TESTOSTERONE FOR WOMEN
SHOULD WOMEN CONSIDER TESTOSTERONE IN PERIMENOPAUSE AND MENOPAUSE?
A recent New York Times Magazine article spotlighted a growing trend: women using testosterone therapy are reporting that they feel “on fire” - more energetic, more alive, and more connected to their sexuality and sense of self.
This mirrors what many clinicians have recognized for years: testosterone is one of the most abundant and influential hormones in women, yet widely misunderstood and under-prescribed.
Women typically have 3-4 times more testosterone than estradiol in circulation (Burger 2002), making testosterone the most abundant active sex hormone in females. It plays significant roles in:
Libido and arousal
Mood and motivation
Cognitive function
Muscle mass and bone density
Sense of well-being
Energy
Body composition
Female testosterone levels decline steadily beginning in the late 20s and continue through menopause (Davis 2015). This drop explains many symptoms attributed to “normal aging” but in reality is linked to androgen decline.
While there are no FDA-approved testosterone products for women, menopause medical societies including the ISSWSH tend to be accepting, though lukewarm, on low dose testosterone for Hypoactive Sexual Desire Disorder (HSDD) and might cautiously consider low-dose testosterone therapy for menopausal women. Medical evidence is supportive of testosterone as a safe and effective tool for women and however in practice, it is widely underutilized. KPM finds this to be a meaningful if not life-changing tool for women in menopause and perimenopause.
TESTOSTERONE CHANGES IN PERIMENOPAUSE & MENOPAUSE
Does Women’s Testosterone Decline With Age?
Yes. Peak levels of testosterone occur in a woman’s 20s and fall approximately 25% by age 40, with a further decline approaching menopause (Burger 2002). The ovaries continue to produce testosterone post-menopause, but total production drops by ~50% (Davis 2015). Stress, age, health status, and genetics can impact these numbers.
Common Symptoms Associated With Declining Testosterone:
Reduced libido
Difficulty with arousal and orgasm
Lower energy
Reduced confidence or motivation
Increased fat mass, decreased muscle mass
Declining cognitive sharpness
Mood changes and anxiety
Many women describe symptoms of low testosterone as “losing my spark,” which aligns with documented neuroendocrine roles of androgens in emotional and motivational circuitry.
(Sherwin 2002)
TESTOSTERONE, SEXUAL FUNCTION & HSDD
Testosterone is a central driver of female sexual desire, affecting both central (brain) and peripheral (genital) sexual response. Randomized controlled trials show that testosterone replacement in menopausal and postmenopausal women with Hypoactive Sexual Desire Disorder (HSDD) improves:
Desire
Arousal
Orgasmic function
Sexual satisfaction
Frequency of satisfying sexual events
Key evidence includes the large-scale APHRODITE trials (Buster 2005; Simon 2005; Kingsberg 2014) and the ISSWSH clinical practice guideline supporting testosterone as first-line therapy for HSDD (Faubion et al. 2020).
SHOULD WOMEN CONSIDER TESTOSTERONE IN MENOPAUSE?
While sexual function or HSDD is the most supported use of testosterone according to medical societies, testosterone therapy benefits a broader set of menopausal concerns.
Potential Domains of Improvement
Evidence ranges from randomized trials to observational data:
Mood, anxiety, and dysphoria: multiple trials show improvement or stabilization in positive mood and sense of well-being, which often changes around menopause (Hackbert & Heiman 2002; Miller 2009). Optimal testosterone levels can improve positive affect, emotional resilience, and overall mood stability in perimenopausal and menopausal women. Women often report feeling less “flat” and more like themselves. These changes align with the hormone’s role in dopamine and serotonin modulation. Low androgen levels are associated with anxiety, fatigue, and low motivation.
Energy & vitality: repeatedly reported in clinical studies and patient-reported outcomes - women report more motivation and energy with testosterone supplementation
Cognition: small trials show improved verbal learning and working memory (Davis et al. 2008)
Body composition: testosterone can increase lean mass and reduce fat mass (Davis 1995; Davis 2000). It improves muscle protein synthesis and reduces visceral fat.
Bone density: androgens support osteoblast function
Reduced musculoskeletal pain: androgen-receptors in muscle and connective tissue help modulate inflammation and pain signaling. Trials and observational data show decreased chronic and mid-life achiness, stiffness, and generalized musculoskeletal discomfort, likely due to improved tissue repair and anti-nociceptive effects.
