Testosterone Therapy for Women: What to Know After Menopause

Mention testosterone and the conversation automatically defaults to men. As the primary male sex hormone, it’s responsible for the characteristics that boys develop during puberty, such as a deeper voice, increased muscle mass, and body hair.

But testosterone also plays in important role in women’s wellbeing. Its use, particularly for women going through menopause, has expanded and become a hot topic among both clinicians and health influencers in the treatment of low libido.

 “There’s been a lot more discussion around the topic in the past few years,” says Grettel Garcia, M.D., an internist with the University of Miami Health System who specializes in menopause. “I teach my patients about it because it’s newer [in terms of therapy] and they don’t know it’s an option. But it’s certainly one more valuable tool we have for treatment.”

In women, testosterone is produced by the ovaries and adrenal glands.

And it’s actually produced in greater daily quantity than the “female” hormones — roughly 10 to 20 times more than estrogen and hundreds of times more than progesterone. That’s because estrogen and progesterone levels fluctuate depending on where a woman is in her menstrual cycle, while testosterone is produced steadily without interruption. After menopause, testosterone is the dominant sex steroid.

While men produce more of it, this hormone plays a similar role in both sexes. In women, it’s essential for bone and muscle health, sexual desire, mood, and cognitive processes. If blood levels dip, these functions are likely to suffer. As research and a growing awareness around treating hypoactive sexual desire disorder (HSDD) grows, prescriptions for testosterone have spiked dramatically in the past 20 years.

One 2021 pharmacoepidemiologic analysis found that U.S. prescribing increased three- to four-fold in the early 2000s.

Many of these scripts were for low libido but others were for other purposes as well. Some prescibers used it as a “natural” anti‑aging therapy, though there is still scant scientific evidence to back that claim.

Testosterone therapy is available in several forms, including gels, creams, compounded formulations, injections, and pellets. However, there is currently no testosterone product approved by the U.S. Food and Drug Administration (FDA) specifically for women.

Researchers are actively studying female-specific testosterone therapies, but it will take several years to fully understand their safety, effectiveness, and appropriate dosing. One of the most advanced clinical trials is evaluating a transdermal testosterone patch for postmenopausal women, designed to deliver consistent, physiologic hormone levels. Early (Phase 1) trial results have been positive.

If future trials confirm safety and efficacy, this patch could become the first FDA-approved testosterone therapy designed specifically for women.

For now, physicians prescribe current medications on the market, though the FDA has not specifically approved testosterone for women. “We use it off-label and when there’s a need [because of low-levels in the blood],” Dr. Garcia says. “It’s a good tool used independently or as an add on.”

The most cited clinical studies of testosterone efficacy are in the area of hypoactive sexual desire disorder in postmenopausal women.

One 2019 meta-analysis found significant improvements in sexual desire, arousal, and orgasm, with no serious short-term affects.

There has also been a growing consensus among medical groups for the use of clinically supervised testosterone. The Menopause Society, a non-profit based in Ohio, is one of the endorsing societies of the Global Consensus Position Statement on the subject.

The paper states that “the only evidence-based indication for testosterone therapy for women is for the treatment of postmenopausal women who have been diagnosed as having HSDD.” It adds that there is currently “insufficient evidence to support the use of testosterone for the treatment of any other symptoms or clinical conditions, or for disease prevention.”

However, Dr. Garcia. who is a Menopause Society Certified Practitioner, says her patients report an improvement in energy and focus, less brain fog, and easier weight loss, even as those are not the reason for treatment. Like most clinicians, her preferred mode of administration is a topical gel or cream, usually applied daily. The use of pellets and injections is not recommended by physicians or medical organizations. This is mainly because dosages can be difficult to control, often leading to unwanted effects such as acne, hair loss, and voice deepening.

Appropriate dosing, as determined by bloodwork, is key.

“Side effects happen only when the dosage is too high,” Dr. Garcia says, “so our goal is to normalize the levels not overtreat it.”

Unlike estrogen and progesterone replacement therapy, which is routinely covered by insurance companies when prescribed for menopause, testosterone therapy is usually not. On rare occasions the insurer might accept off-label use with proof of lab work and medical necessity. “It’s very important to shop around because price can vary,” she adds. (The monthly cost can range from $30 to $80, depending on the concentration and the pharmacy.)

One last word of caution from Dr. Garcia. Testosterone is not a miracle cure and not every woman will experience better sexual function when using it.

“Sex drive is influenced by several factors – the quality of the relationship, stress, physical health, even medications,” she says. “Treatment by itself won’t necessarily change low libido unless other things are in place.”

Written by Ana Veciana-Suarez. Medically reviewed by Grettel Garcia, M.D.