Testosterone Therapy for Women: An Underserved Category

Biology

Testosterone Is a Female Hormone Too

Women produce testosterone in the ovaries and adrenals. Female levels are roughly 5–10% of male levels but contribute to libido, energy, mood, bone density, lean mass, and cognition.

Levels decline gradually from the late 20s through menopause, with a sharper drop after surgical removal of the ovaries. Combined oral contraceptives suppress free testosterone via increased SHBG.

The evidence

What the Evidence Actually Supports

The strongest evidence is for hypoactive sexual desire disorder (HSDD) in postmenopausal women. The 2019 Global Consensus Position Statement — endorsed by the International Menopause Society, Endocrine Society, and others — concluded that transdermal testosterone at female physiologic doses reliably improves sexual desire, arousal, orgasm, and satisfaction in this population.

For energy, mood, cognition, muscle, and bone, evidence is weaker. Some randomized data support modest effects; long-term outcome data is thin.

For premenopausal women, evidence is essentially absent.

Off-label status

Off-Label Status in the U.S.

There is no FDA-approved testosterone product for women in the United States in 2026. Female-dose products exist in other countries (AndroFeme in Australia).

U.S. prescribing uses either compounded testosterone cream at female physiologic doses (typically 1–5 mg/day) or fractional doses of male-indicated products.

Off-label is not unsafe, but it requires a physician familiar with the literature, dosing, and monitoring — not a telehealth-only clinic.

Forms & dosing

How It's Delivered

• ·Compounded transdermal cream — typically 1–5 mg/day; the most flexible dosing.
• ·Topical gel — fractional dosing from male-strength products.
• ·Subcutaneous pellets — convenient but inflexible; commonly over-dosed in commercial pellet clinics, the most frequent source of supraphysiologic side effects in women.
• ·Low-dose injectable testosterone cypionate — used by some menopause specialists; requires careful dosing.

The goal is female physiologic, not supraphysiologic. Treating to high-normal male levels is over-treatment with predictable side effects.

Monitoring

Monitoring and Safety

Baseline: total and free testosterone, SHBG, estradiol, CBC, lipids, liver enzymes.

Follow-up at 6–8 weeks, then every 6 months: total and free testosterone, SHBG, symptom review.

Target: total testosterone in the upper third of the normal female range; free testosterone in the upper end of female range.

Long-term safety at studied doses appears reasonable. Most concerns trace to supraphysiologic dosing — typically from pellet over-implantation — not physiologic replacement.

Side effects

Side Effects — Mostly Dose-Related

At physiologic doses, side effects are uncommon. Above physiologic dosing the predictable issues are acne and oily skin, scalp shedding in predisposed women, terminal facial or body hair, voice deepening (typically irreversible — the most important reason to keep dosing physiologic), clitoral enlargement at sustained high doses, and occasional mood changes.

These are dose problems, not testosterone problems.