Women make more testosterone than estrogen, and lose it for decades before anyone thinks to measure it. For some women, replacing it is the piece that finally makes the difference.
Reviewed by Allison Mollet, PA-C, MSCP
Updated August 2026
It is thought of as a male hormone because men were studied first. Women produce it in the ovaries and the adrenal glands, at higher concentrations than estrogen, and it acts on tissue throughout the body: brain, bone, muscle, blood vessels, and the genital tissues.
It is one of the hormones a woman's body expects to have, not a supporting player.
Estrogen falls off a cliff at menopause. Testosterone does not.
It declines gradually, from roughly the twenties onward. By the time a woman is fifty she has been losing it for decades, and menopause is not what caused it.
That is why the change is so easy to attribute to something else. Nothing that arrives over twenty years announces itself.
Removing both ovaries is the exception. That takes away roughly half the supply at once, and the symptoms arrive accordingly.
Desire returns. This is the clearest effect and the one most women come in for. Not a flicker, but wanting sex again in a way she recognizes from before.
Energy, without stimulation. Not the lift of caffeine. A baseline that had quietly dropped, coming back up.
Training works again. Muscle responds to the same effort that had stopped producing anything. For women already lifting, this is often the change they notice first.
Mood flattens out less. The greyness lifts. Women describe feeling more like themselves rather than feeling happier, which is a different and more accurate thing.
Stamina through the day. Getting to the evening with something left.
Desire is where the published evidence is strongest. The rest is what women tell us and what we see, and we say so on that basis.
Randomized studies in postmenopausal women support testosterone for low sexual desire that causes distress. That is the indication professional bodies recognize, and it is well established.
For energy, mood and strength, the published studies have not demonstrated an effect. They were also not built to find one. Few examined muscle at all, the numbers enrolled were small, and every participant was already taking estrogen.
An absence of findings in studies that small is not a finding of absence. Women report these effects and we see them, and that is the basis on which we describe them.
Nobody has run the study that would settle what testosterone does for a woman's energy and strength. We are not going to tell a woman whose stamina came back that it did not happen. We prescribe on the evidence where there is evidence, and on what we observe where there is not.
— Allison Mollet, PA-C, MSCP
The one that most often brings a woman in is low sexual desire. Not a fluctuation, but a persistent loss of interest she notices and is troubled by.
Commonly alongside it: fatigue that sleep does not fix, flat mood, muscle that will not respond to training, and reduced stamina.
All of these overlap with estrogen deficiency, thyroid disease, iron deficiency, poor sleep and depression. That is the reason for a full evaluation rather than a symptom checklist. Treating testosterone in a woman whose actual problem is her thyroid helps nobody.
There is no FDA-approved testosterone product for women in the United States, so it is prescribed off-label at female-appropriate doses and monitored with labs.
Off-label means an approved medication used outside its labeling. It is a routine and legal part of medical practice, and a great deal of medicine works this way.
What it means in practice is that the dose comes from the prescriber rather than a package insert. That is the argument for having testosterone managed rather than sourced.
The dose is a small fraction of a male dose. This is the most important point on the page. Almost everything that goes wrong with testosterone in women is a dose that went too high.
Cream, gel, or injection. Creams and gels are applied daily and allow small, steady doses. Low-dose injections work well for women who prefer them. Because no product is manufactured at female strength, all of these are either compounded or a carefully measured fraction of an approved product.
The dose is yours. It is adjusted against your symptoms and how you tolerate it, with levels checked to confirm we are in a sensible range. What suits one woman does not suit another, and there is no number this reduces to.
Monitoring is part of the treatment. A baseline before starting, then levels rechecked after starting and periodically. Side effects are dose-related, which is why the dose is watched. The FAQ covers them.
A pellet delivers whatever dose it delivers for three to four months, and the level travels a wide arc over that time. There is no way to trim it.
Insertion is a minor surgical procedure, and once a pellet is in it is not practically removable. If the dose turns out to be wrong, the choice is to wait it out or to cut it out.
