Why are more menopausal women being offered a hormone most of us were taught to think of as male—and what do we actually know about it?
Testosterone has spent decades with a reputation as the “male hormone.” But women produce it too, and as interest in menopause treatment has exploded, testosterone is increasingly entering conversations between women and their doctors.
Some women are being offered testosterone for a distressing loss of sexual desire. Others encounter clinics promising it will restore energy, sharpen thinking, improve mood, build muscle or simply make them feel like themselves again.
There’s just one problem: The enthusiasm is moving considerably faster than the science.
Interest has grown enough that the U.S. Food and Drug Administration is holding a public workshop on September 17 specifically to examine testosterone use in menopausal women. The agency says off-label use is growing while important questions remain about its effects on sexual function, mood, cognition, muscle and bone health—and particularly about long-term cardiovascular and breast cancer safety.
So what does testosterone actually do for women, who might benefit from it, and where are the claims getting ahead of the evidence?
Women have testosterone too
Testosterone isn’t exclusively male any more than estrogen is exclusively female. Both men and women produce both hormones, just in very different amounts.
In women, testosterone is produced primarily by the ovaries and adrenal glands and plays roles in sexual function and other physiological processes. Levels generally decline with age.
That doesn’t mean menopause automatically creates a “testosterone deficiency” that needs to be corrected.
There is no established testosterone level below which an otherwise healthy woman is diagnosed as testosterone deficient. A blood test alone also cannot determine whether low testosterone is responsible for symptoms such as fatigue, low mood or loss of sexual desire.
That’s an important distinction in a marketplace increasingly selling hormone optimization based on laboratory numbers.
There is one use with reasonably good evidence
The strongest evidence for testosterone therapy in women involves hypoactive sexual desire disorder, or HSDD, in appropriately selected postmenopausal women.
HSDD isn’t simply having less interest in sex than you did at 25 or wanting sex less often than your partner does. It involves persistently low sexual desire that causes personal distress and isn’t better explained by another condition, medication, relationship issue or other factor.
Research has found that testosterone can produce a modest but meaningful improvement in sexual desire and sexual satisfaction for some postmenopausal women with HSDD.
A recent clinical review indexed by the National Library of Medicine concluded that testosterone can be beneficial for appropriately selected postmenopausal women with distressing low desire.
That is currently the clearest evidence-based reason for prescribing testosterone to menopausal women.
But testosterone is being marketed for much more than sex
Spend a few minutes browsing menopause clinics online and you may encounter much bigger promises.
More energy. Better mood. Less brain fog. Improved memory. More muscle. Stronger bones. Easier weight management. Better sleep. Greater motivation. A return to your “younger self.”
Those claims are enormously appealing to women struggling with the very real physical and emotional changes that can accompany menopause.
But the evidence doesn’t currently support testosterone as a general anti-aging or menopause cure-all.
The same clinical review found insufficient evidence to recommend testosterone for improving energy, cognition, bone health or brain health in women.
That doesn’t mean researchers will never discover additional benefits. In fact, those unanswered questions are among the reasons the FDA is convening experts.
It means we don’t yet know enough to promise them.
The FDA hasn’t approved testosterone for women
Here’s something many women receiving testosterone may not realize: There is currently no FDA-approved testosterone product specifically for women in the United States.
That doesn’t make prescribing it illegal or automatically unsafe. Physicians routinely prescribe medications “off-label” when evidence and clinical judgment support a use that isn’t included in the drug’s FDA-approved labeling.
But it creates an unusual practical problem.
Testosterone products available in the U.S. were generally designed and dosed for men, whose normal testosterone levels are far higher than women’s.
When testosterone is prescribed to women, clinicians therefore have to use formulations and doses carefully enough to keep testosterone within the normal physiological range for women.
That makes knowledgeable prescribing and monitoring particularly important.
More testosterone isn’t better
This is another place where the wellness world’s “optimization” philosophy can collide with medicine.
The goal of testosterone therapy isn’t to push a woman’s level as high as she can tolerate.
When testosterone is used appropriately in women, the goal is generally to keep levels within the physiological range normally seen in premenopausal women.
Too much testosterone can cause acne, increased facial or body hair and scalp hair loss. Higher exposure can also cause voice deepening and enlargement of the clitoris, some effects of which may not be reversible.
That’s one reason testosterone shouldn’t be approached as an experiment in seeing whether a higher dose produces more energy, muscle or libido.
Be particularly cautious about pellets
Testosterone can be delivered in several ways, and you’ll frequently see hormone pellets marketed by private menopause, anti-aging and wellness clinics.
Pellets are implanted under the skin and slowly release hormone over time. The convenience sounds appealing: insert the pellet and forget about daily medication.
The downside is equally important.
Once a pellet has been inserted, the dose can’t easily be adjusted or the treatment simply stopped if testosterone levels become too high or side effects develop.
The American College of Obstetricians and Gynecologists has specifically recommended other testosterone preparations over pellet therapy because of limited safety data and the inability to remove the pellet easily once it has been implanted.
Compounded hormones deserve scrutiny too
Because there isn’t an FDA-approved testosterone formulation designed specifically for women in the U.S., some women receive testosterone through compounding pharmacies.
Compounded medications can fill legitimate medical needs, but they aren’t reviewed by the FDA for safety, effectiveness and manufacturing consistency in the same way FDA-approved medications are.
