This article is part of WHA’s new perimenopause and menopause series.

During menopause, many women experience changes in libido, energy levels and mood due to hormonal shifts. While menopausal hormone therapy is a common treatment to help alleviate symptoms, it addresses those caused by fluctuating estrogen and progesterone levels, not those caused by a dip in testosterone.

Testosterone therapy, while less studied in women than other hormone treatments, is now part of the evolving conversation about managing menopause symptoms. Though research on testosterone therapy for women is still limited, studies suggest it can help improve sexual health and energy when used carefully and appropriately.

This conversational shift also reflects a broader trend: women are becoming more informed about menopause and advocating for their health, particularly in areas like sexual well-being, that have long been overlooked.

How does testosterone affect a woman’s body?

Testosterone is a hormone often associated with men, but it plays an important role in women’s health, too. While estrogen is the primary hormone driving many changes in a woman’s body, testosterone supports sexual desire, energy levels, mood and muscle strength. As women age, natural testosterone levels decline, particularly during and after menopause.

It’s important to note that much of what we know about testosterone comes from research on men, as studies specifically focused on women are limited. However, we do know that testosterone works differently than estrogen. While estrogen supports bone health, reproductive tissues and other important aspects of women’s health, testosterone plays a complementary role. Understanding this balance is key to exploring how testosterone therapy may help manage menopause symptoms.

Signs of low testosterone in women

Low testosterone in women can lead to symptoms like:

  • decreased sexual desire
  • fatigue
  • muscle loss
  • mood changes, such as irritability, anxiety or depression

If you’re peri- or post-menopausal and experiencing these symptoms, a discussion with your provider can help determine whether testosterone levels might be a factor and if testosterone hormone therapy is a suitable option for you.

How to know if you need testosterone therapy

Testosterone therapy is primarily recommended for postmenopausal women (those who have not had a period for more than 12 months) who are experiencing low libido accompanied by sexual dissatisfaction that significantly impacts their quality of life. I want to emphasize: your wellbeing is what we care about. If these symptoms are distressing to you, we want to talk about them.

While testosterone therapy for women is considered “off-label” in the U.S., it can be a valuable part of a broader menopause care plan when other options haven’t been effective.

Testosterone use in perimenopause is more murky due to limited information on its long-term safety. You and your provider should have a thoughtful discussion about whether it could be appropriate for you. There are FDA-approved products for low libido in perimenopausal women that can be good alternatives.

Forms of testosterone therapy for menopause

The most common types of testosterone therapy used for menopause include:

  • Transdermal gels like Androgel or Testim. These gels allow for more precise dosing and are applied to the skin, offering a safer and more regulated option compared to alternatives like compounded formulas or pellets.
  • Compounded creams can be a second-line option if FDA-approved gels aren’t suitable. However, these are less regulated, meaning their dosage and quality may vary.
  • Pellets are not recommended. This is because they can lead to serious side effects like cardiovascular issues since they are not well monitored and often lead to improper (over) dosing. This is why it’s essential to work with a knowledgeable provider who can monitor your therapy and adjust as needed.

Because testosterone therapy is not FDA-approved for women, insurance doesn’t cover it, and products must be used off-label, proper dosing can be more challenging. Your provider can help you to understand how to use the correct amount.

Risks and side effects of testosterone therapy for menopause

Like any treatment, testosterone therapy comes with potential side effects. These may include:

  • acne
  • abnormal hair growth on the face or chest
  • male-pattern hair loss
  • deepening of the voice
  • enlargement of the clitoris
  • impacts on LDL cholesterol levels

While these side effects are typically mild when therapy is properly managed, improper dosing can increase risks significantly.

How is testosterone therapy monitored?

Monitoring is a crucial part of testosterone therapy for menopause. Before starting treatment, your provider will measure your baseline testosterone levels and evaluate your symptoms. Though there are no universally established parameters for treatment levels, generally, the goal is to keep free testosterone levels within the normal premenopausal range, typically between 27-58 ng/d; some providers consider levels up to 85 ng/dL acceptable.

However, the primary focus isn’t on hitting a specific number but on improving symptoms—how each person feels and functions. Monitoring testosterone levels is essential to ensure staying within a safe range, avoiding the risk of overdose and potential side effects, some of which can be permanent. Ultimately, the numbers guide safe treatment, but symptom relief is the priority.

Once therapy begins, regular check-ins are scheduled. It usually takes 6-8 weeks to notice improvement, and the maximum effect occurs about 12 weeks after starting the therapy. If there aren’t any noticeable improvements by six months, we’ll stop treatment.

Alternatives to testosterone therapy

If testosterone therapy for menopause isn’t the right fit for you, there are other FDA-approved treatments for improving sexual health. Your provider can guide you through these options to find the best solution for your needs.

Lifestyle changes to improve libido during menopause

Testosterone therapy can be an important tool for managing symptoms of low libido during menopause, but it’s just one piece of the puzzle. Factors like relationship health, stress levels and overall personal health also play a significant role in sexual desire and intimacy. Taking time to nurture your emotional connections and address external stressors can often make a meaningful difference in how you feel.

Adopting healthy habits is another essential step. Regular exercise, a balanced diet, stress management and quality sleep can contribute to better energy and mood. Together, these changes can complement any treatment plan.

Supporting your health with testosterone therapy

No matter the symptoms you experience in menopause, you deserve care that addresses your concerns and supports your quality of life. Testosterone therapy can be a helpful option, and if you find it’s not working the way you hoped, it can easily be stopped at any point.

No matter what you decide, a thoughtful and individualized approach to managing menopause symptoms, guided by conversations with your provider, is essential to ensure safe and effective results tailored to your life. Make your appointment today.

Research and findings are based on the International Society for the Study of Women’s Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire in Women, authored by SJ Parish and published in The Journal of Sexual Medicine in 2021.