Testosterone Therapy for Women: Closing the Care Gap

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

Testosterone Therapy for Women

When we talk about hormones during perimenopause and menopause, estrogen and progesterone tend to dominate the conversation. Yet testosterone is also an essential female hormone, playing a role in sexual function and other aspects of women's physiology.

For women navigating midlife, symptoms such as fatigue, changes in sexual desire, low motivation, and difficulty concentrating can be frustrating, particularly when they are dismissed as inevitable consequences of aging.

Although these symptoms have many possible causes, testosterone is one hormone that deserves greater attention in conversations about women's health.

I've previously discussed high testosterone symptoms in women, including androgen excess associated with PMOS (formerly PCOS). Today, we're exploring the other side of the conversation: testosterone decline, testosterone therapy for women, and the persistent gaps in menopause care.

Should testosterone be part of your hormone therapy plan? What does the evidence actually support? And what needs to change to ensure women have access to informed, individualized care?

Let's explore why testosterone matters, what we know about treatment, and why women deserve better.

Testosterone Is a Female Hormone, Too

Testosterone is often described as a male hormone, but this characterization overlooks its essential role in female physiology.

Women naturally produce testosterone in the ovaries and adrenal glands, with additional production occurring through the conversion of other hormones in peripheral tissues.

Testosterone contributes to normal sexual function and participates in biological processes involving muscle, bone, and other tissues.

Yet the longstanding perception of testosterone as primarily a male hormone has contributed to gaps in research, medical education, and treatment options for women.

As Angela DeRosa discusses in her review of testosterone therapy and gaps in women's healthcare, improving care requires better clinician education, appropriate treatment protocols, equitable access, and the development of female-specific therapies.

Testosterone is not exclusively a male hormone. It is a normal part of women's hormonal health, and its role deserves greater clinical recognition.

Importantly, recognizing testosterone's physiological functions does not mean that every woman with symptoms or a lower measured testosterone level needs replacement therapy.

Understanding the distinction between normal hormonal changes, symptoms, and evidence-based treatment indications is essential.

Low Testosterone in Perimenopause and Menopause

Unlike estrogen, which often fluctuates considerably during perimenopause, testosterone generally declines more gradually across the reproductive years.

Levels may begin decreasing well before menopause, although individual patterns vary. Natural menopause itself does not necessarily produce a sudden drop in circulating testosterone.

Factors that influence testosterone availability include age, ovarian and adrenal function, certain medications, and levels of sex hormone-binding globulin (SHBG), a protein that binds circulating sex hormones.

Some women experience symptoms that overlap with those commonly associated with hormonal changes during midlife, including:

• Reduced sexual desire or changes in arousal

• Fatigue or decreased energy

• Changes in mood and motivation

• Difficulty concentrating

• Changes in muscle strength or body composition

• Concerns about bone health

However, these symptoms are not specific to testosterone deficiency. They may also reflect changes in estrogen, sleep disruption, thyroid dysfunction, medications, stress, relationship factors, or other health conditions.

There is currently no universally accepted blood testosterone threshold that diagnoses testosterone deficiency in otherwise healthy women or reliably predicts who will benefit from treatment.

Is Low Libido Always Related to Testosterone?

Low sexual desire is one of the most commonly discussed concerns in relation to testosterone and menopause.

However, libido is complex.

Estrogen deficiency, vaginal dryness or pain, relationship dynamics, psychological well-being, medications, sleep, and chronic stress can all influence sexual desire.

For some women, persistent low desire accompanied by personal distress may meet the criteria for hypoactive sexual desire disorder (HSDD).

A comprehensive clinical assessment is important because testosterone testing alone cannot establish the diagnosis or determine whether therapy is appropriate.

Learn more about testosterone and menopause, including integrative approaches to evaluating women's hormonal health.

Testosterone Therapy for Women: What Does the Evidence Show?

