Last checked September 2026 against 17 sources · Editorial policy
Testosterone for women in perimenopause and menopause
Testosterone can help women with low sexual desire after menopause, and that's the only use with good evidence. In a meta-analysis of 36 trials with 8,480 women, it improved desire, arousal, orgasm and pleasure, with more acne and hair growth but no serious side effects. It hasn't been shown to help energy, mood, memory or muscle. There's no FDA-approved testosterone product for women, so it's prescribed off-label at low doses.
Testosterone has evidence for low sexual desire after menopause, not for energy or mood. Who it's for, doses, side effects, and how to get it.
Testosterone for women: expectation vs reality
What people often expect
“Testosterone is the missing hormone that restores energy, focus and muscle in menopause”
What the evidence shows
The trials don't support that. The largest meta-analysis found benefits for sexual function only; testosterone had no reported effect on body composition, muscle and bone measures or cognition, although data were limited. NICE recommends considering it for low sexual desire if HRT alone hasn't helped. Long-term data on heart, cancer and brain safety are still lacking.
Testosterone in perimenopause and menopause explained
Testosterone levels in menopause
Women make androgens, including testosterone, in the ovaries, and the adrenal glands release androstenedione, which the body converts into other hormones. Unlike estrogen, testosterone doesn't fall suddenly at natural menopause: the NHS notes the ovaries keep producing it for up to 20 years afterwards. Removing both ovaries removes that source, so women after surgical menopause lose testosterone as well as estrogen, which can affect sexual desire and pleasure.
Learn more →What testosterone does for women in menopause
In a meta-analysis of 36 randomized trials with 8,480 postmenopausal women, testosterone improved satisfying sexual events, desire, pleasure, arousal, orgasm, responsiveness and self-image, and reduced sexual concerns and distress. In practical terms, a review describes about one extra satisfying sexual episode a month, plus better desire and less distress, after natural or surgical menopause.
Learn more →Hypoactive sexual desire disorder
Testosterone is used for low desire that causes distress, called hypoactive sexual desire disorder. Low desire is common at midlife: in an Australian study, 68.8% of women reported low desire and 39.7% met criteria for the disorder. Other causes, such as relationship issues, pain during sex, depression, medicines and tiredness, should be addressed first, and HRT itself may help.
Learn more →Testosterone therapy for perimenopause
Most trials studied postmenopausal women, so evidence in perimenopause is limited. NICE suggests considering testosterone for low sexual desire associated with menopause if HRT alone isn't effective, which means estrogen is usually tried first. In the NHS, testosterone is typically prescribed by a menopause specialist. It isn't used for hot flashes, which estrogen treats far better.
Learn more →How testosterone is given to women
Transdermal testosterone, a cream or gel, dosed to keep levels within the normal premenopausal range, is the recommended approach. There's no FDA-approved testosterone product for women in the US, so doctors prescribe compounded creams or reduced doses of products made for men, which is off-label. Injections and pellets produce supraphysiological levels and aren't recommended.
Learn more →Testosterone side effects in women
In the meta-analysis, testosterone was associated with more acne and hair growth, but no serious adverse events. Testosterone taken by mouth raised LDL cholesterol and lowered HDL, while creams and patches didn't affect lipids. An overall increase in weight was recorded. At normal female doses, androgenic side effects are few, but levels that are too high increase them.
Learn more →Does testosterone turn into estrogen?
Partly. The enzyme aromatase, found in fat, skin, bone and the brain, converts androgens into estrogens. After menopause, this conversion in fat and skin becomes the main source of estrogen, and it increases with body weight and age. That's one reason testosterone doses are kept low and why estrogen and progestogen protection still matter for women with a uterus.
Learn more →Testosterone vs estrogen: what's the difference?
Estrogen and testosterone are both steroid hormones that women and men make, in different amounts. In women, estrogen drives the menstrual cycle, protects bone and keeps vaginal tissue healthy, and its fall causes most menopause symptoms. Testosterone plays a part in sexual desire and pleasure. That's why estrogen is the main menopause treatment and testosterone an add-on for desire.
Learn more →Testosterone, cholesterol, weight and the heart
How testosterone is taken matters. In the meta-analysis, testosterone by mouth raised LDL cholesterol and lowered total cholesterol, HDL and triglycerides, while patches and creams had no effect on lipids. An overall increase in weight was recorded with testosterone. Long-term data on cardiovascular, cancer and cognitive safety are lacking, which is why guidance favors low transdermal doses and regular review.
Testosterone for energy, mood and brain fog
Testosterone is often marketed for tiredness, low mood, brain fog and muscle tone, but trials haven't shown these benefits. The meta-analysis found no effects on body composition, muscle and bone measures or cognition, although few women contributed data on these. If these symptoms are your main problem, estrogen HRT, better sleep and treatment for depression have stronger evidence.
Learn more →Testosterone for women by the numbers
From the studies on this page
of midlife Australian women in one study reported low sexual desire
68.8%
after natural menopause, the ovaries can keep producing testosterone
20 years
Bar scaled to a 12-year reference span
36
0
Most trials lasted months rather than years, so long-term safety for the heart, breast and brain is uncertain.
