Is testosterone the answer to all of your health issues?

If there was a textbook about hormones, testosterone has long been the chapter most women skip — after all, that's a guy thing, right? Wrong. Turns out, this so-called "male" hormone exists in women’s bodies too, and does some pretty important work there. And lately, as the role of hormones during the menopause transition is getting more and more attention, testosterone’s share of the spotlight is growing.

"Midlife overall in women is having a moment,” says Susan Davis, Ph.D., director of the Women's Health Research Program at Monash University in Melbourne, Australia. “When traditional hormone replacement therapy (HRT) is not fixing everything, women are looking for ways to feel better. Testosterone has been promoted as one approach by a few, amplified by social media."

The claims sound pretty good: Vanishing libido? Brain fog that makes you forget why you walked into a room? Energy levels that make a sloth look ambitious? Try a prescription testosterone supplement! But how much of that is based on science? Keep reading for what the evidence actually shows.

Testosterone isn't some random hormone that took a wrong turn and accidentally wandered into the female body — it's one of the most abundant hormones pumping through your system during your reproductive years. And unlike estrogen and progesterone, which can take a dramatic nose-dive during menopause, testosterone takes a much slower and gradual route down. Levels decline throughout your life, and by the time menopause arrives, you're likely producing roughly half of what you did at your peak.

Think of testosterone as the ultimate multitasker, with its fingers in a lot of pies. Here's what this hormone handles:

• Sex drive: Testosterone is basically the hormone of desire. It's heavily involved in libido, arousal, and the ability to have satisfying orgasms. When testosterone dips, so does your interest in getting it on.

• Energy and mood: Testosterone plays a role in mood levels, energy, and mental clarity.

• Bone and muscle health: Testosterone can help maintain bone density and muscle mass, with research showing a link between testosterone levels and bone mineral density in postmenopausal women. 

• Cognitive function: Your brain has testosterone receptors too, and the hormone appears to play a role in memory, concentration, and overall cognitive performance.

• Pelvic floor, bladder, and urogenital health: Testosterone receptors are scattered throughout your pelvic region; low levels are linked to an overactive bladder and diminished pelvic floor function.

From a clinical standpoint, prescription testosterone therapy has one established indication: treating hypoactive sexual desire disorder (HSDD) in postmenopausal women, says Dr. Stephanie Faubion, M.D., the director for the Center for Women's Health at the Mayo Clinic, medical director for The Menopause Society, and member of the Weight Watchers scientific advisory board. HSDD is when your sex drive is so low that it's causing you significant distress (not just your partner!). It's the most common form of female sexual dysfunction, affecting about 10% of women. And that number goes even higher when you consider how many women experience sexual issues: Between 68% and 87% of perimenopausal and postmenopausal women report issues with desire, libido, and sexual functioning.

And testosterone can make a big difference in women with HSDD. For instance, a comprehensive meta-analysis of seven randomized controlled trials involving over 3,000 participants with HSDD found that women using transdermal testosterone (so the kind applied to the skin as a patch, cream, or gel) had significantly more satisfying sexual episodes, increased sexual activity, improved orgasms, stronger desire, and reduced personal distress compared to those on placebo.

The Global Consensus Position Statement on prescription testosterone therapy for women — endorsed by major medical organizations including The Menopause Society, the Endocrine Society, and the International Society for Sexual Medicine — supports the belief that testosterone improves sexual desire, arousal, orgasm, and pleasure, and reduces concerns about sex in postmenopausal women with HSDD. If you have more mild libido issues, testosterone might be able to help, but it’s not recommended as a treatment unless you have HSDD.

While influencers may claim adding prescription testosterone to their menopause treatment plan can help with everything from energy to mood, the evidence just isn’t there right now. "There is no data available to suggest that it helps with sarcopenia (age-related muscle loss), bone density, mood, cognition, general well-being, fatigue, or anything else in women," says Faubion. She goes on to emphasize that, unlike with men, "there is no defined lower limit of testosterone in women, and therefore there is no 'deficiency syndrome' when it relates to testosterone in women." This is a critical distinction — testosterone therapy for women isn't about correcting a deficiency; it's a targeted treatment for a specific sexual health concern.

Davis, who has conducted large studies on testosterone and cognition, adds important context. "Some women have been led to believe that testosterone will make them feel better, give them more 'pep,' improve their mood and cognition. So far these effects have not been shown in clinical trials. In large clinical trials to date, wellbeing and mood improvement has not differed between testosterone and placebo." Her conclusion? "While women may 'feel better' on testosterone, we are not sure whether or not this is all placebo effect, and more studies are needed."

Many clinicians and researchers argue that the lack of evidence is due to decades of neglect in women's health research, not because testosterone doesn't help. They point to the biological plausibility (testosterone receptors are throughout the female body), observational data, and countless anecdotal reports from women who say testosterone has been life-changing.

The good news for women is that more and more research is being done on testosterone therapy. For instance, a 2024 pilot study from a UK menopause clinic found that women using transdermal testosterone for four months reported significant improvements in both mood and cognition. Some studies also suggest that testosterone combined with estrogen as part of hormone replacement therapy (HRT) may be effective at increasing bone mineral density.  However, it's crucial to note that these findings remain preliminary and that larger, longer clinical trials are still needed.