Testosterone replacement therapy is widely discussed in men's healthcare, but treatment options for women remain significantly more limited.

There are currently no FDA-approved testosterone products specifically indicated for women in the United States.

When clinically appropriate, qualified healthcare providers may prescribe certain testosterone products off-label. This creates challenges involving dosing, availability, insurance coverage, and consistent product formulations.

The need for appropriately dosed, FDA-approved treatment options for women was among the issues I advocated for during the U.S. Senate's first hearing dedicated to menopause care.

Potential Benefits of Testosterone Therapy

The strongest evidence supporting systemic testosterone therapy in women concerns the treatment of HSDD in postmenopausal women following a comprehensive assessment.

Research has demonstrated that appropriately dosed testosterone therapy can improve several aspects of sexual function in eligible women, including:

• Sexual desire

• Sexual arousal

• Sexual pleasure

• Orgasmic function

• The frequency of satisfying sexual experiences

• Sexual distress associated with HSDD

A 2025 clinical review examines testosterone treatment for HSDD in perimenopausal and postmenopausal women.

Research is also exploring whether testosterone therapy may influence other symptoms and physiological systems.

For example, a 2025 pilot study investigated mood and cognitive symptoms, while a 2026 study evaluated outcomes across multiple organ systems in women receiving testosterone therapy.

These findings are relevant to ongoing research, but they do not establish testosterone as an approved or routinely recommended treatment for fatigue, depression, cognitive difficulties, osteoporosis, cardiovascular disease, or general longevity.

Larger, well-controlled studies are needed to clarify these potential benefits, identify appropriate candidates, and understand long-term outcomes.

Safety and Monitoring Matter

Testosterone therapy is not appropriate for every woman.

When prescribed, treatment should be individualized, with attention to symptoms, medical history, baseline hormone levels, potential contraindications, and follow-up monitoring.

Potential androgen-related side effects include acne and increased facial or body hair. Excessive exposure may increase the risk of more significant effects, including voice changes and clitoral enlargement, some of which may be irreversible.

Available short-term safety data are generally reassuring when testosterone is administered within physiological female ranges in appropriately selected patients. However, long-term safety data remain limited, particularly for cardiovascular and breast health outcomes.

Transdermal preparations are generally preferred in evidence-based guidance. Injections, pellets, and formulations that produce testosterone concentrations above normal female physiological ranges are not recommended.

Compounded testosterone preparations also raise concerns about consistency, dosing accuracy, and the absence of FDA review for safety and effectiveness.

Women deserve access to appropriately formulated, consistently dosed therapies supported by high-quality evidence.

Why Personalized, Integrative Menopause Care Matters

Hormone therapy should never be reduced to a prescription without a broader understanding of a woman's health.

At TārāMD, we approach perimenopause and menopause through an integrative and functional medicine lens, considering the interaction between hormones, metabolism, nutrition, sleep, stress, sexual wellness, and overall health.

A personalized evaluation may include:

• A comprehensive review of symptoms and medical history

• Assessment of menstrual and menopausal changes

• Review of medications and relevant health conditions

• Targeted laboratory testing when clinically appropriate

• Evaluation of sexual health and relationship-related concerns

• Discussion of evidence-based hormone therapy options

• Individualized nutrition, lifestyle, and wellness support

For women considering testosterone therapy, laboratory measurements are primarily useful for establishing baseline levels, identifying unexpectedly elevated concentrations, and monitoring treatment to avoid excessive exposure.

They should not be used in isolation to diagnose a testosterone deficiency syndrome or determine treatment eligibility.

What to Expect When Starting Testosterone Therapy

For appropriately selected women receiving testosterone for HSDD, improvement may develop gradually over several weeks, with some benefits taking a few months to become apparent.

Regular follow-up allows the clinician to assess symptom response, monitor testosterone levels, evaluate side effects, and determine whether treatment remains appropriate.

If meaningful improvement does not occur after an adequate trial, typically within six months, discontinuation should be considered.

