Testosterone Therapy for Women: Benefits, Side Effects & What to Expect

Medically reviewed by Dr. Amy Killen, MD, a board-certified physician specializing in hormone optimization and longevity medicine.

Quick answer: Testosterone therapy for women is a low-dose, prescription treatment, usually a compounded cream, that restores testosterone to the level of a healthy woman in her twenties. The strongest evidence is for low sexual desire after menopause. In my practice it also helps energy, motivation, mood, and the ability to hold on to muscle and bone. Side effects are dose-related and mostly mild (acne, oily skin, a little extra hair). There is no FDA-approved testosterone product for women in the United States, so it is prescribed off-label by a physician who monitors your levels.

Testosterone is not a male hormone

Women make testosterone in the ovaries and the adrenal glands, and a healthy young woman has more testosterone circulating than estrogen. Production peaks around age 25 in both sexes and then drifts down. Estrogen and progesterone fall off a cliff at menopause. Testosterone is a slow roller. By the time a woman is in her forties she may have half the testosterone she had at 25, and women who have had their ovaries removed lose it faster.

Receptors for it sit in the breast, heart, skeletal muscle, fat, bone, brain, pelvic floor, and genitals. In most of those tissues testosterone is anabolic: it builds and maintains. So it makes sense that women notice whole-body changes when it runs low. The bedroom is only one of them.

Symptoms of low testosterone in women

The classic ones are low libido, loss of motivation, fatigue, belly fat that will not budge, and trouble building muscle no matter how hard you train. Less recognized symptoms include irritability, low mood, poor focus and memory, hot flashes, and urinary complaints. Symptoms often start in the forties, but younger women can have them too, especially women on oral birth control pills, which raise the protein that binds testosterone and lowers the amount your body can use.

Low testosterone is a clinical diagnosis. The lab result supports it; the symptoms make it. A woman with every symptom on this list and a “normal” lab value still has a problem worth treating, because normal for a 55-year-old is a low number.

Benefits of testosterone therapy for women

Sexual desire. This is where the evidence is deepest. Multiple randomized trials, and the 2019 Global Consensus Position Statement endorsed by the International Society for the Study of Women’s Sexual Health and several menopause societies, support transdermal testosterone for postmenopausal women with hypoactive sexual desire disorder. Women in those trials reported more desire, more arousal, more satisfying sexual events, and less distress.

Energy, motivation, and mood. This hormone affects drive and sense of well-being. Women who start it often describe wanting to do things again: lift, work, plan, go out. Randomized data here are thinner than for libido, and testosterone therapy has not been shown to harm mood or cognition. One trial found transdermal testosterone improved verbal learning and memory; another found no cognitive effect. In my clinic the motivation change is one of the first things women report.

Muscle and bone. It stimulates osteoblasts, the cells that build bone, and higher free testosterone levels track with better bone density and lower hip fracture risk in menopausal women. In a placebo-controlled trial of women thrown into early menopause by surgery, 24 weeks of testosterone improved lean mass, chest press power, and stair climb power in a dose-dependent way.

Heart and blood vessels. It acts directly on vessel walls to improve blood flow, and low levels are associated with more cardiovascular disease. Studies of testosterone therapy in menopause have not shown an increase in cardiovascular events as long as levels stay in a physiologic range.

A caveat I give every patient: the doses used in the libido trials were small, roughly 0.3 mg a day from a patch. Those doses moved desire without moving blood levels much. The whole-body benefits I see in practice come at higher, still physiologic, doses. That difference is why some doctors will tell you testosterone “only works for libido.” It works for what it was tested for.

Who is a candidate

A good candidate is a perimenopausal or postmenopausal woman with symptoms of low testosterone, or a younger woman with symptoms and a low free testosterone level, who is not pregnant, not trying to conceive, and not breastfeeding. Testosterone is prescribed alongside estrogen and progesterone when those are also low; it is not a substitute for them.

Who should not take it: women with an active hormone-sensitive cancer, women who could become pregnant without reliable contraception (high-dose testosterone can harm a developing baby), and women who already have high androgen levels, such as many women with PCOS, where adding more makes acne and hair growth worse. Severe acne and a high red blood cell count also call for caution.

Hormones do the heavy lifting, but the right supplements make them work better. I put the ten I actually recommend, with doses, in my free Top Ten Supplements Guide.

How testosterone therapy is prescribed for women

Here is the part that surprises most women: there is no FDA-approved testosterone product for women in the United States. Men have more than 30. Testosterone is approved for women in the UK and Australia, and it has been used in women for more than 80 years, but American physicians prescribe it off-label. Off-label is routine medicine (beta blockers for stage fright, minoxidil for hair loss), not a loophole. It does require a doctor with a DEA number, because testosterone is a controlled substance.

