Testosterone for Women

Here's something that might surprise you: testosterone isn't just a "male hormone." Your body makes it too — or at least, it used to make a lot more of it. Women produce testosterone in the ovaries and adrenal glands, and it plays a crucial role in energy, mood, mental clarity, muscle maintenance, bone density, and yes — libido. When your testosterone levels drop (which happens gradually starting in your 30s and accelerates during perimenopause and menopause), the effects can be profound. And profoundly frustrating.

If you've been told your labs are "normal" but you still feel exhausted, foggy, unmotivated, and completely uninterested in sex — low testosterone might be part of the picture. Let's talk about what that means, what the options are, and why this is one of the most under-addressed aspects of menopause care.

Why testosterone matters for women

We tend to think of estrogen and progesterone as the "female hormones" and testosterone as the "male hormone," but that framing is misleading. Yes, men produce much more testosterone than women do. But testosterone is essential for women's health in ways that are only now getting the attention they deserve.

In premenopausal women, the ovaries and adrenal glands produce about 0.1-0.4 mg of testosterone per day. That may sound tiny compared to male production (about 7 mg/day), but it's enough to have significant physiological effects. Testosterone influences:

• Sexual desire and arousal. Testosterone is the primary driver of libido in both men and women. It's not the only factor (relationship quality, stress, body image, and other hormones all play roles), but it's the hormonal foundation.
• Energy and motivation. Many women describe the effect of low testosterone as a persistent "flatness" — not quite depression, but a loss of drive, initiative, and zest for life.
• Cognitive function. Testosterone receptors exist throughout the brain. Low levels are associated with brain fog, difficulty concentrating, and reduced mental sharpness.
• Muscle mass and strength. Testosterone helps maintain lean muscle mass. Its decline contributes to the loss of muscle and increase in body fat that many women experience during menopause.
• Bone density. Testosterone contributes to bone mineral density, and its decline may contribute to osteoporosis risk alongside estrogen loss.
• Mood and well-being. Low testosterone is associated with increased anxiety, irritability, and a general decline in sense of well-being.

What happens to testosterone during menopause

Here's what makes testosterone levels tricky in women: unlike estrogen, which drops dramatically during menopause, testosterone declines gradually over decades. By the time a woman reaches menopause, her testosterone levels are roughly half of what they were at age 20. But this decline started much earlier — often in the early 30s — so by perimenopause, you may have been running on progressively lower testosterone for years without realizing it.

Women who have had their ovaries removed (surgical menopause) experience an even more dramatic testosterone drop, since the ovaries are a major production site even after natural menopause. These women often have the most pronounced symptoms of testosterone deficiency.

Another complication: when you take oral estrogen (estrogen pills), your liver produces more sex hormone-binding globulin (SHBG), a protein that binds to testosterone and makes it inactive. This means oral estrogen therapy can actually worsen testosterone deficiency symptoms by reducing your available (free) testosterone — even if your total testosterone level looks okay on blood work. This is one more reason many specialists prefer transdermal estrogen (patches or gel): it doesn't spike SHBG the way oral estrogen does.

Symptoms of low testosterone in women

Low testosterone doesn't look the same in everyone, but common symptoms include:

• Low or absent libido — not just "not in the mood," but a complete absence of sexual desire or sexual thoughts
• Persistent fatigue — tiredness that isn't explained by sleep issues or other medical conditions
• Brain fog and poor concentration — difficulty focusing, word-finding problems, feeling mentally "slow"
• Loss of motivation — a pervasive sense of "meh," difficulty getting excited about things you used to enjoy
• Decreased muscle mass — feeling weaker, loss of muscle tone despite exercise
• Increased body fat — particularly around the midsection
• Mood changes — increased anxiety, irritability, or a flat emotional landscape
• Joint pain — testosterone has anti-inflammatory properties; low levels may contribute to aches

Here's the challenge: many of these symptoms overlap with estrogen deficiency, thyroid dysfunction, depression, sleep disorders, and the general stress of life at midlife. That's why it's important to work with a provider who considers testosterone as part of the whole hormonal picture — not in isolation.

What the research says

The strongest evidence for testosterone therapy in women is for hypoactive sexual desire disorder (HSDD) — clinically low libido that causes personal distress. A landmark 2019 systematic review and meta-analysis published in The Lancet Diabetes & Endocrinology, analyzing 36 randomized controlled trials with over 8,000 women, found that testosterone therapy significantly improved sexual function, including desire, arousal, orgasm, and satisfaction.

The Global Consensus Position Statement on Testosterone Therapy for Women, published in 2019 by an international panel of experts across multiple medical societies (including The Menopause Society, the Endocrine Society, and the International Menopause Society), concluded:

• Testosterone therapy at physiological (normal female) doses can be effective for HSDD in postmenopausal women.
• Testosterone should be prescribed at doses that approximate premenopausal levels.
• Treatment should be assessed at 3-6 months, and discontinued if no benefit is seen.
• Blood levels should be monitored to avoid supraphysiological dosing.

For symptoms beyond libido — energy, mood, cognition, muscle — the evidence is more preliminary but growing. Many experienced menopause clinicians report significant improvements in these areas with testosterone therapy, and several smaller studies support these observations. But we don't yet have the large randomized trials that would make these "evidence-based indications" in the strict clinical sense.