Everything that makes testosterone work well in a woman is in the adjusting. Cream, gel and injection can all be adjusted. A pellet cannot, and that is the whole of our objection to it.
Almost everything that goes wrong with testosterone in women is a dosing problem. At female doses, adjusted against how a woman actually feels, it is one of the more useful things we prescribe. The skill is in the adjusting, which is also why we do not use any form that cannot be adjusted.
— Allison Mollet, PA-C, MSCP
Testosterone works best as part of a whole hormone plan rather than on its own.
Low desire has more than one cause. Estrogen deficiency reduces it, and dryness that makes sex uncomfortable will not be fixed by testosterone. That needs vaginal estrogen. Sorting those out often changes what testosterone is being asked to do.
Thyroid function, iron, vitamin D and sleep deserve assessment too, because each produces symptoms that look like low testosterone and each is treated differently.
None of which means testosterone waits its turn. For some women it is the piece that was missing, and the evaluation is how we find out.
Let's begin
An evaluation looks at your hormones, thyroid, metabolic markers and nutrients together, so the plan treats what is actually causing your symptoms. An unhurried hour with a Menopause Society Certified Practitioner, in Brea. To speak with us first, call 714-671-2005.
The forms of hormone therapy, and how treatment is personalized
The benefits of hormone therapy
Menopause: what changes, and what helps
Perimenopause: what's happening, and what helps
Women produce it and run on it. It comes from the ovaries and adrenal glands, circulates at higher concentrations than estrogen, and acts on brain, bone, muscle, blood vessels and genital tissue. Whether replacing it will help you depends on your symptoms and your levels, which is what an evaluation establishes.
Less than people assume. Estrogen falls sharply at menopause. Testosterone declines gradually from a woman's twenties, so by fifty she has been losing it for decades. Removing both ovaries is the exception and takes roughly half the supply at once.
No. There is no FDA-approved testosterone product for women in the United States. It is prescribed off-label at female-appropriate doses, which is a routine and legal part of medical practice, and it is why the dose and the monitoring matter.
Most commonly a persistent loss of sexual desire that troubles you. Fatigue, flat mood, muscle that will not respond to training and reduced stamina are frequently reported alongside it. All overlap with thyroid disease, iron deficiency, estrogen deficiency and poor sleep, which is why they are evaluated together.
This is where the published evidence is strongest. Randomized studies support testosterone for low sexual desire causing distress in postmenopausal women. Worth knowing that low desire has more than one cause, and that discomfort with sex needs vaginal estrogen rather than testosterone.
Women tell us their training works again, and that is what we see.
The published studies have not demonstrated an effect on muscle, and they were not designed to find one. Few looked at muscle at all, the numbers were small, and every participant was already on estrogen. We describe this as what women experience, because that is what it is.
Not at the doses used here. Acne and increased hair growth where a cream is applied are the more common effects, and both usually respond to a dose change or a different application site.
Deepening of the voice and enlargement of the clitoris are uncommon and associated with excessive dosing. At physiologic doses the international consensus statement found mild acne and hair growth but not voice change or clitoral enlargement. Avoiding those is what dose discipline and monitoring are for.
A daily cream or gel, or low-dose injection. Because no product is manufactured at female strength, it is compounded or a measured fraction of an approved product.
No. A pellet delivers a fixed dose for three to four months, the level travels a wide arc over that time, and it is not practically removable once inserted. Adjusting the dose is most of what makes testosterone work well in women, and a pellet removes the ability to do it.
A baseline level before starting, then levels rechecked after starting and periodically. Dose is adjusted against how you feel, with levels confirming we are in a sensible range rather than serving as the target.
Testosterone is not used in pregnancy, and women who could become pregnant need contraception alongside it.
Long-term data in women is limited, largely because no product has been developed and studied for this use. Safety data at physiologic doses do not extend beyond about two years.
At female doses with monitoring it is generally well tolerated, and the known side effects are dose-related. That is part of the conversation before starting.