Exercise tolerance and recovery: Even low doses of testosterone increases muscle protein synthesis and supports ligament and tendon integrity (less injury). Clinical studies showed gains in strength, endurance, and overall physical function, with women reporting better stamina and recovery from exercise-related strain.
Sleep: improvements noted in quality-of-life studies. Patients report being able to stay asleep longer, and not feeling “wired and tired” at night. Like estrogen, testosterone has effects on thermoregulation and is extremely effective at reducing night sweats for women.
Urinary symptoms: partly via pelvic floor and urogenital tissue effects
Vaginal dryness / painful intercourse: testosterone is active in vulvar and vaginal tissue; androgens increase blood flow and sensitivity
The musculoskeletal benefits of testosterone for women in menopause are not about building body-builder muscle - they’re about restoring functional strength, reducing chronic aches, and improving physical confidence and movement quality.
Clinical experience consistently shows that testosterone can be a transformative tool for the right patient, especially when used as part of a comprehensive menopausal treatment plan. You can read more about our approach to treating menopause on our Menopause Medicine page.
TESTOSTERONE DELIVERY METHODS FOR WOMEN: CREAMS, PELLETS, AND INJECTIONS
There are multiple delivery options for testosterone therapy. Each can be effective delivery, however they individually offer unique advantages and disadvantages.
1. Topical Creams and Gels
Topical formulations can come as a cream, gel, or spray. They are absorbed through the skin. They climb gradually for 2-4 hours, reaching peak around 6 hours. These preparations are generally applied daily to areas such as the inner thigh or lower abdomen.
Advantages
Ease of dosing adjustments: Because absorption is incremental, topical testosterone can be adjusted with relative ease.
Stable serum levels: Many women experience fewer peaks and troughs compared to pellets.
Non-invasive: Application is simple and needle-free.
Limitations
Daily commitment: The convenience of avoiding procedures is counterbalanced by the need for consistent application.
Transference risk: Skin-to-skin contact shortly after application can unintentionally transfer testosterone to others, particularly children, pets, and partners.
Variable absorption: Factors such as skin integrity, body composition, and concurrent skincare products can often create inconsistent hormone absorption.
2. Subcutaneous Pellets
Hormone pellets are small, cylindrical implants - typically composed of bioidentical testosterone - inserted beneath the skin (often in the hip region) during a brief in-office procedure. They gradually release hormones over 3-4 months. You can learn more about our approach to bioidentical hormone pellets on our Hormone Pellet Therapy page.
Advantages
Long-term stability: Pellets deliver a steady, low-level release of testosterone, often providing the most consistent and predictable serum concentrations over time.
Convenience: Because they last 3-4 months, they eliminate the need for daily application or frequent appointments.
High satisfaction among some users: Women who prefer a “set it and forget it” approach often appreciate the predictability of pellet therapy.
Limitations
Inflexibility: Once implanted, dosing cannot be quickly adjusted. If levels are too high - or if side effects occur - removal is not possible.
Procedure-related issues: Though minor, insertion carries risks such as bruising, discomfort, or infection (rare).
Potential for supra-physiologic levels: Pellets should be dosed conservatively so as to avoid levels that create side effects.
3. Injections
Injectable testosterone - typically administered at home intramuscularly or subcutaneously - is less commonly used for women but remains a highly viable option for certain patients.
Advantages
Predictable pharmacokinetics: Testosterone injections provide both predictable levels and time-line of hormone release. This allows for a high degree of precision and
Subcutaneous dosing options: Testosterone for women can be self administered via a subcutaneous route, meaning the use of a small and short needle once to twice a week into the low belly or glute area.
Rapid symptom response: Women experience a quick onset of symptom relief with injections.
Ease of dosing adjustments: Patient and clinician can adjust doses quickly.
Limitations
Fluctuating levels: Injections can create higher peaks and troughs, however, once or twice-weekly dosing mitigates this.
Needle aversion or discomfort: Self-injection may not appeal to everyone.
* Oral testosterone or troches is not something we generally recommend at KPM. It tends to be hard on the liver (pills), less effective and less predictable.
MYTHS AND MISCONCEPTIONS
With reference to Glaser & Dimitrakakis, 2013 (Myths & Misconceptions About Testosterone in Women).
Myth 1
“Testosterone is a male hormone.”
Women have lower levels than men, but testosterone is the most abundant active sex hormone in women (Burger 2002). It is essential for mood, energy, libido, and physical health.
