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Testosterone for women

For women, the only use of testosterone supported by randomized trial evidence is hypoactive sexual desire disorder in postmenopausal women — distressing low sexual desire that is not explained by something else. There is no FDA-approved testosterone product for women in the United States, so any use is off-label, at roughly a tenth of a male dose. The international consensus position statement does not support prescribing testosterone for energy, mood, cognition, muscle mass, bone density, or general wellbeing in women, and neither do we.

Who this is for

  • Postmenopausal women with hypoactive sexual desire disorder — low sexual desire that causes personal distress
  • Women for whom other causes have been addressed first: relationship factors, depression, medication side effects, pain with sex, and genitourinary syndrome of menopause
  • Women who have had a full conversation about the size of the expected benefit and the fact that use is off-label

Why this page is written the way it is

Testosterone for women is heavily marketed, and most of what is claimed for it is not supported. It is sold for energy, focus, motivation, muscle, sleep, and general vitality. Randomized trials do not show those benefits.

There is one indication that holds up: hypoactive sexual desire disorder in postmenopausal women. The 2019 Global Consensus Position Statement, endorsed by the major menopause and endocrine societies, reviewed the evidence and reached that conclusion, and it explicitly did not support prescribing for the other indications.

So this page tells you the same thing we would tell you in the room, which is that there is a real indication, the benefit for it is modest, the use is off-label, the long-term safety data are limited, and everything else being advertised is not established.

What we do before prescribing

Low sexual desire usually has more than one cause, and testosterone addresses only one of them.

If sex hurts, desire will not return until the pain does not. Genitourinary syndrome of menopause is the most common reason, and treating it with vaginal estrogen resolves the problem for a large share of women who thought they had a desire problem.

If you are depressed, or exhausted, or taking a medication that blunts desire — SSRIs are the common one — that is where to start. If the relationship is the issue, a hormone will not fix it, and saying so plainly is more respectful than prescribing around it.

We work through all of that first. Sometimes the answer at the end of it is testosterone. Often it is not.

If we do prescribe it

We use a small measured amount of an FDA-approved transdermal product at roughly one tenth of a male dose. We check a baseline level to make sure you are not already high, recheck it a few weeks in, and confirm you stay within the normal premenopausal female range.

We watch for androgenic effects. Acne and unwanted hair growth are dose-related and reversible. Voice deepening may not be, so any voice change means stopping immediately rather than waiting to see.

We set a six-month trial with a defined way to measure whether it helped. If it has not, we stop. Continuing an off-label hormone with modest average benefit and limited long-term safety data, when it is not working, is not something we will do.

Options

What we prescribe, and what we do not.
Approach How it is taken Where we stand
Transdermal testosterone at a female dose A small measured amount of an FDA-approved male gel applied daily to the skin, at approximately one tenth of a male doseThis is the approach the international consensus position statement supports, used off-label. It is what we prescribe when testosterone is appropriate.
Compounded testosterone creams at custom doses Mixed by a compounding pharmacyWe do not use these. Dose accuracy varies, and there is no reason to prefer them over a measured amount of a tested product.
Implanted hormone pellets Inserted under the skin in the officeWe do not offer implanted testosterone or estrogen pellets. Doses are not adjustable once inserted, blood levels frequently run supraphysiologic, and they cannot be removed if you have a problem.
Testosterone injections Intramuscular injectionNot used in women. Peak levels far exceed the female physiologic range.
Oral testosterone A tabletNot used in women. Oral androgens carry liver and lipid effects that transdermal delivery avoids.

What the evidence supports

Each claim below carries a rating. Strong means randomized trials and current specialty guidelines support it. Moderate means the evidence is real but has meaningful limits. Limited means early, small, or indirect evidence — and where we say Limited, that is us telling you not to count on it.

  • Improves sexual desire, arousal, and satisfying sexual events in postmenopausal women with HSDD

    Evidence for Improves sexual desire, arousal, and satisfying sexual events in postmenopausal women with HSDD: Moderate evidence

    Meta-analyses of randomized trials show a statistically significant improvement over placebo. The average effect is modest — on the order of one additional satisfying sexual event per month — and the placebo response in these trials is substantial. Women deserve that number before deciding, not an adjective.

  • Improves energy, mood, cognition, muscle mass, or bone density in women

    Evidence for Improves energy, mood, cognition, muscle mass, or bone density in women: Limited evidence

    The 2019 Global Consensus Position Statement on the use of testosterone therapy for women concluded the evidence does not support prescribing testosterone for these indications. We do not prescribe it for them.

  • A blood testosterone level identifies women who will benefit

    Evidence for A blood testosterone level identifies women who will benefit: Limited evidence

    There is no blood level that diagnoses testosterone deficiency in women, and levels do not predict who responds. Assays are also unreliable at female concentrations. We measure a baseline to make sure you are not already high, and a follow-up level to confirm you have not gone above the normal female range — not to chase a target.

  • Long-term safety of testosterone in women is established

    Evidence for Long-term safety of testosterone in women is established: Limited evidence

    Trials have generally run 6 to 24 months. Long-term cardiovascular and breast safety data in women are not available. That uncertainty is part of the conversation before starting, and it is a reason to review rather than to continue indefinitely by default.

What this treats

  • Hormone therapy

    Estrogen therapy is a separate decision and treats different symptoms.

  • Vaginal estrogen

    Local treatment for the pain and dryness that often underlie low desire.

Common questions

Will testosterone give me my energy back?

We cannot tell you that, because the evidence does not support it. The global consensus position statement reviewed the trials and concluded testosterone should not be prescribed for fatigue, mood, cognition, muscle mass, or general wellbeing in women. If you are exhausted, that deserves a workup — thyroid, iron, sleep apnea, depression, and medication review — not a hormone prescribed on a claim that has not held up.

Why is it off-label if it works?

There is no FDA-approved testosterone product for women in the United States. Australia and the United Kingdom have had approved or specifically marketed female formulations at various points; the US has not. So prescribing means using a measured fraction of an approved male product, which is legal and is what the consensus statement describes, but you should know that is what is happening.

Do you offer implanted hormone therapy?

No. We do not insert hormone pellets. The dose cannot be adjusted once it is in, blood levels frequently run well above the normal female range, and there is no way to stop treatment quickly if you develop side effects. We do not use this delivery route at all, and the published safety concerns about it are why that is a firm position rather than a preference.

How much improvement should I expect?

In randomized trials, on average, about one additional satisfying sexual event per month compared with placebo, with improvements in desire and reduced distress. Some women do considerably better than the average and some notice nothing. We set a 6-month trial and a way to measure it, and if it has not helped, we stop.

Should my testosterone level be checked to see if I'm low?

Screening a blood level to diagnose deficiency is not supported — there is no threshold that defines deficiency in women, levels do not predict response, and commercial assays are imprecise at female concentrations. We check a level for safety, to confirm you are not already high before starting and not above the female range afterward.

Medically reviewed by PLACEHOLDER — Medical Director, MD · Reviewed · Updated
PLACEHOLDER: replace with the reviewing clinician before launch.

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