Professional guidance has therefore generally favored carefully adjusted doses of approved transdermal testosterone products when testosterone is appropriate, rather than compounded formulations when suitable alternatives are available.
“Bioidentical” or “custom compounded” doesn’t automatically mean safer or more natural.
Those words are powerful marketing tools, but they aren’t substitutes for evidence.
A testosterone blood test doesn’t tell the whole story
It might seem logical that a woman experiencing low libido should simply have her testosterone checked.
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The reality is more complicated.
Testosterone levels can be measured, but experts do not recommend diagnosing HSDD simply by finding a low number on a laboratory report. There isn’t a universally accepted blood level that separates women with healthy sexual desire from women with HSDD.
Instead, clinicians should consider the whole picture.
Low desire can be related to vaginal dryness or painful sex, medications including some antidepressants, depression, anxiety, sleep deprivation, relationship difficulties, stress, chronic illness and other hormonal or medical issues.
Treating a testosterone number without investigating why a woman has lost interest in sex risks missing the actual problem.
Blood testing becomes particularly useful once testosterone treatment is being considered or used, because it can help establish a baseline and make sure levels don’t climb above the normal female range during therapy.
What about muscle and bone?
This is one of the most intriguing areas—and one where it’s easy to get ahead of ourselves.
Testosterone clearly plays an important role in muscle and bone physiology. That makes it tempting to assume that supplementing testosterone after menopause will prevent muscle loss, strengthen bones or help women remain physically robust as they age.
Researchers are investigating those possibilities.
But interesting biology isn’t the same thing as proof that a treatment improves health outcomes.
Current evidence isn’t strong enough to recommend testosterone therapy to women specifically for preserving muscle, preventing osteoporosis or improving physical performance.
Exercise—particularly resistance training—along with adequate protein, good nutrition and established osteoporosis prevention and treatment strategies remain much better-supported approaches.
What about mood, brain fog and energy?
These may be the claims most likely to attract women who aren’t particularly concerned about libido.
Fatigue, difficulty concentrating, sleep disruption and changes in mood are common complaints during the menopause transition.
If testosterone could reliably fix those problems, it would be enormously important.
So far, there isn’t convincing evidence that testosterone should be prescribed to menopausal women specifically to improve cognition, mood or general energy.
That doesn’t mean a woman who takes testosterone for HSDD could never report feeling better in other ways. Sexual well-being, sleep, mood, relationships and overall quality of life are interconnected.
But an individual experience isn’t the same thing as evidence that testosterone treats brain fog or fatigue.
You may want to read: Can Allegra and Pepcid AC really help menopause brain fog and pain?
The biggest unanswered question may be what happens years later
Short-term studies of appropriately dosed testosterone have generally been reassuring, particularly when levels remain within the normal female range.
The problem is time.
We don’t have the kind of long-term safety data we’d ideally want for a hormone that women might potentially use for years.
The FDA specifically identifies cardiovascular effects and breast cancer risk among the areas where important knowledge gaps remain.
That doesn’t mean testosterone has been shown to cause heart disease or breast cancer in women.
It means we don’t yet have sufficient long-term evidence to confidently rule out risks—or establish benefits—over extended treatment.
That’s a very different statement, and an important one.
Questions to ask before saying yes to testosterone
If a healthcare professional recommends testosterone, the conversation shouldn’t begin and end with “your testosterone is low.”
Ask what symptom is actually being treated and what evidence supports testosterone for that problem. Ask what formulation you’ll receive, what dose will be used and whether the product is compounded. Ask how your testosterone level will be monitored and what symptoms could indicate that the dose is too high.
And perhaps most importantly, ask what improvement you should realistically expect and how you’ll decide whether the treatment is working.
If testosterone is being recommended for fatigue, weight loss, memory, muscle building or general “hormone optimization,” it’s reasonable to ask what clinical evidence supports that use.
Testosterone may ultimately have a bigger role in women’s health
None of this means testosterone should be dismissed as another menopause fad.
Quite the opposite.
The fact that the FDA is devoting a full scientific workshop to the subject reflects how important the unanswered questions have become. Researchers are actively investigating testosterone’s effects on sexual function, cognition, mood, musculoskeletal health and long-term safety.
A 2026 review of the evidence concluded that testosterone’s potential benefits beyond sexual desire are intriguing but not yet strong enough to change clinical guidelines.
Women deserve better research into a hormone that has historically received far less attention in female health than it has in male health.
But better research and bigger marketing claims aren’t the same thing.
Final word
For decades, testosterone was treated as though it belonged almost entirely to men. Now the pendulum may be swinging in the opposite direction, with some clinics presenting it as a missing ingredient that can restore everything menopause supposedly took away.
The science currently sits somewhere in between.
Testosterone appears to have a legitimate role for some postmenopausal women experiencing distressing low sexual desire. Beyond that, there are intriguing possibilities—but also substantial unanswered questions.
That makes testosterone neither something women should automatically fear nor something every menopausal woman needs to “optimize.”
It makes it a medical treatment worth discussing carefully, with realistic expectations about what we know, what we don’t know and what researchers are still trying to find out.
And next week’s FDA meeting may tell us considerably more about where that research needs to go.
Have you ever been offered testosterone for menopause symptoms—and were you told which benefits are actually supported by evidence?
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