Testosterone isn't optional biology, women produce it throughout life, and it plays real physiological roles. When testosterone levels decline and symptoms emerge, testosterone therapy can make a meaningful difference, especially for sexual desire and wellbeing. The key is knowing when it's appropriate, how to use it safely, and what to realistically expect.
This article breaks down what the science actually shows, what testosterone can and can't do, and how to pursue treatment appropriately if it's right for you.
Does testosterone actually decline during menopause?
Yes, and this decline can contribute to symptoms. Testosterone drops gradually starting in early adulthood, not suddenly at menopause. We'll explain what this means and when it matters.
What does testosterone therapy actually help with?
Strong evidence supports its use for low sexual desire and sexual distress in postmenopausal women. We'll explain how it works and what to realistically expect.
Is testosterone therapy safe for women?
When properly dosed and monitored, short-term safety is well-established. We'll cover what's known, what remains uncertain, and why testing and monitoring matter.
Why do symptoms and blood tests sometimes not match?
Because diagnosis is based on your symptoms and distress, not just lab numbers. We'll explain how testosterone levels are used (and not used) in clinical practice.
Testosterone gets labeled a "male hormone," but that's misleading. Women produce testosterone throughout life, primarily in the ovaries and adrenal glands. In fact, women have far more testosterone than estrogen during most of adulthood (just at much lower absolute concentrations than men).
The timeline matters. Unlike estrogen's sharp drop around menopause, testosterone declines gradually over decades, beginning in early adulthood. By midlife, many women have lost roughly 50% of their peak testosterone levels, even before menopause occurs.
This gradual decline explains why testosterone-related symptoms may feel subtle at first, then become more noticeable once estrogen levels fall and that hormonal buffering disappears.
The key point: Testosterone levels alone don't tell you whether you need treatment. Your symptoms and how they affect your life are what matter most. According to clinical guidelines, testosterone testing before treatment helps establish a baseline and guide appropriate dosing—but the decision to treat is based on your experience, not a number on a lab report.
Menopause changes how tissues and the brain respond to hormones, not just how much hormone is present. With estrogen withdrawal:
This helps explain why you might feel "fine on paper" but not fine in reality.
Testosterone influences sexual desire through its effects on dopamine pathways in the brain. These are the same neurotransmitter systems involved in motivation, reward, and wanting. In women, testosterone receptors are found throughout the brain regions that regulate sexual interest and arousal.
When researchers tested testosterone therapy in postmenopausal women with low sexual desire causing them distress, the results were consistent: women experienced meaningful improvements in sexual desire, arousal, orgasm frequency, and satisfaction. Importantly, they also reported feeling less bothered by the lack of desire.
Based on this evidence, international medical societies agree that testosterone is an evidence-based treatment for postmenopausal women with hypoactive sexual desire disorder (HSDD). This isn't experimental or fringe medicine, it's supported by multiple high-quality studies and endorsed by major medical organizations.
Who benefits: Women with persistently low desire that causes them distress. If low sexual desire is affecting your quality of life and relationships, testosterone therapy may genuinely help.
Testosterone affects dopamine signaling, which is why many women describe feeling more motivated, energetic, or engaged when taking it. The biological mechanism is real.
But when researchers try to measure this systematically the effects don't show up consistently in trials. Large-scale studies haven't found measurable improvements in general wellbeing.
The disconnect: Some women genuinely report these benefits. But the research tools we have may not be capturing what women are actually experiencing, or the effects may be too variable or subtle to show up in population studies.
Testosterone is anabolic, meaning it promotes muscle protein synthesis. In men, this effect is dramatic. In women at physiologic doses, the effect is modest at best.
Research shows testosterone can slightly increase lean body mass, but it doesn't consistently improve strength, physical function, or body composition in ways that matter clinically. It's not a substitute for resistance training, and it shouldn't be used as a weight loss or muscle-building treatment.
Women often describe testosterone's effects in emotional terms. They feel more like themselves, more confident, more mentally sharp. These are real experiences.
