Testosterone for Women in Menopause: What It Treats, What It Doesn't, and How It's Prescribed

What testosterone is proven to treat

The 2019 Global Consensus Position Statement, written by a task force from menopause, endocrine and sexual-medicine societies, concluded that the only evidence-based indication for testosterone in women is postmenopausal HSDD diagnosed after a full biopsychosocial assessment ^[1]. HSDD means low desire that bothers you, not simply a lower sex drive than before.

The statement is blunt about blood tests: no testosterone level can separate women with and without sexual dysfunction, so a lab result cannot diagnose a "testosterone deficiency" in women ^[1]. The UK's NICE guideline takes a stepwise view, suggesting testosterone for low sexual desire associated with menopause when hormone therapy alone has not helped ^[5].

What the trials found

A 2019 systematic review in The Lancet Diabetes & Endocrinology pooled 36 blinded randomized trials of at least 12 weeks (46 reports, 8,480 participants) ^[2]. In postmenopausal women, testosterone increased satisfying sexual events by 0.85 a month and improved desire, pleasure, arousal, orgasm, responsiveness and self-image while lowering sexual distress ^[2].

Route mattered. Oral testosterone raised LDL cholesterol and lowered HDL cholesterol, while patches and creams did not change lipids; weight rose slightly overall ^[2]. The consensus statement therefore recommends against oral testosterone ^[1].

What it has not been shown to do

So if a clinic offers testosterone for fatigue, brain fog, weight or "hormone balance", that is outside what the trials support. If those are your main symptoms, see our perimenopause symptoms checklist and the options covered in our hormone therapy guide.

• Wellbeing and mood: available data show no effect on general wellbeing or depressed mood in postmenopausal women ^[1].
• Brain: there is insufficient evidence that testosterone improves thinking or delays cognitive decline ^[1].
• Bone and muscle: no effect on spine or hip bone density at 12 months, and no significant change in lean mass, fat mass or strength at physiological doses ^[1].
• Before menopause: the data are insufficient to recommend testosterone for sexual function or anything else in premenopausal women ^[1], and a 2025 review in Obstetrics & Gynecology describes only limited research in late reproductive age ^[6].

How it is prescribed in the US

Unlike estrogen products, testosterone has no FDA-approved indication for menopausal women; the FDA notes that off-label use has grown over the past decade and that testosterone is approved for HSDD in women in Australia, New Zealand, the UK and South Africa ^[3]. ACOG's 2023 consensus adds that compounded testosterone is often part of compounded "bioidentical" hormone therapy ^[7].

The Menopause Society's 2023 practice pearl says that when no women's product is available, it is reasonable to prescribe an approved men's formulation off-label at about one-tenth of the men's dose ^[4]. The consensus statement asks for a baseline total testosterone before starting, a repeat level 3 to 6 weeks in, a check every 6 months for overuse, and stopping if there is no benefit by 6 months ^[1].

It also warns that direct (immunoassay) tests for total and free testosterone are highly unreliable in the female range; mass-spectrometry assays are accurate, and direct assays are acceptable mainly to rule out high levels ^[1]. Ask which method your lab uses.

Side effects and safety

At doses that approximate premenopausal blood levels, trials linked testosterone to mild increases in acne and body or facial hair in some women, but not to hair loss, clitoral enlargement or voice change ^[1]. ACOG lists unwanted hair growth, acne and masculinizing changes among reported side effects in women, noting the masculinizing changes may be irreversible ^[7]; the consensus advises against pellets, injections and any product that produces above-normal levels ^[1].

Non-oral testosterone did not change lipids, blood pressure, blood glucose or HbA1c in trials; a non-significant trend toward more deep-vein clots could not be separated from the estrogen most participants also took ^[1]. Short-term transdermal use did not raise breast density or breast cancer risk, but long-term breast data are lacking, and safety data stop at 24 months ^[1]. Women with hormone-sensitive breast cancer were excluded from the trials ^[1].

Getting care online

Menopause telehealth services mostly prescribe estrogen and progesterone first; Gala's hormone page, for example, lists estradiol pill or patch, progesterone, vaginal estradiol and non-hormonal options ^[8]. That order matches NICE, which positions testosterone after hormone therapy has been tried ^[5]. Compare services, prices and pharmacy types on our online menopause HRT comparison and menopause treatment cost pages.

Whoever prescribes testosterone should follow the monitoring above: a baseline level, a repeat at 3 to 6 weeks and a review at 6 months ^[1]. You can order your own blood work for the baseline if you want your own copy of the number.