship strain, depression, medication side effects, pain or vaginal dryness. In that setting, trials show improvements in desire, arousal, orgasm and satisfaction. A clinician should assess those other causes first.
Why a blood test does not settle it
The consensus states that a blood testosterone level should not be used to diagnose HSDD, and there is no validated "low testosterone" level that identifies which women will benefit. Blood tests are still useful: to check that levels are not high before starting, and to make sure treatment keeps them within the normal premenopausal range.
The regulatory situation
There is no FDA-approved testosterone product for women in the United States. In practice:
- Off-label prescribing. Clinicians often prescribe a small dose of an approved men's transdermal product, at roughly a tenth of a man's dose.
- Compounded products. The consensus does not recommend them unless no approved equivalent is available, because the FDA does not verify their safety, effectiveness or quality before they are sold, and potency can vary.
- Insurance coverage. Generally not covered. Cash-pay is typical.
- Provider variability. Some menopause specialists prescribe testosterone for HSDD; others do not because it is off-label.
Two online services prescribe testosterone to women
Midi: 24 states and DC, a compounded cream, visits billable to most PPO plans (Medicare patients pay out of pocket). Hone Health: 33 states for women's hormone care, from $65 test, then $155/mo membership + medication. Compare them
The Midi link is not paid: we earn nothing if you choose Midi. The Hone Health link is a partner link: we may earn a commission, at no extra cost to you.
Forms to avoid
- Pellets and injections: not recommended, because they can push levels above the normal female range, and pellets cannot be removed if side effects appear.
- Oral testosterone: not recommended, because of its effect on cholesterol.
How to bring this up with your provider
- If low sexual desire is causing you distress, say so directly, and describe what has changed and when
- Expect questions about other causes first: mood, medications, relationship factors, pain, vaginal dryness and sleep
- If testosterone is appropriate, ask for a transdermal product dosed for women, a baseline blood test and follow-up tests to keep levels in range
- If your current provider is not comfortable prescribing it, ask for a referral to a menopause specialist. Check first: many menopause platforms do not prescribe testosterone at all, and Winona states in its FAQ that it does not, offering DHEA instead
Risks and side effects
Short-term studies of physiological doses are reassuring, but long-term safety data are limited. Possible side effects, which are dose-dependent, include:
- Acne
- Hair growth on the face or body
- Hair thinning on the scalp
- Voice deepening and clitoral enlargement, which are rare at physiological doses but may not reverse
Monitoring blood levels to keep them within the normal female range is what keeps these risks low.
What actually helps muscle and body composition
For muscle, strength and body composition in menopause, the best-supported tools are resistance training and adequate protein; see our guides to strength training for menopause and protein in menopause.
The bottom line
Testosterone has a real, evidence-based use in women: distressing low sexual desire after menopause, assessed by a clinician. For weight, body fat, muscle, strength, energy, mood and memory, trials at safe doses have not shown a benefit. If you are considering it, the conversation belongs with a clinician who will assess the cause, prescribe a dose made for women, and monitor your levels.
This article is for educational purposes only and is not medical advice. Testosterone therapy decisions should be made with a qualified provider experienced in women's hormone care.
Keep reading: whether HRT helps with weight loss · strength training for menopause · the estrogen and weight connection
Find a menopause specialist
FindMyHRT lists menopause and hormone therapy providers across the country, including clinicians who prescribe testosterone. Filter by state and treatment type.
Find a ProviderGet testosterone prescribed online
There is no FDA-approved testosterone product for women in the US, so it is prescribed off-label. The evidence supports it for one use: low sexual desire that bothers you (HSDD), after a clinician has assessed you. These online services prescribe it to women. Each covers different states, so check yours first.
Midi Health
A low-dose compounded testosterone cream from a virtual menopause clinic. Midi says most women have two video visits, with baseline blood tests, before a prescription, and only if a clinician decides it is appropriate.
The cream starts at $100 for a 90-day supply. Visits can be billed to insurance (Midi is in-network with most PPO plans) or cost $250 for the first visit self-pay; Medicare is self-pay only.
That evidence comes from trials of standardized, non-compounded testosterone used on the skin at doses that keep levels in the normal female range. The same international consensus does not recommend compounded testosterone, like Midi's cream, because its efficacy and safety have not been shown; it suggests small doses of an approved men's product instead, with blood levels checked. Ask any provider which product you would get and how your levels will be monitored.
Offered in 24 states and DC: AZ, CA, CO, DC, DE, FL, IA, IL, IN, KS, MA, MD, ME, NC, NJ, NM, NV, NY, OH, OR, PA, TX, UT, VA and WA.
Not a paid link: we earn nothing if you choose Midi.
Hone Health
Prescribes testosterone to women online, after a blood test.
From $65 test, then $155/mo membership + medication.
33 states for women's hormone care.
Partner link: we may earn a commission, at no extra cost to you.
Neither covers your state, or you would rather see someone in person? Find a clinic near you or compare online options.
Some links above are partnerships. If you start care through them, we may earn a commission at no extra cost to you. Partners we can earn from may be shown first in some lists, but commission never changes the facts we report about any provider.
Related reading
Does HRT Help With Weight Loss? The Honest Answer
HRT is not a weight loss drug. It treats menopause symptoms and may modestly affect abdominal fat, while nutrition and activity drive weight loss. The honest version.
HRT Weight Loss Timeline: What the Evidence Actually Shows
What to expect in the first year on HRT: symptom relief comes first, and trials show no clear effect on body weight.
Does HRT Reduce Belly Fat? What the Research Actually Shows
HRT may modestly limit belly-fat gain after menopause, but it is not a belly-fat treatment; training and nutrition do most of the work.
Bioidentical Hormones and Weight Loss: Separating Marketing From Medicine
Are bioidentical hormones better for weight loss? The honest comparison between FDA-approved bioidentical, compounded products, and conventional HRT.
Medical Disclaimer
The information on FindMyHRT is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have read on this website.