Hormonal needs and health priorities may also evolve as women transition through perimenopause, menopause, and postmenopause.

This is why ongoing, individualized care matters.

Our broader approach may include bioidentical hormone therapy, nutrition counseling, lifestyle interventions, and sexual wellness support, tailored to each patient's clinical needs.

Midlife women deserve more than a prescription. They deserve thoughtful, personalized care that considers their symptoms, health history, priorities, and long-term well-being.

Women Deserve Better: Closing the Gaps in Testosterone Care

Despite increasing awareness of menopause, significant gaps remain in how women's hormonal health is researched, taught, and treated.

Women may encounter clinicians who have received limited training in menopause medicine or sexual health. Others struggle to access specialists or obtain appropriate therapies.

These challenges reflect broader shortcomings in women's healthcare.

Improving the system requires action in several areas.

1. More Research Focused on Women

We need larger, longer-term clinical trials that examine testosterone therapy in diverse populations of women.

Research should clarify treatment benefits, safety, appropriate dosing, and the relationship between testosterone and other aspects of health.

2. Better Clinician and Patient Education

Healthcare professionals need comprehensive, evidence-based education about perimenopause, menopause, sexual health, and hormone therapy.

Women also need access to accurate information that empowers them to participate in informed decisions about their care.

3. FDA-Approved Testosterone Options for Women

The absence of female-specific FDA-approved testosterone products creates unnecessary barriers.

Appropriately dosed and rigorously evaluated products could improve treatment consistency, accessibility, and confidence in prescribing.

4. Greater Emphasis on Preventive Midlife Healthcare

Perimenopause and menopause represent important opportunities to evaluate cardiovascular risk, bone health, metabolic changes, and other factors that influence healthy aging.

Preventive care should be comprehensive and evidence-based rather than focused on any single hormone.

The Future of Testosterone and Women's Health

Testosterone is a normal and important female hormone, yet its role in women's healthcare remains underrecognized.

Although testosterone therapy is not appropriate for every woman, eligible patients should have access to informed discussions about its potential benefits, limitations, and risks.

We are encouraged by the growing public conversation around menopause, the women advocating for better care, and the clinicians working to close longstanding gaps in medical research and education.

At TārāMD, our commitment extends beyond individualized patient care. We also support greater awareness, improved clinical education, and policies that expand access to evidence-based women's healthcare.

Every woman deserves to have her concerns taken seriously, receive a comprehensive evaluation, and make informed decisions alongside a knowledgeable healthcare professional.

The future of menopause care should be defined by better science, greater access, and truly personalized medicine.

Learn more about our approach to integrative and functional women's health at TārāMD.

References

1. DeRosa, A. (2025). Testosterone: Strong Enough for a Man, but Made for a Woman. Medical Research Archives, 13(11).

2. Scott, A., & Newson, L. (2020). Should we be prescribing testosterone to perimenopausal and menopausal women?. British Journal of General Practice, 70(693), 203–204.

3. Hernandez, B. S., et al. (2026). Improvement in multiple organ systems following testosterone replacement therapy in women previously on standard hormone replacement therapy. The Journal of Sexual Medicine, 23(9), qdag116.

4. Kling, J. M. (2025). Testosterone for the Treatment of Hypoactive Sexual Desire Disorder in Perimenopausal and Postmenopausal Women. Obstetrics & Gynecology, 146(3), 341–349.

5. Glynne, S., et al. (2025). Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study. Archives of Women's Mental Health, 28(3), 541–550.

6. Simon, J. A., et al. (2018). The role of androgens in the treatment of genitourinary syndrome of menopause. Menopause, 25(7), 837–847.

Additional Clinical Guidance

7. Davis, S. R., et al. (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women. The Journal of Clinical Endocrinology & Metabolism, 104(10), 4660–4666.

8. Parish, S. J., et al. (2021). International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. Journal of Women's Health, 30(4), 474–491.