"Isn't testosterone a man's hormone?"
I hear that a lot, usually right after a woman tells me her desire has disappeared, her energy is gone, and she can't find her motivation anywhere.
Here's what I want you to know: women make testosterone too. In fact, before menopause, most women have more testosterone than estradiol in their bloodstream much of the time. It matters for how you feel, and it's a conversation worth having.
Quick summary: what you need to know
- Women make testosterone. Levels fall gradually with age, and they can drop more after your ovaries are removed.
- No testosterone product is FDA-approved for women in the United States. It's prescribed off-label, a common and accepted practice in medicine.
- The research is strongest for desire. Studies show it can help low desire in women after menopause.
- Women tell us about more than desire. Energy, mood, motivation, and zest for life come up often, though not all of these have been studied.
- It needs careful dosing and follow-up. Women use much lower doses than men, and we watch for side effects.
Do women need testosterone?
Women need testosterone, and their bodies make it every day in the ovaries and the adrenal glands. It plays a part in desire, energy, and how you feel in your body.
Testosterone tends to drift down slowly through your 30s and 40s. It doesn't drop off a cliff at menopause the way estrogen can, and it can fall more sharply if your ovaries are removed. That slow drift is one reason women often can't put a finger on what changed.
What does the research show about testosterone for women?
The research is clearest for low sexual desire after menopause. In 2019, a group of international medical societies reviewed the studies together. They found testosterone can improve desire, arousal, orgasm, and the distress that comes with low desire in postmenopausal women, and they called that the one use with solid evidence.
They also found the evidence isn't there yet for other uses, such as bone, muscle, memory, and mood. That doesn't mean those benefits don't happen. It means the studies haven't shown them clearly, and more research is needed.
What do women tell you they notice?
The thing I hear most, and the thing I see testosterone help most, is motivation. When testosterone is low, the everyday things you have to do start to feel like work you just don't want to do anymore. When their levels come up, women tell me their whole life doesn't feel like such a chore. They have the drive to get to the gym again, and they have more zest for life. I see the same thing in men.
Sex often stops feeling like a chore too. Many women tell us they'd forgotten how much they enjoyed it. And more than a few have told me, with a laugh, that they don't have to pretend to be asleep when their partner comes to bed anymore. It's incredibly satisfying to have so many women come back and tell us they finally feel like themselves again.
Some also find it easier to build muscle and lose weight, often because they finally have the energy to do the work.
These come from our clinical experience and what patients tell us, not from large studies. Not all of these have been studied in women, and every woman responds differently. Testosterone for women has been part of our practice at AgeWell, a physician-led midlife medicine practice for men and women in Amarillo, Texas, for many years, in several forms, including injections.
What are the side effects of testosterone for women?
The most common side effects of testosterone are what we call dose-dependent. That means the higher your levels, the more likely you are to have side effects. The ones we see most are acne and more hair on the face or body, which usually tells us your levels are too high. These often get better as we adjust and bring the dose down. Less common changes include hair thinning on the scalp, a deeper voice, and an enlarged clitoris, and they're the reason dosing and follow-up matter so much.
Testosterone may not be right for you if you've had breast cancer or another hormone-sensitive cancer, you're pregnant or trying to be, or you have certain heart, liver, or clotting conditions. These don't automatically rule it out, and they do call for a careful conversation with you and your other doctors. At AgeWell, no single condition or lab makes this decision for you. We look at the whole picture.
How do women take testosterone?
Women can use many of the same forms men do, at much lower doses, including injections, creams, and pellets. Each has tradeoffs. Injections let us make small changes, creams need a daily routine, and pellets last a few months and are harder to adjust once they're placed.
You can read more in testosterone injections, creams, or pellets. The best form is the one that fits your body, your life, and your labs.
How do you know if testosterone is right for you?
Start with what you're hoping it will do, and look at everything else that could be playing a part. Low desire, for example, can come from estrogen changes, vaginal dryness or pain, sleep, stress, medications, and your relationship. Testosterone is one tool, and it works best when the rest of the picture is addressed too.
We look at your symptoms, history, goals, risks, and labs before we talk about testosterone. A blood level alone can't tell us whether you'll benefit, and we don't treat a number by itself. Read what a normal testosterone level means and the benefits and risks of testosterone therapy, or learn about hormone therapy for women at AgeWell.
The decision is yours. We keep you safe, and you keep your say.
Frequently asked questions
Is testosterone safe for women?
At carefully chosen doses with good follow-up, many women use it safely. Long-term safety hasn't been studied as much as we'd like, so we monitor closely and talk through the risks with you.
Will testosterone make me look masculine?
Not at the low doses women use, for most women. Acne and extra hair are the most common side effects, and they usually mean your levels are too high, so we adjust the dose.
Does testosterone help with weight loss in women?
It hasn't been shown to cause weight loss directly. Some women tell us they have more energy and motivation to exercise, which can help.
Can I take testosterone if I'm still having periods?
Although most of the research is in women after menopause, many women before menopause benefit from testosterone too. It's a decision to make carefully with your clinician.
See if AgeWell is right for you
This article is for education and isn't a substitute for personalized medical advice. Talk with your clinician about your own situation. If you have severe or urgent symptoms, seek emergency care.
Sources
- Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Journal of Clinical Endocrinology and Metabolism. 2019.
- Cleveland Clinic: Testosterone
- Cleveland Clinic: Menopause