Testosterone therapy options for women compared
Transdermal testosterone for low desire
Strong evidenceA cream or gel dosed to keep levels within the normal premenopausal female range improved desire, arousal and satisfying sexual events in trials, with few androgenic side effects at those doses. NICE suggests trying it if HRT alone hasn't helped desire. Because it's off-label in the US, ask how your dose will be measured and reviewed.
Estrogen HRT first
Strong evidenceEstrogen treats hot flashes, sleep problems and vaginal dryness, which often dampen desire. Low-dose vaginal estrogen makes sex comfortable again for many women. Try this before adding testosterone. Estrogen also protects bone, which testosterone hasn't been shown to do.
Related guide →Treat pain during sex
Strong evidenceIf sex hurts, desire falls. Vaginal estrogen improves genitourinary symptoms by about 60% to 80%, and lubricants and moisturizers help too. Relationship and mood factors matter too, and talking therapies can help.
Related guide →Testosterone pellets or injections
No good evidenceNot recommended: they push testosterone above the normal female range, which raises the risk of acne, unwanted hair and other androgenic effects, and can't be quickly adjusted.
Related guide →
When to talk to a doctor about testosterone
Low sexual desire that causes you distress
Talk to your doctor. Causes such as pain, mood, medicines and relationship issues can be addressed, and HRT or testosterone considered.
More →Acne or new facial hair on testosterone
Tell your doctor; your dose may be too high.
Low desire after surgery to remove both ovaries
Ask about hormone replacement, including testosterone if estrogen alone doesn't help.
More →
Testosterone in menopause: questions women ask
What does testosterone do for women in menopause?
It can improve sexual desire, arousal, orgasm and pleasure in postmenopausal women with low desire, according to a meta-analysis of 36 trials. It hasn't been shown to improve energy, mood, cognition or muscle.
Should I take testosterone in perimenopause?
Usually only if low sexual desire is distressing and HRT hasn't helped. Most evidence is from postmenopausal women. Testosterone doesn't treat hot flashes or irregular periods.
Is testosterone part of hormone replacement therapy for women?
It can be added, but standard HRT is estrogen with a progestogen. Testosterone is an add-on for low desire, prescribed off-label in the US because no product is approved for women.
What is a normal testosterone level for women after menopause?
Treatment aims to keep testosterone within the normal range for premenopausal women, avoiding the higher levels seen with pellets and injections. Your lab report gives the reference range, which varies between laboratories.
Does testosterone turn into estrogen?
Some of it can. The enzyme aromatase in fat, skin, bone and brain converts androgens into estrogens, and after menopause this becomes the main source of estrogen, increasing with body weight and age.
What are the side effects of testosterone for women?
Acne and increased hair growth are the most common. Taken by mouth it can worsen cholesterol, which is why creams or gels are preferred. No serious adverse events were found in trials at normal female doses.
What is the difference between estrogen and testosterone?
Estrogen is the main female sex hormone, controlling the menstrual cycle and keeping bone and vaginal tissue healthy; its fall causes most menopause symptoms. Testosterone is an androgen that contributes to sexual desire and pleasure. Both are steroid hormones, and some androgens are converted into estrogens by the enzyme aromatase.
Can I use a testosterone and progesterone cream?
Combined compounded creams aren't FDA-approved, and compounded hormones lack data on dose accuracy, safety and effectiveness. If you need both, ask for separately dosed, proven products: transdermal testosterone for desire and an approved progestogen, such as micronized progesterone, to protect the uterus.
Can testosterone help with energy or brain fog in menopause?
Trials haven't shown it. The largest meta-analysis found no effect of testosterone on cognitive measures, body composition or muscle, although data were limited. Estrogen HRT, better sleep and treating low mood have stronger evidence for these symptoms.
Related →Sources
- Islam RM, Bell RJ, Green S, et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754-766.
- Pinkerton JV, Blackman I, Conner EA, et al. Risks of Testosterone for Postmenopausal Women. Endocrinol Metab Clin North Am. 2021;50(1):139-150.
- NICE. Menopause: identification and management (NG23). Updated 2024.
- NHS. Hysterectomy: considerations.
- Prescribing information: Estradiol tablets USP. Teva Pharmaceuticals, 2024. DailyMed, US National Library of Medicine.
- Nelson LR, Bulun SE. Estrogen production and action. J Am Acad Dermatol. 2001;45(3 Suppl):S116-24.
- Fooladi E, Islam RM, Bell RJ, et al. The prevalence of hypoactive sexual desire disorder in Australian and Iranian women at midlife. Menopause. 2020;27(11):1274-1280.
- NHS. Treatment for menopause and perimenopause.
- MedlinePlus, US National Library of Medicine. Estrogen levels test.
- Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420.
- NHS. Benefits and risks of hormone replacement therapy (HRT).
- The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
- The North American Menopause Society. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976-992.
- NHS. Low sex drive (loss of libido).
- Jiang X, Bossert A, Parthasarathy KN, et al. Safety assessment of compounded non-FDA-approved hormonal therapy versus FDA-approved hormonal therapy in treating postmenopausal women. Menopause. 2021;28(8):867-874.
- Pinkerton JV. Concerns About Compounded Bioidentical Menopausal Hormone Therapy. Cancer J. 2022;28(3):241-245.
- British Menopause Society. Tool for clinicians: HRT preparations and equivalent alternatives. 2024.
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