Testosterone for women - the new buzz!

Why people consider testosterone for women

Though often thought of as a “male” hormone, testosterone also plays a role in female physiology — including sexual desire, bone and muscle health, mood, and energy. As women age, especially through menopause or after surgical removal of the ovaries, testosterone levels may decline, which can contribute to decreased libido and other symptoms.

For some women, adding a low dose of testosterone appears to restore aspects of sexual function and well-being, particularly when other causes of low libido (like psychosocial stress, medications, or relationship issues) have been ruled out.

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What the evidence supports — and what remains uncertain

There is fair-to-good evidence that low-dose testosterone therapy can improve sexual desire, arousal, and satisfaction in postmenopausal women (and, more cautiously, in late-reproductive-age premenopausal women) — but only when they meet strict criteria.

Improvements in “well-being,” mood or general energy have been reported in some studies, but evidence for testosterone improving bone health, muscle mass, cognition, fatigue, or overall health in women is weak, ambiguous or lacking so far.

Long-term safety data are limited. While short-term studies (up to 1–2 years) using physiological doses haven’t generally shown severe adverse events such as liver damage or increased cardiovascular risk, it remains unclear whether therapy over many years is safe.

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When testosterone supplementation is currently recommended (or considered)

According to current expert guidelines and consensus statements, the most accepted indication by far is:

Hypoactive Sexual Desire Disorder (HSDD) in women — defined as a persistent lack of sexual desire that causes marked personal distress — after a thorough evaluation (medical, psychological, social) rules out other causes.

Typically, a short-term trial (3–6 months) of low-dose, transdermal testosterone (gel or cream) is recommended rather than long-term indefinite therapy.

In some cases, late-reproductive-age premenopausal women may be considered — but only if they meet strict criteria and after careful evaluation.

Importantly: regulatory bodies have not approved testosterone products specifically for women in many countries — so any use tends to be “off-label.”

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Risks, side-effects and limitations

Testosterone supplementation in women is not risk-free. Common side effects (especially if doses are too high) include:

Acne, oily skin, increased facial/body hair (hirsutism), male-pattern hair thinning, possible voice changes or clitoral enlargement.

Changes in lipid profile (for instance, reduced “good” HDL cholesterol), particularly with some oral or methyl-testosterone forms.

Because long-term data are limited, potential risks to cardiovascular health, breast or uterine tissue, metabolism, or other systems cannot be ruled out.

Because of this, experts generally advise against using testosterone for vague or non-specific complaints such as fatigue, “low energy,” weight concerns, bone health, or general “aging” — unless there is a documented, distressing sexual dysfunction (HSDD).

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What to keep in mind if considering testosterone

A thorough evaluation should come first — to exclude psychological, relational, medication or other medical causes of sexual dysfunction.

Baseline and follow-up lab tests are useful to monitor testosterone levels (though lab assays in women are imperfect), and therapy should aim for physiological pre-menopausal ranges.

Therapy should be time-limited and reassessed (many guidelines suggest evaluating at 3–6 months, discontinuing if there’s no improvement).

Risks vs benefits must be weighed carefully, and the decision should ideally come through shared decision-making with a knowledgeable clinician.

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My view: proceed with caution — but don’t dismiss the possibilities

Testosterone supplementation for women remains a “gray-area” therapy. For women with clear, distressing sexual desire issues (HSDD), low-dose transdermal testosterone — under close supervision — is the only well-supported indication today. For other complaints — fatigue, low mood, “aging,” bone health — the evidence is too weak to justify routine use.

It’s also important to recognise that testosterone is aromatized into estrogen in peripheral tissues. This means that some of the perceived improvements in mood, energy or overall well-being may actually be related to a subtle rise in estrogen, rather than a direct testosterone effect. In other words, some “androgen benefits” may simply reflect improved estrogenic activity — especially in women who are estrogen-deficient or on suboptimal estrogen therapy.

For other complaints — fatigue, low mood, cognition, musculoskeletal concerns — the evidence for direct testosterone benefit remains limited. Given the risk of androgenic side effects and the lack of long-term safety data, any use should be cautious, personalized, and regularly reassessed.

As the data continues to emerge, we should continue to refine our practice. Essentially, personalized care is where we should all be aiming for. Focus on the individual and their needs in the context of their lives. We were not factory made and no two people, even identical twins, are really the same.