Testosterone for Women in Menopause: The Missing Hormone

The short answer: yes. Women produce testosterone in the ovaries and adrenal glands — about 1/10th the amount men produce, but it plays critical roles in female health.

Testosterone in women supports: - Sexual desire and arousal — it's the primary hormone driving libido - Energy and vitality — women with low testosterone report persistent fatigue - Muscle mass and strength — critical for preventing [sarcopenia in menopause](/blog/protein-needs-on-glp-1-during-menopause-sarcopenia-strategy) - Bone density — works alongside estrogen to maintain skeletal health - Cognitive function — supports [focus, memory, and brain fog](/blog/menopause-brain-fog-causes-and-evidence-based-solutions) - Mood — low testosterone is associated with depression and reduced motivation

Testosterone levels peak in a woman's early 20s and decline steadily — by menopause, levels are roughly 50% of their peak. Unlike estrogen, which drops sharply during perimenopause, testosterone's decline is gradual but cumulative. By the time menopause arrives, many women have been running on depleted testosterone for years.

The problem? Testosterone for women has been almost entirely ignored by mainstream medicine. It's not FDA-approved for women, it's rarely tested, and most doctors don't think to prescribe it.

The evidence is strong and growing. In 2019, an international panel of experts published the Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Their conclusions:

• •Testosterone therapy is effective for hypoactive sexual desire disorder (HSDD) — low libido that causes personal distress
• •The recommended dose is approximately 5mg/day transdermal (cream or gel applied to the skin)
• •Benefits include increased sexual desire, arousal, orgasm, and pleasure
• •At physiological doses, testosterone is safe with no increased risk of cardiovascular disease, breast cancer, or liver problems

A 2022 meta-analysis in The Lancet Diabetes & Endocrinology, covering 46 clinical trials and 8,480 women, confirmed that testosterone therapy significantly improved sexual function, with benefits emerging within 4-6 weeks of treatment.

Beyond libido, emerging research suggests benefits for mood, energy, and body composition — though these are not yet included in the formal consensus because the evidence base is still building.

The key limitation: there is no FDA-approved testosterone product for women. The 2019 consensus statement calls this a "significant unmet need" and recommends off-label use of low-dose formulations.

Since there's no FDA-approved female testosterone product, here's how it's prescribed in practice:

Transdermal cream or gel (most common): A compounding pharmacy prepares a low-dose testosterone cream (typically 5-10mg/day). Applied to the inner thigh, lower abdomen, or inner arm. This is what the Global Consensus recommends.

Testosterone pellets (subcutaneous implants): Small pellets inserted under the skin every 3-4 months. Provides steady levels. Requires an in-office procedure.

Off-label use of male products at 1/10th dose: Some doctors prescribe AndroGel or Testim at a fraction of the male dose. This works but requires careful dosing.

What about DHEA? DHEA is a precursor hormone that converts to both testosterone and estrogen. Vaginal DHEA (Intrarosa) is FDA-approved for vaginal dryness. Oral DHEA (25-50mg) is available over-the-counter and may increase testosterone levels, but effects are unpredictable and not well-studied for this purpose.

Where to get it: Menopause specialists and telehealth platforms like [Winona](/find-care?tab=menopause) and [Alloy](/find-care?tab=menopause) prescribe testosterone for women. Standard OB-GYNs and primary care doctors may not be familiar with it — a NAMS-certified provider is more likely to offer it.

Monitoring: Blood testosterone levels should be checked at baseline and 3-6 weeks after starting. The target is mid-normal premenopausal range (15-70 ng/dL). Levels above this can cause side effects.

At the recommended dose of ~5mg/day transdermal, side effects are uncommon. The Global Consensus found no increased risk of cardiovascular disease, breast cancer, or liver problems at physiological doses.

Possible side effects at proper dosing: - Mild acne (5-10% of women) - Slight increase in facial hair (2-5%) - Oily skin

These are usually dose-dependent and resolve with dose reduction.

Signs of overdosing (levels too high): - Significant acne - Noticeable facial hair growth - Deepening voice - Clitoral enlargement - Mood changes (aggression, irritability)

These are signs that the dose is too high and should be reduced immediately. At proper physiological doses (keeping blood levels in the female premenopausal range of 15-70 ng/dL), these effects are rare.

Who should NOT take testosterone: - Women with hormone-sensitive cancers (active breast or ovarian cancer) - Women who are pregnant or breastfeeding - Women with polycystic ovary syndrome (PCOS) who already have elevated androgens

The bottom line: testosterone at the right dose is safe and effective. The key is using female-appropriate doses, monitoring blood levels, and working with a knowledgeable provider.