Menopause brings significant hormonal changes, and while most women know about declining estrogen and progesterone, many do not realize that testosterone levels also drop substantially during menopause. Testosterone therapy for menopause is gaining attention as a treatment option for women experiencing low libido, fatigue, brain fog, and loss of muscle mass. Here is what you need to know about testosterone for women during and after menopause.

What Is Testosterone and Why Do Women Need It?

Testosterone is often thought of as a male hormone, but women produce testosterone too. The ovaries, adrenal glands, and peripheral tissues all contribute to a woman's testosterone production. In fact, women produce more testosterone than estrogen throughout most of their lives.

Testosterone plays important roles in women's health, including supporting sexual desire and arousal, maintaining muscle mass and bone density, contributing to energy levels and mood regulation, and supporting cognitive function and mental clarity.

By the time a woman reaches menopause, her testosterone levels may have declined by 50% or more compared to her peak levels in her 20s. This decline begins during perimenopause and continues into postmenopausal years.

Signs of Low Testosterone in Women

Low testosterone in women can cause a range of symptoms that overlap with other menopause symptoms. Common signs of low testosterone in menopausal women include:

Reduced sexual desire (low libido) and diminished arousal
Fatigue and low energy that does not improve with rest
Loss of muscle mass and increased body fat
Brain fog, difficulty concentrating, and poor memory
Depressed mood, irritability, or anxiety
Decreased bone density
Vaginal dryness and discomfort during intercourse
Reduced sense of well-being

These symptoms can significantly impact a woman's quality of life. If you are experiencing several of these symptoms during or after menopause, talk to your doctor about testing your testosterone levels.

What Happens If a Menopausal Woman Takes Testosterone?

When testosterone therapy is prescribed at appropriate low doses for women, research shows it can provide meaningful benefits. A landmark global consensus position statement endorsed by the International Menopause Society, the Endocrine Society, and several other medical organizations concluded that testosterone therapy can be effective for postmenopausal women with hypoactive sexual desire disorder (HSDD).

Benefits observed in clinical studies include improved sexual desire, arousal, and orgasm, increased energy levels and reduced fatigue, better mood and reduced symptoms of depression, improved muscle strength and body composition, and enhanced cognitive function and mental clarity.

However, it is important to note that testosterone therapy for women is prescribed at much lower doses than for men. Women typically receive about one-tenth of a male dose to bring their levels into the normal female physiological range.

Does Testosterone Help With Weight Loss During Menopause?

Many menopausal women struggle with weight gain, particularly around the midsection. While testosterone therapy is not a weight loss treatment, research suggests it may help improve body composition by increasing lean muscle mass and reducing fat mass. Muscle tissue burns more calories at rest than fat tissue, so maintaining muscle mass through menopause can support a healthier metabolism.

Testosterone therapy combined with regular exercise, particularly resistance training, may offer the best results for managing body composition changes during menopause.

What Forms of Testosterone Therapy Are Available for Women?

There is currently no FDA-approved testosterone product specifically formulated for women in the United States. However, doctors can prescribe testosterone off-label using products designed for men at adjusted lower doses, or through compounding pharmacies that create custom formulations.

Testosterone Cream and Gel

Topical testosterone cream or gel is the most commonly prescribed form of testosterone therapy for women. A small amount is applied daily to the skin, typically on the inner thigh or lower abdomen. Testosterone cream provides steady hormone levels and is easy to adjust for dosing. Many doctors prescribe compounded testosterone cream in concentrations appropriate for women.

Testosterone Pellets

Subcutaneous testosterone pellets are inserted under the skin every 3 to 6 months by a healthcare provider. Pellets provide consistent testosterone release without the need for daily application. However, once implanted, the dose cannot be adjusted until the pellets are fully absorbed.

Testosterone Patches

While testosterone patches exist, most are dosed for men. Some providers use a portion of a male patch for women, but this approach is less common than creams or pellets.

Testosterone Injections

Injectable testosterone is occasionally used for women at very low doses, though topical formulations are generally preferred because they provide more stable blood levels and are easier to dose accurately for the smaller amounts women need.

Risks and Side Effects of Testosterone Therapy for Women

When prescribed at appropriate physiological doses and properly monitored, testosterone therapy is generally well tolerated by women. However, potential side effects include:

Acne or oily skin
Unwanted facial or body hair growth (hirsutism)
Hair thinning on the scalp
Deepening of the voice (rare at appropriate doses)
Clitoral enlargement (rare at appropriate doses)
Mood changes

Most side effects are dose-dependent and reversible if the dose is reduced or treatment is stopped. The risk of virilization (developing male characteristics) is low when testosterone is prescribed at physiologically appropriate female doses and monitored regularly.

