If you are a woman over 40, you have probably seen social media influencers talking about testosterone therapy. They say it’s the secret to more energy, better moods and a renewed sex drive.
Hormone therapy has been trending for some time, but recently testosterone has gone full pop culture. From viral TikToks to podcasts promising “optimized womanhood,” it might seem like taking one hormone can fix all your problems.
Let’s slow the scroll for a second.
As women, we often don’t think much about testosterone. We usually focus more on estrogen and progesterone, the so-called “female” hormones. But women do produce testosterone. We don’t produce as much as men, but even the small amount we make can affect our health and well-being.
But while testosterone therapy for men is well-studied, the science around its use for women is still evolving.
To help sort fact from fiction, we turned to Debra Wickman, MD, an OBGYN with Banner -University Medicine who specializes in sexual health and menopause care. She breaks down what testosterone does, when therapy may help, possible risks and what medical experts really recommend.
What does testosterone actually do in women?
Testosterone is often mislabeled as the male hormone but women produce it, too. According to Dr. Wickman, “The role of testosterone is vital in women’s health.”
Testosterone helps with several things:
- Energy, motivation and stamina
- Sex drive, arousal and orgasms
- Mood and emotional balance
- Endurance and strength
- Overall sense of well-being
Why are so many women asking about testosterone therapy?
No matter your sex, testosterone levels go down as you get older.
“Women produce a significant amount of testosterone in their younger years,” Dr. Wickman said. “Production starts to drop off in the mid-30s. It can go down further if you take oral contraceptive pills or have a lot of stress.”
The drop can be really noticeable when you hit the perimenopause and menopause years.
When testosterone levels fall, you may feel:
- More tired
- Less interested in sex
- Less motivated or enthusiastic
- Flatter emotionally
- Weaker or slower during exercise
- More pain with sex
Not every symptom is caused by hormones, of course. But when these problems happen along with more women talking about menopause online, it’s normal for women to wonder if testosterone therapy might help.
Should women take testosterone therapy?
You’ll hear a lot of bold claims about testosterone therapy for women. Some say it can help with tiredness or losing weight. Others say it can improve thinking or mood. But the truth is more complicated.
Here is where research is strongest:
1. Sexual desire and satisfaction
Testosterone therapy is sometimes prescribed off-label to treat HSDD (hypoactive sexual desire disorder) in postmenopausal women. HSDD is when you have a low sex drive or no sex drive.
“Testosterone is a strong hormone that sends messages to the dopamine center in the brain. It affects attraction, desire, motivation and productivity,” Dr. Wickman said. “It also helps with sexual pain, called vestibulodynia, which is pain at the opening of the vagina caused by inflammation from low androgen levels. This is often a side effect of oral contraceptives.”
2. Bone density and lean muscle
Some studies show a small improvement in bone and muscle health. But these benefits are less than what you might see in men and require ongoing monitoring.
On the other hand, the research is weak or inconsistent in these areas:
- Energy and motivation
- Mood and emotional balance
- Cognition or brain fog
- Weight management
Most studies focus on postmenopausal women; research in younger women is limited. As well, no testosterone product is approved by the FDA just for women.
Are there any risks?
Like any hormone therapy, testosterone isn’t risk-free.
Possible downsides include:
- Acne or oily skin
- Increased facial or body hair
- Scalp hair thinning
- Mood changes
- Weight gain
- Clitoral changes (rare)
- Changes in cholesterol or liver function (with high doses)
Most risks increase when levels exceed the normal female range.
“To avoid these problems, we suggest taking small doses, increasing gradually or using supplements to stop the conversion of free testosterone into DHT (dihydrotestosterone),” Dr. Wickman said. “DHT is the form that affects hair follicles and skin glands.”
You should also avoid testosterone if you are:
- Pregnant, breastfeeding or trying to get pregnant
- Have liver disease, heart disease or hormone-sensitive cancers
- Taking other interacting hormone therapies
What forms of testosterone are available?
There are several formulations of testosterone, but insurance doesn’t currently cover any of the forms available for women.
“We can use products FDA-approved for men at approximately one-tenth of the dose for women,” Dr. Wickman said. “You can also use GoodRx or other discount platforms to purchase it very reasonably.”
Testosterone is available in several methods, including:
- Compounded creams and gels: These allow custom dosing. They can also be combined with estradiol for vulvar or vaginal use.
- Lozenges (troches): Dissolve in the mouth and deliver hormones through mucosal absorption.
- Pellets: Inserted under the skin and release hormones gradually.
- Patches: Offers consistent dosing but may cause skin irritation. There aren’t any patches currently available for women. And it is not recommended to cut patches designed for men.
- Injections: This isn’t a preferred method for most women, as it has a higher chance of converting into DHT.
No matter the form, Dr. Wickman stresses one thing:
“Your serum (blood) levels need to be followed and doses adjusted accordingly for safety,” she said. “Follow directions carefully and message your provider if anything unexpected or unusual happens.”
Curious about testosterone? Start here.
If you’re curious about whether testosterone therapy might help, Dr. Wickman recommends a thoughtful, informed first step.
“Read trusted authorities online and books on menopause or seek experts in sexual pain or low desire,” she said. “A next best step is to see a provider who specializes in treating women with menopause, hormone issues or sexually related issues.”
Sometimes it helps to find a provider by calling a compounding pharmacy to ask the pharmacist which provider has a lot of experience writing prescriptions for testosterone. Your primary care provider can also make a referral.
Bottom line
Feeling unlike yourself can be frustrating. You deserve answers, clarity and care that looks at the whole picture.
Testosterone can be helpful for some women, but it’s not a one-size-fits-all miracle cure. And it shouldn’t be started casually.
Work with someone who understands women’s hormones, monitors levels responsibly and helps you find the correct dose and not the highest one.
If you have symptoms that affect daily life or intimate relationships, you don’t have to rely on social media advice. A trained expert at Banner Health can help you explore whether testosterone is appropriate, safe and tailored to your needs.
