Written by Dr. Specialist Stine Andreasen
Specialist in Gynecology and Obstetrics, PhD in Obstetrics in 2015 and more than 15 years of clinical practice in Obstetrics and Gynecology
Testosterone isn’t only a male hormone. Women produce it too, mainly in the ovaries and adrenal glands, and it plays a role in sexual function. Testosterone therapy is getting more attention as a menopause treatment, but the evidence behind it is far narrower than many claims suggest. It is also not part of standard hormone therapy (HRT) for menopause.
Key takeaways
- The one evidence-based use is persistent, distressing low sexual desire in postmenopausal women.
- The effect is modest: on average, about one additional satisfying sexual experience per month compared with placebo.
- Current evidence does not support testosterone for fatigue, mood, memory, muscle strength or bone health.
- Treatment aims for normal female testosterone levels. Levels that are too high can cause side effects, and some of them are permanent.
- Long-term safety beyond about two years has not been established.
Do testosterone levels drop at menopause?
Not suddenly. Unlike estrogen, testosterone declines gradually with age. The exception is women who have had both ovaries surgically removed, who may experience a more abrupt drop.
Can testosterone help with low libido after menopause?
Yes, for some women. The main evidence-based reason for testosterone therapy is hypoactive sexual desire disorder (HSDD) in postmenopausal women. HSDD means sexual desire that is persistently low or absent, causes you real distress, and isn’t better explained by other medical, psychological, relationship or medication factors. Lower sexual desire during menopause is common, and it isn’t automatically a medical condition that needs treatment. Desire is shaped by many things: hormones, relationship satisfaction, psychological well-being, sleep, stress, medications and physical health.
If vaginal dryness or pain during sex is part of the picture, reduced interest can follow. In that case, treating the discomfort, for example with vaginal estrogen, may help more than testosterone. Testosterone may be an option for postmenopausal women with persistent, distressing low desire, after a thorough assessment and a conversation about benefits and risks. The evidence is strongest after menopause, although some specialist guidelines allow it to be considered for selected women in late reproductive life.
How much does testosterone help with sexual desire?
Clinical studies show a modest improvement in sexual desire and satisfaction for carefully selected postmenopausal women with HSDD. Possible benefits include:
Increased sexual desire
Improved arousal
More frequent satisfying sexual experiences
Less distress about low desire
On average, trials found about one additional satisfying sexual event per month compared with placebo. Individual responses vary, and some women notice little or no change. What matters is whether treatment makes a meaningful difference to your own symptoms and quality of life.
Does testosterone help with menopause fatigue, mood or brain fog?
Current research does not show that it does. Testosterone is sometimes promoted for low energy, poor concentration, memory problems, low mood or loss of strength during menopause, but studies have not consistently shown meaningful improvements in:
Energy levels or fatigue
Memory or cognitive performance
Mood or psychological well-being
Muscle strength or physical performance
Bone density or fracture prevention
General health or ageing
These symptoms are common in midlife and can have many causes, including poor sleep, stress, depression, thyroid disorders and anaemia. Feeling tired, unmotivated or unfocused is not on its own a reason to start testosterone. A low testosterone result on its own doesn’t mean you have a deficiency that needs treatment either.
How is testosterone therapy for women given?
Usually as a gel or cream applied to the skin in a carefully measured dose. The goal is to keep testosterone within the normal range for healthy premenopausal women, not to reach the levels typical in men.
In many countries, no testosterone product is approved specifically for women with HSDD. Treatment may therefore use carefully adjusted doses of products made for men, prescribed off-label under medical supervision. Dosing needs particular care, because these products contain much more testosterone than women need.
What are the side effects of testosterone in women?
In short-term studies, testosterone is generally well tolerated when levels stay within the normal female range. Side effects are more likely if levels get too high. They include:
Acne and oily skin
Increased facial or body hair
Thinning scalp hair
Changes in skin condition
Skin irritation where the gel or cream is applied
Too much testosterone can cause stronger effects, such as a deeper voice and clitoral enlargement. Some of these changes may be permanent, which is why correct dosing and monitoring matter.
Is testosterone therapy safe long term?
We don’t know yet. Most trials have been short, and safety beyond about two years is not well established. Open questions remain about long-term effects on:
Breast cancer risk
Cardiovascular health
Metabolic health
Short-term studies using physiological doses in carefully selected women haven’t found major safety concerns, but that is not the same as proven long-term safety. Women with significant cardiovascular risk factors or a history of hormone-sensitive cancer should be cautious and may benefit from a specialist assessment.
Do you need a blood test before starting testosterone?
Yes, but not to diagnose the need for treatment. Testosterone levels in women vary widely, and no blood level reliably predicts who will benefit. A low result on its own is not a reason to start. Blood tests matter for safety:
Before treatment: total testosterone is measured to set a baseline and catch unexpectedly high levels. Sex hormone-binding globulin (SHBG) may also be measured.
After starting: levels are usually rechecked after three to six weeks, and again after any dose change.
Ongoing: once treatment is stable, regular check-ups and blood tests continue.
The aim is to avoid excessive testosterone exposure, not to hit a specific number.
How long should you take testosterone?
Think of it as a monitored trial, not a lifelong commitment. Changes in desire may appear within a few weeks, but the full effect can take longer.
Response is usually assessed after about three months.
If there’s no meaningful benefit after six months, treatment should generally stop.
If it clearly helps, it may continue, with regular reviews of symptoms, side effects, testosterone levels and personal risk factors.
Because long-term safety data are limited, the need to continue should be reviewed periodically.
FAQ – Testosterone therapy for women in menopause
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Yes. Women produce testosterone mainly in the ovaries and adrenal glands, and levels decline gradually with age.
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Current evidence does not show that testosterone improves memory, concentration or cognitive function in menopausal women.
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Some women notice changes within a few weeks. Response is usually assessed after about three months, and treatment is generally stopped if there’s no meaningful benefit after six months.
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In some countries this is done off-label under medical supervision, using a much smaller, carefully adjusted dose. It should never be self-dosed.
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No. A low result on its own does not establish a deficiency that needs treatment.