Menopause is one of the most significant hormonal transitions in a woman’s life. While estrogen and progesterone often dominate discussions surrounding menopause treatment, another hormone plays an important role in women’s health and well-being: testosterone. 

Although commonly referred to as a "male hormone," testosterone is also produced in women and contributes to sexual function, energy, mood, cognition, muscle mass, bone health, and overall quality of life.¹ During the menopausal transition, testosterone levels gradually decline, and for some women, this reduction may contribute to distressing symptoms that affect daily functioning and relationships. 

Interest in testosterone replacement therapy (TRT) for women has increased substantially in recent years. However, misconceptions and inconsistent clinical guidance have left many women wondering whether testosterone therapy is safe, effective, and appropriate for their symptoms. 

In this article, we’ll discuss: 

• What testosterone does in the female body 
• How testosterone changes during menopause 
• Symptoms associated with low testosterone 
• What the research says about testosterone replacement therapy 
• Potential risks and considerations 
• How testosterone therapy fits into a comprehensive menopause treatment plan 

Understanding Testosterone in Women 

Although women produce significantly less testosterone than men, the hormone remains critically important throughout a woman’s lifespan. In women, testosterone is produced by the ovaries and adrenal glands and serves as a precursor for estrogen production.² 

Testosterone influences numerous physiological processes, including: 

• Sexual desire and arousal 
• Energy and motivation 
• Cognitive performance/concentration 
• Mood/emotional well-being 
• Muscle mass/strength 
• Bone density 
• Body composition 
• Overall vitality¹,² 

Unlike estrogen, which fluctuates significantly during perimenopause and declines sharply after menopause, testosterone levels decline gradually beginning in a woman's late twenties and continue to decrease with age.¹ Bymidlife, women may have approximately half the testosterone levels they had in their twenties. Surgical menopause may result in an even more pronounced reduction because of the abrupt loss of ovarian androgen production.⁸ 

Menopause: More Than an Estrogen Deficiency 

Menopause affects nearly every system in the body. Declining estrogen levels contribute to numerous symptoms including hot flashes, night sweats, sleep disturbances, vaginal dryness, bone loss, and increased cardiovascular risk.³ 

However, many women experience additional symptoms that do not always respond fully to estrogen therapy alone, including: 

• Low libido 
• Reduced sexual satisfaction 
• Difficulty achieving orgasm 
• Fatigue 
• Decreased motivation 
• Loss of muscle mass 
• Reduced exercise performance 
• Brain fog 
• Diminished sense of well-being¹ 

Many women describe feeling as though they have "lost themselves." For some, declining testosterone levels may contribute to these symptoms. However, menopausal symptoms are often multifactorial and may involve sleep disruption, psychosocial stressors, metabolic changes, and coexisting medical conditions.⁸˒⁹ Testosterone therapy should therefore be considered within the context of a comprehensive menopause evaluation. 

Understanding Female Sexual Dysfunction and HSDD 

Female sexual dysfunction (FSD) encompasses disorders of sexual desire, arousal, orgasm, and sexual pain.⁸ One of the most common manifestations in postmenopausal women is hypoactive sexual desire disorder (HSDD), characterized by a persistent absence or reduction in sexual thoughts, fantasies, and desire that causes significant personal distress and cannot be explained by relationship issues, medications, psychiatric disorders, or other medical conditions.⁷˒⁸ 

The Global Consensus Position Statement and the International Society for the Study of Women’s Sexual Health (ISSWSH) identify HSDD as the primary evidence-based indication for testosterone therapy in women.⁴˒⁵ 

What Is Testosterone Replacement Therapy? 

Testosterone replacement therapy involves administering low doses of testosterone to restore concentrations to the physiologic range observed in premenopausal women.⁴ 

Several formulations have been used in clinical practice, including: 

• Transdermal creams 
• Gels 
• Patches 
• Compounded preparations 
• Subcutaneous pellets 
• Injectable formulations⁴˒⁹ 

Currently, no testosterone product is approved by the U.S. Food and Drug Administration specifically for women.⁴˒⁹ Consequently, treatment often involves carefully dosed off-label use of male-formulated products or compounded preparations designed to achieve female physiologic levels.⁹ 

Among available options, transdermal therapy is generally preferred because it most closely mimics physiologic testosterone delivery while minimizing the risk of supraphysiologic serum concentrations and androgenic adverse effects. ⁹ 

The goal of therapy is not to produce testosterone concentrations above normal female levels but rather to restore concentrations sufficient to improve symptoms while minimizing adverse effects.⁴˒⁵ 

Diagnosing Low Testosterone in Women 

Unlike many endocrine disorders, there is no universally accepted serum testosterone cutoff that defines androgen deficiency in women.⁸˒⁹ Testosterone assays often lack sensitivity at the low concentrations present in women, and hormone levels vary significantly throughout life.⁸ 

Therefore, testosterone therapy should be guided primarily by a comprehensive clinical evaluation and symptom assessment rather than isolated laboratory values.⁸˒⁹ Baseline total testosterone and sex hormone-binding globulin (SHBG) measurements are used primarily to establish baseline values and monitor treatment safety.⁴˒⁹ 

What the Research Says About Testosterone Therapy in Menopause 

The strongest evidence supporting testosterone therapy in women pertains to sexual function. 

