Testosterone is not just a “male hormone” – women also produce it, just in much smaller quantities. In women, testosterone supports sexual desire and arousal and plays a role in bone, muscle, and brain health. Many experts agree that there is evidence that testosterone therapy can be used in women to treat low sexual desire that is disruptive or distressing after menopause, a condition called hypoactive sexual desire disorder (HSDD).
There is no FDA-approved testosterone made just for women in the United States yet, so care can be confusing. Here’s what you should know:
What is Testosterone?
Testosterone is one of the body’s sex hormones that plays a large role in the reproductive system in both men and women. “We think it might be important for bone mass, mood and other areas of health in women, but we’re still figuring that out,” said Dr. Nora Lansen, family doctor and chief physician at Elektra Health.
Much more is known about testosterone’s direct effects on men, including its powerful effects on libido, bone mass, mood and muscle growth, Lansen explained. “Average levels are about 10 to 20 times higher in men than in women,” she said.
In women, testosterone levels slowly decline with age, reaching a low point in the late 50s and then rising slightly again. Research shows that this pattern has more to do with age than with the menopausal transition itself.
What is testosterone used for?
Testosterone is best for postmenopausal women with low sexual desire that is bothersome or distressing, after a complete review of other causes such as medications, sleep, mood, pain, and relationship factors, said Sameena Rahman, MD, an ob-gyn and sexual medicine specialist. Major medical groups, including the Menopause Society, follow this approach and advise careful dosing and monitoring.
Lansen noted that treatment is personal and that cravings can be influenced by other factors. If a woman’s testosterone levels are normal or high, adding extra testosterone to her system would not be safe or helpful, she explained. While testosterone is most commonly prescribed after menopause, Lansen said it may be considered for women in late perimenopause on a case-by-case basis after evaluation and laboratory testing.
How testosterone therapy works
Before any prescription, your doctor should look at the bigger picture. If low desire is still bothersome after this investigation, testosterone may be considered for HSDD.
Forms and dosages
In accordance with the International Society for the Study of Women’s Sexual Health (ISSWH), most experts prescribe very low-dose skin gels or creams designed for men but administered at a fraction of the male dosage. Many start their patients with about a tenth (some even use less) and slowly get used to it. A small, measured amount is applied once daily to clean skin, such as the thigh. Pellets are typically avoided because they cannot be adjusted or removed and can cause levels to rise too high, said pharmacist Jobby John, PharmD, founder of Lake Hills compounding pharmacy in Bee Cave, Texas.
Measuring doses helps
With compound metered dosing devices, each “click” corresponds to one dose, reducing measurement errors and lowering the risk of transmission, John noted. Some providers also use tiny local tissue effects vaginal tablets, if necessary, that are made per patient with a valid prescription and should meet certain quality standards, John said.
Surveillance and security
Doctors often check total testosterone levels about three to six weeks after starting or changing a dose, then every four to six months if the dose is stable. The goal is to keep levels within a normal premenopausal range and monitor for side effects. Call your HCP if you notice:
- acne
- More facial hair
- Hair loss on the scalp
- A deeper voice
- Clitoris growth
We do not yet know the long-term effects on the heart, brain, bones or breast tissue. Practice shared decision-making with your HCP to determine whether the benefits of using testosterone outweigh the risks to you.
Insurance and costs
Because there is no FDA-approved testosterone for women in the United States, the drug is often not covered by insurance. Office visits and laboratory visits may be covered. “Compound testosterone is almost never covered by insurance and most women pay around $45 to $90 per month, depending on the formula,” John said. Vouchers can reduce the cost of male-labeled gels used in very low doses.
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Access and equity
The off-label status and cash costs make it difficult to provide care to lower-income people and those who live far from specialty clinics. Research shows there are already gaps in menopause care based on race and income. Women of color are less likely to be offered or receive standard hormone therapy, and cost, bias, and medical mistrust may play a role in these disparities.
When a treatment is off-label and paid for in cash, these gaps can widen. “While it is really great that menopause is a topic that is increasingly being discussed in the media, it is not fair to make information about menopause available to everyone but to reserve treatment only for those who can afford it,” said Lansen.
If cost or access is a barrier, ask:
- Insurance-friendly clinics (including Medicaid) and financial counseling
- Telemedicine options and pharmacies that ship
- Cash prices and discounts for low-dose gels labeled for men used off-label
- Accredited compounding pharmacies (PCAB/NABP) and clear, metered dosage to eliminate waste
The future of testosterone therapy for women
Researchers are working on women-specific formulations and better long-term safety data. There’s already a testosterone cream for women in Australia, and some experts want an FDA-approved option in the US so dosage and access are clearer. Until then, care will likely remain off-label, with careful monitoring and consideration of equity and cost.
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