The UK's National Institute for Health and Care Research is currently funding the ESTEEM trial, which will measure testosterone's effects on overall menopause-related quality of life beyond sexual function. Results are expected in 2028.

If you and your healthcare provider decide prescription testosterone therapy is worth trying to improve sexual function, here's what to expect:

• Formulation: The most common method is a transdermal cream or gel that you apply daily to your skin — typically the upper thighs, lower abdomen, or buttocks. The key is choosing a spot where you won't accidentally transfer it to others (including pets!) through touch. Always wash your hands thoroughly after application.

• Dosing: Women receive a tiny fraction of the dose that men get if they are receiving testosterone therapy. The goal isn't to pump you up to superhuman levels — it's to restore your testosterone to the levels you had in your twenties and thirties. 

• Monitoring: You'll need baseline blood work before starting, followed by repeat testing after beginning treatment, then periodically thereafter. This ensures your levels stay in the appropriate physiological range.

• What to avoid: Injectable testosterone, pellet implants, and high-dose oral formulations can cause testosterone levels to spike too high and are harder to control. This is why  global consensus recommendations do not recommend these preparations.

• Possible side effects: There are common (and usually manageable) side effects, such as hair growth at the application site, mild acne, and a slight increase in facial hair. (These are typically signs that your dose needs adjusting. Switching application sites or reducing the dose usually helps.) Rare but serious side effects (from improper dosing) include: male-pattern baldness, deepening of the voice (usually irreversible), and clitoral enlargement. 

Some women should not use testosterone, including:

• Those who are pregnant or breastfeeding

• Those with liver disease

• Those with certain heart conditions or high cholesterol being treated with medication

• Women with a history of hormone-sensitive breast or uterine cancer (though this is being reconsidered on a case-by-case basis)

Here's where things get frustrating: Despite solid evidence that testosterone helps with HSDD, there is currently no FDA-approved testosterone product specifically for women in the United States. (There are only a few nations with approved prescription testosterone medication for women, including the UK, Australia, New Zealand, and South Africa.) "It would be great to have an FDA-approved option [for women]," says Faubion, "Right now we either have to compound testosterone (meaning use a custom-made, non-FDA approved formulation) or prescribe medications that were formulated for use in men, which means using one-tenth of a male dose." 

This workaround adds complexity and cost for both patients and providers, says Dr. Erin Gross, M.D., clinical professor and director of the UCSD Vulvar and Sexual Health Clinic at the UC San Diego Health System. “It can mean a higher up-front cost for patients when they need to purchase a supply that may last a man 30 days but would last them 300 days.” And other non-FDA approved options, like testosterone pellets, aren’t regulated for quality and safety. “If there were an FDA-approved option, this would ensure quality and standard dosing,” says Gross. This lack of FDA-approved options also means that insurance typically won't cover testosterone, leaving women to pay out of pocket.

There's also a training gap: Many primary care physicians don't feel confident prescribing testosterone for women, in part because they have not received adequate education on this topic or the appointments are too short to actually delve into this intimate topic. This has created a system where women who can afford to see private menopause and midlife health specialists have access to testosterone, while others struggle to get it through standard healthcare channels.

You may notice a lower-than-usual libido and feel ready to get on a prescription testosterone supplement, but hit pause first and talk with your clinician about whether that’s the right treatment plan. There are many factors that can contribute to low libido, and those things need to be explored because testosterone won’t fix everything, says Faubion. Davis also notes that testosterone should only be trialed after treating issues like vaginal dryness, painful sex, relationship issues, depressive symptoms, and medications causing low libido.

There are also other options:

• Optimize your estrogen-based HRT first: Make sure you're on the right dose and formulation of estrogen and progesterone (if needed). Many symptoms attributed to low testosterone like low energy or brain fog can actually improve by having a clinician work carefully with you on a tailored HRT plan.

• Vaginal DHEA or estrogen: For vaginal dryness and painful sex, topical estrogen or DHEA can be game-changers and may indirectly improve libido by making sex more comfortable.

• Cognitive behavioral therapy: Research presented at the 2024 Menopause Society meeting showed that CBT significantly improved sexual functioning, body image, and relationship satisfaction in perimenopausal and postmenopausal women.

• Other FDA-approved medications for HSDD: Flibanserin (Addyi) and bremelanotide (Vyleesi) are approved for low libido in premenopausal women and work through different mechanisms than testosterone.

Prescription testosterone therapy for menopausal women is a legitimate, evidence-based treatment for low libido that's causing distress. It's not a miracle cure for all of menopause's indignities, but for many women, it can restore a sense of vitality, desire, and connection that they thought was gone forever. The frustrating part is that access remains uneven. The lack of an FDA-approved product for women, combined with possible insurance coverage issues and provider training gaps, means that many women who could benefit from testosterone simply can't get it. 

If you're struggling with low libido, persistent fatigue, or other symptoms that might be related to declining testosterone, start by talking to a healthcare provider who specializes in menopause, like those through the Weight Watchers Menopause Program. Clinicians can explain the available treatment options and help you determine which might be the best fit.