However, when tested in clinical trials, testosterone doesn't show consistent effects on mood disorders, depression, anxiety, or cognitive function. Clinical guidelines conclude there isn't enough evidence to recommend testosterone for these purposes.
Why the gap? Most trials are short (under 2 years), use narrow outcome measures, and may not capture subjective or domain-specific effects. The research hasn't caught up to what some women report experiencing.
Getting testosterone therapy right requires three things: appropriate dosing, the right delivery method, and regular monitoring.
Testing is essential, before you start and throughout treatment:
Formulation matters enormously:
Clinical guidelines strongly recommend transdermal preparations (patches or creams formulated for women) because they:
Pellets are problematic and should be avoided:
Testosterone pellets (implanted under the skin and releasing hormone over months) create several serious issues:
Bottom line: Safe, effective testosterone therapy requires individualized dosing, appropriate formulation, and ongoing monitoring. More is not better, the goal is to restore physiologic levels, not exceed them.
"Testosterone is only a male hormone"
Women produce and rely on testosterone throughout life. It's essential for normal physiology, not just for men.
"It makes women aggressive or masculine"
These effects come from excessive dosing far above physiologic levels, not from proper replacement therapy at appropriate doses.
"More testosterone means better results"
Higher levels increase side effects without added benefit. The goal is physiologic replacement, not supraphysiologic levels.
"You don't need testing, you can just tell if you need it"
Testing before treatment establishes a baseline and helps determine appropriate dosing. Regular monitoring ensures you stay in a safe, effective range.
"All testosterone products work the same"
Formulation matters enormously. Transdermal preparations allow for controlled, adjustable dosing. Pellets create uncontrolled, often excessive levels that can't be adjusted.
"If it doesn't help immediately, it doesn't work"
Testosterone effects on sexual desire typically take weeks to months to become apparent. Most providers recommend at least 3-6 months before assessing effectiveness.
Based on clinical guidelines, testosterone therapy may be appropriate if you're experiencing:
If you're a good candidate for testosterone therapy, here's what appropriate treatment looks like:
The goal is safe, effective treatment that genuinely improves your quality of life.
If you’re still unsure, here is a list of good questions you can ask your clinician. We recommend finding a team who specializes in menopause care and HRT for women.
Here is a quick list of questions:
Testosterone plays a real, measurable role in women's sexual health and wellbeing. When testosterone levels decline in menopause and symptoms emerge, testosterone therapy can provide meaningful relief.
The evidence is clear: Testosterone improves sexual desire and reduces sexual distress in postmenopausal women with HSDD. This benefit is backed by multiple high-quality trials and international consensus. For women struggling with this specific issue, testosterone therapy isn't experimental, it's evidence-based medicine.
For other symptoms (energy, mood, cognition, muscle) the evidence is less clear. Some women report these benefits, but systematic research hasn't confirmed them yet. That doesn't mean they're impossible, just that they're not proven.
Safety depends on doing it right: Testosterone therapy appears safe in the short term when properly dosed and monitored. That means:
The key message: Testosterone isn't a cure-all, but it's also not something to dismiss or fear. For women with appropriate indications, it can genuinely improve quality of life. The key is proper patient selection, appropriate formulation, correct dosing, and ongoing monitoring.
If you're struggling with symptoms that might respond to testosterone, it's worth having an informed conversation with a healthcare provider who takes your concerns seriously.
American Urological Association, Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, & American Urogynecologic Society. (2025). Genitourinary syndrome of menopause: AUA/SUFU/AUGS guideline. https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-menopause
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Parish, S. J., Simon, J. A., Davis, S. R., Giraldi, A., Goldstein, I., Goldstein, S. W., Kim, N. N., Kingsberg, S. A., Morgentaler, A., Nappi, R. E., Park, K., Stuenkel, C. A., Traish, A. M., & Vignozzi, L. (2021). International Society for the Study of Women's Sexual Health clinical practice guideline for the use of systemic testosterone for hypoactive sexual desire disorder in women. Journal of Women's Health, 30(4), 474–491. https://doi.org/10.1089/jwh.2021.29037