Long-term safety data for testosterone therapy in women beyond 24 months is limited. The global consensus statement recommends that women on testosterone therapy have their levels monitored every 6 months to ensure they remain within the normal female range.

Why Are Doctors Hesitant to Prescribe Testosterone for Women?

Despite growing evidence supporting its use, many doctors are hesitant to prescribe testosterone therapy for menopausal women. Several factors contribute to this reluctance:

No FDA-approved product for women: The lack of an FDA-approved testosterone formulation specifically for women makes some providers uncomfortable prescribing off-label.
Limited long-term safety data: While short-term studies (up to 24 months) show a favorable safety profile, data beyond that timeframe is sparse.
Training gaps: Many medical schools provide minimal education on hormone therapy for menopause, leaving some providers unfamiliar with testosterone prescribing for women.
Confusion with male TRT: Some providers worry about prescribing a hormone they associate primarily with men, despite testosterone being a natural and important hormone in women.

If your primary care provider is unwilling to discuss testosterone therapy, consider seeking a menopause specialist, endocrinologist, or a clinic that specializes in hormone therapy for women.

How Is Testosterone Therapy Monitored in Women?

Proper monitoring is essential for safe testosterone therapy. Your doctor should check your testosterone levels before starting treatment and at regular intervals (typically every 3 to 6 months). Monitoring usually includes:

Total testosterone and free testosterone levels
Sex hormone-binding globulin (SHBG)
Complete blood count to check red blood cell levels
Lipid panel to monitor cholesterol changes
Liver function tests
Assessment of symptoms and side effects

The goal is to restore testosterone to levels within the normal premenopausal range for women, not to achieve male-range levels. If levels rise too high, your doctor will adjust the dose accordingly.

Should You Consider Testosterone Therapy for Menopause?

Testosterone therapy may be worth discussing with your doctor if you are a postmenopausal woman experiencing persistent low libido that has not responded to estrogen therapy alone, if you are experiencing unexplained fatigue and loss of motivation, or if you have symptoms of low testosterone confirmed by blood tests.

Testosterone therapy is typically prescribed alongside estrogen therapy (hormone replacement therapy), not as a standalone treatment. Most guidelines recommend trying estrogen-based HRT first, then adding testosterone if sexual desire does not improve.

Frequently Asked Questions

Does testosterone therapy help with menopause symptoms beyond libido?

The strongest evidence supports testosterone therapy for improving sexual desire in postmenopausal women. Emerging research suggests potential benefits for mood, energy, cognitive function, and bone density, but these uses are not yet supported by the same level of clinical evidence.

Is testosterone therapy safe for women long-term?

Studies up to 24 months show a favorable safety profile when testosterone is dosed appropriately for women. Long-term data beyond 2 years is limited, which is why regular monitoring is recommended. The Global Consensus Position Statement supports short to medium-term use with ongoing assessment.

Can I get testosterone therapy over the counter?

No. Testosterone is a prescription medication. Over-the-counter supplements marketed as testosterone boosters for women are not the same as pharmaceutical testosterone and are not regulated by the FDA. Always work with a qualified healthcare provider for hormone therapy.

Will testosterone therapy make me look masculine?

At the low doses prescribed for women, significant masculinizing effects are uncommon. Side effects like excess hair growth or acne may occur but are typically mild and reversible with dose adjustment. Your doctor will monitor your levels to keep them in the normal female range.

Find a Hormone Therapy Clinic Near You

If you are experiencing menopause symptoms and want to explore testosterone therapy, use our clinic directory to find providers who specialize in hormone therapy for women.

Sources

Davis, S.R. et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Journal of Clinical Endocrinology & Metabolism, 2019. pmc.ncbi.nlm.nih.gov
Islam, R.M. et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. The Lancet Diabetes & Endocrinology, 2019. pubmed.ncbi.nlm.nih.gov
Parish, S.J. et al. Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care. British Journal of General Practice, 2020. pmc.ncbi.nlm.nih.gov
Mayo Clinic. Testosterone therapy in women: Does it boost sex drive? mayoclinic.org
The Menopause Society. Hormone Therapy Position Statement. menopause.org
Cleveland Clinic. Should Women Get Treatment for Low Testosterone? health.clevelandclinic.org

Testosterone Therapy for Menopause: Benefits, Risks, and What Women Should Know