When most people think of testosterone, they associate it with men. In reality, testosterone is a vital hormone for women as well, playing a key role in libido, energy, mood, bone density, and muscle mass. In fact, most people don’t realize that a woman’s testosterone levels are higher than her estrogen levels during much of her reproductive life, and almost always higher after menopause.

Testosterone Levels in Women

While estrogen and progesterone decline very suddenly during the menopausal transition, testosterone levels fall gradually beginning as early as the 30’s and 40’s.  Unlike the severe symptoms that many women experience with dropping estrogen and progesterone, most women don’t notice the gradual changes associated with falling testosterone levels. Nevertheless, testosterone therapy can make a huge improvement in quality of life in some women. Recently testosterone therapy has become a topic of growing interest. Let’s explore what it is, why you might use it, and what the science says about its risks and benefits.

What Is Testosterone Therapy?

Testosterone can be taken as a gel, cream, injection, or pellet implant. Since there is no FDA approved testosterone product for women in the U.S., supplementation is done off label. Fortunately, there are evidence-based protocols recommended by the Menopause Society (of which I am a member). In my practice, we use low dose topical gel or cream.  I don’t recommend injectable pellets as they often result in much higher blood levels than is natural or safe for women. Testosterone products like the ones I recommend are approved in other countries such as Australia, New Zealand, UK and South Africa.

Why Women Consider Testosterone Therapy

There are several reasons why women might explore taking testosterone, including:

  • Low libido or sexual dysfunction: Numerous studies have shown that testosterone can improve sexual desire and satisfaction in menopausal women1-5. This is the primary reason we prescribe testosterone to women.
  • Muscle mass and bone health: Testosterone helps maintain muscle strength6 and bone density, both of which can decline with age. Studies show that higher levels of testosterone are associated with higher bone density in postmenopausal women7.
  • Mood and emotional well-being: Some research, including a randomized controlled trial, shows that for pre-menopausal women with low testosterone, giving testosterone improves mood, wellbeing, and libido8.

Potential Risks and Side Effects

As with any hormone therapy, testosterone supplementation carries potential side effects. These can include acne, unwanted hair growth or loss, voice deepening, mood changes or irritability, or altered cholesterol levels.  With inappropriately high dosing can cause the development of an Adam’s apple on the neck and clitoris enlargement. Long term safety data is lacking so there are potentially other risks we aren’t aware of. In my experience, most women can find a dose that gives them a boost in libido without any of the above unwanted side effects.  With safety in mind, I check baseline hormone levels, assess symptoms, initiate therapy, then monitor treatment response closely.

The Bottom Line

Testosterone is an essential hormone for women’s overall health and well-being. For some, carefully managed testosterone therapy can meaningfully improve sex life and quality of life. However, it’s not a one-size-fits-all solution. I always counsel my patients on other behavioral, lifestyle, and nutritional approaches to support libido, mood, energy, and muscle mass. Consultation with a knowledgeable healthcare provider, regular monitoring, and a holistic approach to health remain the best ways to ensure successful outcomes.


Dr. Bronwyn Fitz is double board certified in Obstetrics and Gynecology and Integrative Medicine. If you would like to learn more about her practice or make an appointment, please visit her website and click on the “Get started” tab to set up a free 15-minute discovery call.

  1. Buster JE, et al. “Testosterone patch for low sexual desire in surgically menopausal women: a randomized trial”. Obstet Gynecol. 2005;105:944–52
  2. Davis SR, et al. APHRODITE Study Team. “Testosterone for low libido in postmenopausal women not taking estrogen”. N Engl J Med. 2008;359:2005–17
  3. Panay N, et al. “Testosterone treatment of HSDD in naturally menopausal women: the ADORE study”. Climacteric. 2010;13:121–31
  4. Simon J, et al. “Testosterone patch increases sexual activity and desire in surgically menopausal women with hypoactive sexual desire disorder”. J Clin Endocrinol Metab. 2005;90:5226–33
  5. Shifren JL, et al. “Testosterone patch for the treatment of hypoactive sexual desire disorder in naturally menopausal women: results from the INTIMATE NM1 Study”. Menopause. 2006;13:770–9
  6. Huang, Grace et al., “ Testosterone dose-response relationships in hysterectomized women with or without oophorectomy: effects on sexual function, body composition, muscle performance and physical function in a randomized trial,“ Menopause. 2014 Jun;21(6):612-23.
  7. Yang, Jin Xiao et al.,“Association between Serum Total Testosterone Level and Bone Mineral Density in Middle-Aged Postmenopausal Women,” Int J Endocrinol, 2022 Aug 17:2022:4228740.
  8. Goldstat, Rebecca, et al., “Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women.” Menopause. 2003 Sep-Oct;10(5):390-8.