What it is
Testosterone isn't only a "male hormone" — women's bodies make it too, and levels decline gradually through midlife. In menopause care, testosterone therapy means restoring levels to the normal female physiologic range. That last phrase matters: the evidence-supported approach uses low doses that keep blood levels where a premenopausal woman's would naturally be.
Common forms
There is currently no FDA-approved testosterone product designed for women in the United States, so clinicians who prescribe it typically use a small, carefully measured fraction of an approved product — most often a transdermal gel or cream — with blood-level monitoring. This is a well-recognized practice pattern, and it's also why the prescribing conversation matters more here than for most therapies.
When it comes up
The one use with consistent clinical trial support is hypoactive sexual desire disorder (HSDD) — a persistent, distressing loss of sexual desire — in postmenopausal women. It often enters the conversation when desire has faded in a way that bothers the woman herself (that distress is part of the definition), especially after other contributors like GSM, relationship factors, medications, and mood have been considered.
Common misconceptions
Three big ones. First: "testosterone will fix my energy, mood, and focus." Those claims circulate widely, but current evidence supports benefit for sexual desire — not for energy, cognition, mood, or muscle mass at female-range doses; guidelines are explicit about this. Second: "pellets are the natural, superior option." Testosterone pellets frequently produce blood levels far above the female physiologic range and can't be removed or adjusted once implanted — which is why major menopause and sexual-medicine organizations do not recommend them. Third: that side effects are inevitable. At physiologic doses with monitoring, side effects like acne or unwanted hair growth are uncommon and typically reversible; voice deepening is associated with supraphysiologic dosing.
What women often notice
Not guaranteed, and not everyone — educational only. In clinical trials, women treated for HSDD reported meaningful increases in desire and satisfying sexual events, with benefit typically assessed over about three to six months. Clinicians commonly discontinue therapy if there's no benefit by then — a useful expectation to set at the first visit.
Before you decide
Before You Start Testosterone
Questions that may help guide a conversation with your healthcare professional before beginning testosterone therapy.
- 1Does my experience fit hypoactive sexual desire disorder (HSDD), or could something else be contributing first?
- 2Low desire has many possible drivers — medications, sleep, mood, GSM, relationship factors. Have we evaluated those first?
- 3Is a formulation and dose appropriate for women available to me, and how will the dose be measured?
- 4What testing is recommended before starting, and how will testosterone levels and symptoms be monitored over time?
- 5What's a realistic timeline to judge benefit — and when would we stop if it isn't helping?
- 6Why do major guidelines recommend against pellets and compounded formulations?
- 7What is known — and still unknown — about long-term safety in women?
These are conversation starters, not medical advice or a recommendation for or against any treatment.
Who might help?
Low desire and midlife sexual health concerns can overlap across several areas of care. Depending on what's driving your symptoms, one or more of these clinicians may be helpful.
Menopause clinician
Commonly helps with GSM, menopause symptoms, vaginal estrogen, and hormone-related treatment decisions.
OB/GYN
Commonly evaluates vulvovaginal symptoms, abnormal bleeding, pelvic concerns, and gynecologic causes of symptoms.
Sex therapist
Commonly helps with desire, arousal, sexual communication, relationship dynamics, and the emotional/behavioral effects of pain or sexual changes.
Psychologist or licensed therapist
Mood, anxiety, stress, sleep behavior strategies (such as CBT-I), and coping support.
Pelvic floor physical therapist
May help with pelvic pain, painful sex (dyspareunia), urinary urgency or leakage, and pelvic floor muscle dysfunction.
Primary care clinician
Often a good starting point for urinary symptoms, infection evaluation, medication review, and coordinating referrals.
Your own clinician can help you decide who, if anyone, to involve next.
Questions you may wish to discuss
- Does my experience fit HSDD, or could something else (GSM, medications, sleep, mood, relationship factors) be contributing first?
- If we try testosterone, how will my blood levels be monitored, and what's the target range?
- What form and dose keep me in the female physiologic range?
- What's a realistic timeline to know whether it's helping — and when would we stop?
- What's your view on pellets, and why do guidelines advise against them?
✓ EVIDENCE SNAPSHOT
The Global Consensus Position Statement on testosterone therapy for women — endorsed by major menopause and sexual-medicine societies — supports testosterone for postmenopausal women with HSDD, at doses that approximate premenopausal physiologic levels, with monitoring; it found insufficient evidence for other uses (energy, mood, cognition, bone, muscle), and it recommends against compounded and pellet formulations when regulated alternatives exist.⁵
Learn next
- Libido & HSDD
- GSM
- Sexual health & pain with sex
- Vaginal (local) estrogen
- Mood & anxiety
- The North American Menopause Society (now The Menopause Society). The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022;29(7):767–794.
- Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the Women's Health Initiative randomized trials. JAMA. 2017;318(10):927–938.
- The North American Menopause Society (now The Menopause Society). The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society. Menopause. 2020;27(9):976–992.
- The North American Menopause Society (now The Menopause Society). The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society. Menopause. 2023;30(6):573–590.
- Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660–4666.
- Rossouw JE, Anderson GL, Prentice RL, et al; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002;288(3):321–333.
- American College of Obstetricians and Gynecologists. Practice Bulletin No. 141: Management of Menopausal Symptoms. Obstet Gynecol. 2014;123(1):202–216.