Medically Reviewed by Dr. Tashiya Mirando, MD, Written by Grace Oh, Licensed Menopause Champion and Integrative Nutrition Health Coach

When we think of testosterone, we often associate it with men’s health. However, testosterone plays a vital role in women’s well-being too. From supporting libido and mood to enhancing energy and concentration, this hormone is essential for women’s overall health. Yet, as women age—or undergo surgical menopause—testosterone levels can decline, leading to symptoms that may impact quality of life.

This blog post explores the role of testosterone in women, the potential benefits and limitations of testosterone therapy, and important considerations for those thinking about this treatment. Let’s dive into the science and practical applications of testosterone therapy for women.

The Role of Testosterone in Women’s Health

Testosterone is often referred to as a “male hormone,” but it is equally important for women. It contributes to:

• Libido (sexual desire): Testosterone helps maintain a healthy sex drive.
• Mood and energy levels: It can improve overall vitality and reduce feelings of fatigue.
• Cognitive function: Testosterone supports concentration and mental clarity.
• Physical stamina: It aids in maintaining muscle strength and endurance.

As women age, testosterone levels naturally decline. This decline is gradual but can be more pronounced in women who undergo surgical menopause (removal of the ovaries), as the ovaries are a primary source of testosterone production.

When Is Testosterone Therapy Recommended?

Currently, testosterone therapy is primarily recommended for women experiencing persistent low libido that significantly impacts their quality of life. While some women report improvements in energy, mood, and cognitive function with testosterone therapy, there is insufficient scientific evidence to support its use for these symptoms alone.

Key Points to Consider:

• Evidence-based use: Testosterone therapy is supported by studies up to 5 years, which show no adverse effects in healthy postmenopausal women. However, long-term data is still limited.
• Combination therapy: Testosterone is often prescribed alongside estrogen-based hormone therapy. For women with a uterus, progestogens are also recommended to protect the endometrium (the lining of the uterus).
• Vaginal health: Vaginal estrogen may be recommended alongside testosterone to address symptoms like vaginal dryness, which can accompany menopause.

In summary, testosterone therapy is a well-supported option for women experiencing persistent low libido, particularly when combined with estrogen-based treatments and tailored to individual health needs, though further research is needed to fully understand its long-term effects and broader applications.

How Is Testosterone Therapy Administered?

Testosterone is most commonly available in gel form, though it can also be administered as an implant, which is a less commonly used method. In Australia, a licensed testosterone product for women called AndroFeme 1 is available. This cream comes with a measuring device to ensure accurate dosing and is applied daily.

Practical Tips for Using Testosterone Therapy:

1. Rotate the application area on the skin to avoid irritation.
   
   
2. Avoid exceeding the recommended dosage to prevent side effects such as acne or unwanted hair growth.
   
   
3. Be patient: The full effects of testosterone therapy may take 3-6 months to become noticeable.

Before starting therapy, and again after 3-6 months, blood tests may be recommended to monitor testosterone levels and ensure they remain within an appropriate range.

Who Should Avoid Testosterone Therapy?

While testosterone therapy can be beneficial for some women, it is not suitable for everyone. The following groups should avoid or use caution with testosterone therapy:

• Pregnant or breastfeeding women: Testosterone can affect fetal development and milk production.
• Women with active liver disease: The liver metabolises hormones, and impaired liver function can complicate menopause hormone therapy.
• Women with a history of hormone-sensitive breast cancer: Testosterone may stimulate hormone-sensitive tissues, though in some cases, it may be considered under close medical supervision.
• Competitive athletes: Testosterone levels must remain within the normal female range to comply with athletic regulations.
• Women with high baseline testosterone levels or elevated Free Androgen Index (FAI): Additional testosterone could exacerbate symptoms like acne or excessive hair growth.

That being said, while testosterone therapy offers potential benefits for certain women, it is not appropriate for everyone, particularly those who are pregnant, breastfeeding, have liver disease, a history of hormone-sensitive breast cancer, or elevated baseline testosterone levels, as well as competitive athletes who must adhere to strict hormonal regulations.

The Global Landscape of Testosterone Therapy for Women

Australia is a pioneer in this field, with AndroFeme 1 being the first government-approved testosterone product specifically for women. In many other countries, women rely on testosterone products approved for men, using them at lower doses for “off-label” purposes. This highlights the need for more research and regulatory approval of testosterone therapies tailored to women’s health.

Key Takeaways

• Testosterone is a crucial hormone for women, influencing libido, mood, energy, and cognitive function.
• Testosterone therapy is currently recommended primarily for low libido in postmenopausal women, with limited evidence for other uses.
• Therapy is often combined with estrogen-based treatments and requires careful monitoring to avoid side effects.
• Not all women are candidates for testosterone therapy, and individual health factors must be considered.

By understanding the role of testosterone and the potential benefits and risks of therapy, women can make informed decisions about their health. If you’re considering testosterone therapy, consult a healthcare provider to discuss your individual needs and circumstances.

References

1. Low testosterone in women. (2024, May 1). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/24897-low-testosterone-in-women 

2. Abernethy, K. & British Menopause Society. (2022). Testosterone for women. https://www.womens-health-concern.org/wp-content/uploads/2022/12/22-WHC-FACTSHEET-Testosterone-for-women-NOV2022-B.pdf 

3. BRITISH MENOPAUSE SOCIETY. (2022). Testosterone replacement in menopause. In BRITISH MENOPAUSE SOCIETY Tool for Clinicians. https://thebms.org.uk/wp-content/uploads/2022/12/08-BMS-TfC-Testosterone-replacement-in-menopause-DEC2022-A.pdf 

4. Grainger, S. (n.d.-d). Testosterone and Women – Australasian Menopause Society. https://www.menopause.org.au/health-info/resources/testosterone-and-women