Why there's no FDA-approved testosterone for women

This frustrates a lot of women — and a lot of providers. There is no FDA-approved testosterone product for women in the United States. Period. The only FDA-approved testosterone products (gels, patches, injections) are formulated and dosed for men, at levels 10-20 times what a woman needs.

Why? Partly economics, partly regulatory structure. Developing an FDA-approved drug requires massive clinical trials costing hundreds of millions of dollars. Pharmaceutical companies have been reluctant to invest because the patent landscape for testosterone (a naturally occurring molecule) makes it hard to recoup costs. LibiGel, a testosterone gel for women, completed Phase III trials in 2012 but was never submitted for FDA approval due to safety signal concerns and business decisions.

The Australian company Mayne Pharma received approval in Australia for a female testosterone cream (AndroFeme) in 2020, but it's not available in the US. Efforts to bring an FDA-approved female testosterone product to market continue, but for now, women who need testosterone therapy must rely on compounded products.

How testosterone is prescribed for women

Since there's no FDA-approved product, testosterone for women is compounded — meaning a compounding pharmacy creates it based on a provider's prescription. The most common formulations include:

Compounded testosterone cream

This is the most commonly prescribed form. A small amount of cream (typically 0.5-1 mg/day of testosterone) is applied to the inner thigh, inner forearm, or labia daily. Compounding pharmacies can make this in various strengths. It's absorbed through the skin (transdermal), which avoids first-pass liver metabolism. Many providers start at 0.5 mg/day and adjust based on symptoms and blood levels.

Testosterone troches (lozenges)

Sublingual troches dissolve under the tongue or between the cheek and gum. They're convenient but can cause more variable absorption and higher DHT (dihydrotestosterone) conversion than transdermal cream. Some providers prefer them; others avoid them for this reason.

Testosterone pellets

As discussed in our pellet therapy article, testosterone can be delivered via subcutaneous pellets inserted every 3-5 months. This provides very steady levels but carries the risk of supraphysiological dosing and the inability to adjust quickly if side effects occur.

Testosterone injections

Less common for women but sometimes used. These create more of a peak-and-trough pattern, which most specialists try to avoid. Low-dose subcutaneous injections (weekly or biweekly) are used by some providers.

Off-label use of male products

Some providers prescribe men's testosterone products (like AndroGel or testosterone patches) at a fraction of the male dose. This is legal (off-label prescribing) but requires careful dosing, as these products weren't designed for female physiology. A common approach is using 1/10th of a male dose.

Dosing: less is more

Proper dosing is critical. The goal of testosterone therapy in women is to restore levels to the normal premenopausal range — typically a total testosterone of 15-70 ng/dL, with many providers targeting the mid-range (30-50 ng/dL). This is a physiological dose — replacing what your body used to make, not exceeding it.

Signs that your testosterone dose may be too high include:

• Acne (especially along the jawline)
• Oily skin
• Facial hair growth (hirsutism)
• Hair thinning on the scalp
• Deepening of the voice
• Clitoral enlargement
• Irritability or aggression

Some of these effects — particularly voice changes and clitoral changes — may not be fully reversible, which is why careful dosing and monitoring matter enormously. A knowledgeable provider will start low, go slow, and check your blood levels regularly (typically every 3-6 months initially).

Finding a provider who understands testosterone for women

This can be the hardest part. Many OB/GYNs and primary care doctors are uncomfortable prescribing testosterone for women because it's off-label, because they weren't trained on it, or because they're not familiar with the growing evidence base. You may need to seek out:

• Menopause specialists — providers certified by The Menopause Society (MSCP) are more likely to be current on testosterone research
• Endocrinologists with experience in female hormone management
• Integrative or functional medicine providers — many have extensive experience with testosterone therapy, though be cautious of aggressive dosing
• Telehealth menopause clinics — several national telehealth platforms now offer testosterone therapy for women with appropriate evaluation and monitoring

Questions to ask your provider

• What testosterone level do you target for women? (Look for providers who aim for the normal premenopausal range, not supraphysiological levels.)
• What formulation do you recommend, and which compounding pharmacy do you use?
• How often will you monitor my blood work?
• What side effects should I watch for, and what's the plan if they occur?
• Do you prescribe testosterone alongside estrogen and progesterone, or alone?

The bottom line

Testosterone is not just a male hormone, and its decline is not something you have to just live with. For many women, appropriate testosterone replacement — at physiological doses, monitored carefully — can meaningfully improve libido, energy, mental clarity, mood, and quality of life. The lack of an FDA-approved product is a regulatory and economic failure, not a reflection of the evidence.

You deserve to feel like yourself again. If you suspect low testosterone is part of your menopause picture, find a provider who takes it seriously, understands the dosing, and will work with you to find the right approach. You're not imagining it, and you're not asking for too much.

This article is for educational purposes only and is not medical advice. Testosterone therapy decisions should be made with a qualified healthcare provider who can evaluate your individual health history, risk factors, and symptoms. The information here is based on current clinical guidelines and published research as of 2024, including the Global Consensus Position Statement on Testosterone Therapy for Women, but medicine evolves — always consult your provider for the most current recommendations.