Myth 2
“Testosterone only affects sex drive.”
Testosterone influences mood, strength, cognition, metabolism, body composition, and overall well-being. Libido is just one aspect.
Myth 3
“Testosterone will masculinize women.”
Masculinization occurs only with supraphysiologic doses in conjunction with estrogen suppression (as used in Trans care, i.e., Female to Male hormone therapy).
Myth 4
“Testosterone causes hoarseness or voice deepening.”
Glaser 2013 and ISSWSH guidelines note that the risk of voice changes is rare, not permanent, and generally dose-dependent. Most voice hoarseness is inflammatory, age-related, and not androgenic.
Myth 5
“Testosterone always causes hair loss.”
Hair loss is multifactorial. If shedding occurs, it is typically dose-related and improves with dose adjustment or supportive therapies, like medications and supplements.
Myth 6
“The clitoris will grow too much.”
Mild increases in clitoral size or sensitivity are possible. Testosterone can often be helpful, especially in women with clitoral atrophy during menopause. Large changes are rare and dose-dependent.
SIDE EFFECTS AND SAFETY CONSIDERATIONS
Acne: surprisingly, acne is rare with testosterone therapy. If it occurs, KPM manages through dose adjustments and we often reach for DIM, a supplement that supports hormone metabolism
Hair Growth: testosterone can stimulate hair follicles leading to increase in facial hair, under arm hair, etc. We recommend laser hair removal or other tools for managing. Nuisance hair growth is somewhat dose-dependent, and something a woman needs to weigh against the benefits of replacement
Hair Loss: while hair loss is multifactorial, testosterone can lead to higher DHT levels which is linked to hair loss in some women, especially those genetically predisposed. This risk can be mitigated with different therapies, but also must be weighed against the benefits of testosterone therapy.
Breast Cancer Risk: Testosterone does not increase breast cancer risk (Glaser 2013; Dimitrakakis 2004)
Cardiovascular Risk: Testosterone did increase cardiovascular risk in women in longitudinal studies.
No adverse effect on lipids at physiologic doses (Davis 2006; Braunstein 2005)
THE BOTTOM LINE: TESTOSTERONE USE IN WOMEN IS UNDERUTILIZED
Testosterone is essential for women’s health - yet it remains one of the most under-discussed and underutilized tools in perimenopause and menopause care. As public awareness grows (including the recent NYT Magazine coverage), more women are asking:
“Would my life feel better with testosterone?”
For many women, the answer is: it’s worth an informed conversation with an informed doctor.
At Kass Precision Medicine, we evaluate symptoms, labs, goals, and your whole health picture to determine whether testosterone is an appropriate part of your personalized menopausal plan.
References
NYT Magazine. Women on Testosterone Feel “On Fire.” 2025.
Faubion SS et al. Clinician’s Guide to Testosterone Therapy for Women. ISSWSH Clinical Practice Guideline. J Women’s Health. 2020.
Glaser RL, Dimitrakakis C. Menopause myths and misconceptions about testosterone in women. HormoneBalance.org, 2013.
Burger HG. Androgen production in women throughout life. J Clin Endocrinol Metab. 2002.
Davis SR et al. Androgens and female sexual function. J Sex Med. 2015.
Davis SR et al. Testosterone and cognition in postmenopausal women. Menopause. 2008.
Davis SR et al. Effects of androgen therapy on body composition. JCEM. 1995, 2000.
Sherwin BB. Androgens and mood/cognition. Psychoneuroendocrinology. 2002.
Hackbert L & Heiman J. Testosterone for mood and sexual function. Arch Sex Behav. 2002.
Miller KK. Androgen therapy for women: review. JCEM. 2009.
Buster JE et al. Testosterone patch for HSDD (APHRODITE). NEJM. 2005.
Simon J et al. Testosterone therapy for sexual dysfunction. Obstet Gynecol. 2005.
Kingsberg SA. Testosterone and female sexual desire. J Sex Med. 2014.
Dimitrakakis C et al. Breast cancer risk with testosterone. Maturitas. 2004.
Braunstein GD. Safety of testosterone therapy. Fertil Steril. 2005.
IF YOU WOULD LIKE TO DISCUSS TESTOSTERONE THERAPY FOR MENOPAUSE OR PERIMENOPAUSE, CALL OUR OFFICE AT
425-272-9404.