Randomized controlled trials and international consensus statements have concluded that testosterone therapy can significantly improve: 

• Sexual desire 
• Sexual arousal 
• Orgasmic function 
• Frequency of satisfying sexual experiences 
• Sexual distress in women with HSDD⁵˒⁶ 

Research demonstrates that appropriately selected postmenopausal women receiving testosterone therapy experience improvements in sexual well-being and increased frequency of satisfying sexual experiences.⁶ 

Some studies suggest potential benefits in mood, energy, motivation, and sense of well-being.¹ However, evidence supporting testosterone therapy for cognition, depression, fatigue, or body composition remains limited and inconsistent.⁴˒⁸ Additional research is needed before testosterone can be routinely recommended for these indications. 

Testosterone Therapy and Body Composition 

One of the most frustrating changes during menopause is the shift in body composition. 

As women age, they often experience: 

• Loss of lean muscle mass 
• Increased visceral fat accumulation 
• Reduced metabolic rate 
• Declines in strength and physical performance 

Testosterone plays an important role in maintaining skeletal muscle and physical function.² Emerging evidence suggests that physiologic testosterone therapy may help preserve lean body mass and support exercise performance, although these findings remain preliminary.⁴˒⁹ 

Importantly, testosterone is not a weight-loss medication. Its effects on body composition appear modest and are most beneficial when combined with resistance training, adequate protein intake, sleep optimization, and comprehensive hormone management.¹ 

Potential Risks and Side Effects 

When prescribed appropriately and monitored carefully, testosterone therapy appears to have a favorable short-term safety profile.⁶˒⁹ 

Potential adverse effects include: 

• Acne 
• Oily skin 
• Increased facial or body hair 
• Scalp hair thinning 
• Voice changes 
• Clitoral enlargement⁵˒⁶˒⁹ 

Most adverse effects are dose-dependent and occur when testosterone levels exceed the physiologic female range.⁵ 

Current evidence has not demonstrated significant increases in cardiovascular events or breast cancer risk with short-term physiologic testosterone therapy. ⁶ However, long-term safety data remain limited, and additional studies are needed to fully evaluate the effects of prolonged testosterone exposure in women.⁸˒⁹ 

Monitoring During Testosterone Therapy 

Regular monitoring is essential during testosterone therapy.⁸˒⁹ Baseline evaluation should include a medical and sexual history, psychosocial and medication review, and measurement of total testosterone and sex hormone-binding globulin (SHBG).⁴˒⁹ Patients should be reassessed periodically for symptom improvement and signs of androgen excess to ensure therapeutic benefit, maintain testosterone levels within the physiologic female range, and minimize adverse effects.⁴˒⁹ 

Testosterone Therapy and Hormone Replacement Therapy 

Testosterone therapy is not a replacement for estrogen therapy. While estrogen remains the primary treatment for vasomotor symptoms, genitourinary syndrome of menopause, and bone loss prevention, testosterone may be used adjunctively to address other menopausal concerns, particularly sexual dysfunction.³ 

A Comprehensive Approach to Menopause 

Menopause is more than an estrogen-deficiency state; it is a whole-body transition affecting hormonal, metabolic, cognitive, and sexual health.³ Although testosterone therapy may improve quality of life and sexual well-being in selected women, it should be incorporated into an individualized treatment plan that includes appropriate hormone therapy, balanced nutrition, regular exercise and resistance training, stress management, sleep optimization, and healthy lifestyle behaviors to support overall well-being and long-term health.⁵˒⁸˒⁹ 

References 

1. Davis SR, Wahlin-Jacobsen S. Testosterone in women—the clinical significance. Lancet Diabetes Endocrinol. 2015;3(12):980-992. doi:10.1016/S2213-8587(15)00284-3. 
2. Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: A reappraisal. J Clin Endocrinol Metab. 2014;99(10):3489-3510. doi:10.1210/jc.2014-2260. 
3. Kaunitz AM, Manson JE. Management of menopausal symptoms. Obstet Gynecol. 2015;126(4):859-876. doi:10.1097/AOG.0000000000001058. 
4. Parish SJ, Simon JA, Davis SR, et al. 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. J WomensHealth (Larchmt). 2021;30(4):474-491. doi:10.1089/jwh.2021.29037. 
5. Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660-4666. doi:10.1210/jc.2019-01603. 
6. Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: A systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754-766. doi:10.1016/S2213-8587(19)30189-5. 
7. Kingsberg SA, Clayton AH, Pfaus JG. The female sexual response: Current models, neurobiological underpinnings, and agents for treatment of hypoactive sexual desire disorder. Mayo Clin Proc. 2019;94(5):842-856. doi: 10.1016/j.mayocp.2019.01.018. 
8. Uloko M, Rahman F, Puri LI, Rubin RS. The clinical management of testosterone replacement therapy in postmenopausal women with hypoactive sexual desire disorder: a review. Int J Impot Res. 2022;34(7):635-641. doi:10.1038/s41443-022-00613-0. 
9. Montero Bernaldez J, Burgess ER, Martinez R, Peñalver M. Testosterone therapy in women: a literature review of clinical indications, dosing, routes of administration, and safety. Cureus. 2026;18(4): e106713. doi:10.7759/cureus.106713.