The usual options:

• Compounded cream or gel (the standard). Applied once daily to thin, low-hair skin such as the inner thighs or inner arms. A typical starting dose is 3 to 6 mg a day, about a tenth of a man’s dose, dispensed from a pump or click device so the dose is accurate. Compounding is how nearly every woman in this country gets testosterone, and a good compounding pharmacy is a normal part of care.
• Vaginal or vulvar cream. A lower dose applied locally helps dryness, sensation, and urinary symptoms; a slightly higher dose absorbs systemically.
• Sublingual troche. Dissolves under the tongue, peaks within 30 minutes, and is gone in a few hours. Some women use it on demand before sex.
• Weekly subcutaneous injection. A tiny dose (5 mg) with an insulin syringe. Less studied in women, but steady and inexpensive.
• Pellets. Implanted under the skin every three to five months. Steady levels and nothing to remember, but a pellet cannot be removed once it is in, so if the dose is too high you live with it for months. Pellets are a legitimate option for some women, usually after the flexible options have been tried. They are not most clinicians’ first choice.

The twice-weekly patches used in the big libido trials are not sold in the United States. Oral methyltestosterone, the old pill form, is hard on the liver and is not used in modern hormone therapy.

Side effects of testosterone therapy for women

Side effects track the dose and the blood level. At the doses above, most women have none. The ones that show up:

• Acne or oily skin, usually in the first months, usually dose-related.
• Extra hair on the face or body. At supraphysiologic levels (the kind high-dose pellets can produce) most women notice some; at physiologic doses it is uncommon and reversible.
• Scalp hair thinning in women who are genetically prone to it.
• Voice deepening and clitoral enlargement. These happen at high doses, and they can be permanent. This is the reason I keep women’s levels well below a man’s range and recheck labs rather than guess.
• Transfer to others. Cream on your skin can transfer to a partner, a child, or a pet. Wash your hands after applying, let it dry, and keep the site covered.
• Fluid retention or mood changes, usually a sign the dose is too high.

Every one of these improves when the dose comes down or the testosterone stops, with the exception of the voice and clitoral changes if they are allowed to go on too long. Dosing low, going slow, and checking levels prevents them.

What to expect: timeline, labs, and follow-up

Weeks 1 to 4. Most women feel nothing yet. Some notice better sleep or a little more drive. Skin may get oilier.

Weeks 4 to 8. Libido, energy, and motivation usually show up here. This is the window where women tell me they are “back.”

Months 3 to 6. Full effect, including muscle response to training and body composition changes. Bone changes take years and show up on a DEXA scan, not in the mirror.

Labs. I check total and free testosterone (free matters most if you take oral estrogen or have a high binding protein level), ideally by the LC-MS method, before starting and again 6 to 12 weeks after any dose change, then every 6 to 12 months. Blood levels do not correlate well with how a woman feels, so I adjust the dose to symptoms and use the labs to keep her safe. My rough goal is the high end of the normal range for a 25-year-old woman, rather than the range for her age, and always far below a man’s range.

If it does not work. Reasons include a dose that is too low, a binding protein level that is soaking up the hormone (common with oral estrogen), untreated low estrogen or thyroid, or a problem that was never hormonal: medications, relationship strain, pain with sex. A good prescriber looks for those before adding more testosterone.

Testosterone and breast cancer

The worry comes from studies in the 1980s and 1990s of a pill that combined synthetic oral testosterone with synthetic oral estrogen. That combination raised breast cancer risk and was hard on the liver. Bioidentical testosterone given through the skin is a different drug. Breast cells carry androgen receptors, and in laboratory and primate studies testosterone slows breast cell growth. Newer observational studies suggest women treated with testosterone may have a lower incidence of breast cancer. That research is encouraging and still emerging. I do not prescribe hormones to women with an active hormone-sensitive cancer, and any woman with a cancer history should make this decision with her oncologist in the room.

Frequently asked questions

Is testosterone therapy safe for women?

At physiologic doses with monitoring, yes. Randomized trials of transdermal testosterone in postmenopausal women have not shown increases in cardiovascular events or breast cancer. Long-term safety data beyond a few years are limited, which is why levels are checked and kept in a woman’s range.

How much testosterone does a woman take?

A typical compounded cream dose is 3 to 6 mg a day, about one tenth of a man’s dose. The dose is adjusted to symptoms and blood levels over the first few months.

How long does testosterone take to work in women?

Most women notice changes in libido and energy within 4 to 8 weeks. Muscle and body composition changes take 3 to 6 months. Bone benefits take years.

Will testosterone make me look masculine?

No, at the doses used for women. Voice deepening and other permanent changes happen only at high, sustained levels, which is why your prescriber checks labs and keeps your level in a woman’s range.

Can I take testosterone without estrogen?

Some women do, particularly those who cannot take estrogen. For most menopausal women the two work together, and testosterone will not fix symptoms caused by low estrogen.

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This article is for educational purposes only and is not a substitute for individualized medical advice from your own physician.