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.
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.