Usually not. Standard menopause hormone therapy is estrogen, with a progestogen added for women who have a uterus. Testosterone is a separate question. International experts agree it has one evidence-based use in women: low sexual desire that causes distress after menopause. There is no FDA-approved testosterone product for women in the United States.
That surprises many women, especially with testosterone for women getting so much attention online. Here is what the evidence supports, and what it does not.
What “HRT” usually means for women
For most women, HRT means estrogen therapy, sometimes paired with a progestin. Testosterone is not a standard part of it.
The American College of Obstetricians and Gynecologists (ACOG) describes two basic forms: estrogen only, and estrogen plus progestin for women who still have a uterus. The progestin is there to lower the risk of uterine cancer that estrogen alone can cause.
Testosterone, when it is used at all, is added for a specific reason and evaluated on its own merits.
Where testosterone fits: the 2019 Global Consensus
The only evidence-based reason to use testosterone in women is hypoactive sexual desire disorder (HSDD) after menopause. That is the conclusion of an international expert panel.
The Global Consensus Position Statement on the Use of Testosterone Therapy for Women was published in 2019 and endorsed by groups including The Endocrine Society, The North American Menopause Society (now The Menopause Society) and the International Menopause Society. Its key points:
- Testosterone is supported for postmenopausal women diagnosed with HSDD after a full biopsychosocial assessment.
- At doses that keep levels in the normal premenopausal female range, it produced on average about one additional satisfying sexual event per month compared with placebo, plus improvements in desire, arousal and pleasure.
- There are insufficient data to support it for any other symptom or condition, or for disease prevention.
- Available data show no effect on general wellbeing or depressed mood, and insufficient evidence for cognition.
- There is not enough evidence to make recommendations for premenopausal women.
What HSDD means
HSDD is a diagnosis of persistently low sexual desire, and the consensus names relief of the distress it causes as a primary aim of treatment. Sexual concerns have many possible causes, including physical illness, relationship difficulties and psychological distress, and the panel says these must be identified and addressed before testosterone is started. A blood testosterone level alone should not be used to diagnose HSDD.
Is testosterone FDA-approved for women?
No. There is no FDA-approved testosterone formulation for women in the United States.
A 2021 review in the Cleveland Clinic Journal of Medicine states this directly and links it to unknown long-term safety. Cleveland Clinic notes that when testosterone is prescribed for women, it is usually a small dose based on a product approved for men, which is off-label use.
The Global Consensus adds cautions about how testosterone is given:
- Compounded “bioidentical” testosterone is not recommended because of a lack of evidence for safety and effectiveness, unless no approved equivalent is available.
- Pellets and injections that push levels above the normal female range are not recommended.
- Oral testosterone is not recommended because of its negative effects on cholesterol.
- If a trial is given, a baseline level should be checked, then rechecked 3 to 6 weeks after starting.
Low testosterone in women: why symptoms are hard to pin down
Symptoms blamed on low testosterone overlap with many other common conditions. That is why a lab number alone rarely answers the question.
Cleveland Clinic lists commonly cited signs:
- Diminished sex drive
- Irregular menstrual cycles
- Lack of energy
- Mood changes
- Brain fog
- Loss of muscle mass and strength
- Insomnia
It also points out the problem: a lot of things can cause these symptoms. Being tired does not mean your testosterone is low. Perimenopause, thyroid disease, anemia, poor sleep, depression, stress and medications can all look similar.
The lab side is just as uncertain. The Global Consensus found that no blood level cutoff can separate women with and without sexual dysfunction, and the Cleveland Clinic Journal of Medicine review notes that low androgen levels do not reliably correlate with symptoms like chronic fatigue or low mood.
Possible side effects
At doses that stay within the normal female range, side effects in trials were generally mild. The Global Consensus reported mild increases in acne and facial or body hair in some women.
At higher, above-normal levels, the risks change. Cleveland Clinic lists voice deepening, male-pattern hair loss, clitoral enlargement, acne and cholesterol changes among potential effects, and stresses regular testing to keep levels in a safe range. The 2021 review warns that some changes, such as voice changes and clitoral enlargement, may be irreversible.
What this means if you are wondering about your hormones
Start with an evaluation of the whole picture, not a single hormone. If low desire, low energy, poor sleep or mood changes are bothering you, the first step is understanding why.
Our women’s hormone evaluation is built for that conversation: menopause, perimenopause, sleep, mood, energy and libido, reviewed together with your history and labs. It is an evaluation pathway. Your provider will discuss what the evidence supports for your situation, including when hormones are not the answer.
What an appointment at Hormone Balance Centers looks like
Hormone Balance Centers is a telehealth practice for eligible adults in Utah and Idaho, with secure video visits and evening appointments available. Women’s evaluation is a separate pathway from men’s testosterone care.
- Call or text 385-361-8549 to begin.
- Labs. Your provider decides which tests are appropriate.
- Meet online with Adam Russell, PA-C, a board-certified Physician Assistant with experience in endocrinology and internal medicine, to go over symptoms, history, labs, risks and goals.
- A plan. If treatment is appropriate, it comes with an individualized care and monitoring plan. The practice does not assume every symptom needs hormones.
Care is self-pay, with documentation available on request for possible out-of-network reimbursement.
Frequently asked questions
Can women have low testosterone?
Yes, but it is hard to define. Women make testosterone mainly in the ovaries, and levels naturally fluctuate, including across the menstrual cycle. No blood level cutoff separates women with and without sexual dysfunction, and symptoms overlap with many other causes, so an evaluation matters more than one number.
Does testosterone help women with energy, mood or weight?
The evidence does not support it. The 2019 Global Consensus found no effect on general wellbeing or depressed mood and insufficient data for other uses. Its only evidence-based indication is low sexual desire with distress in postmenopausal women.
Should I get my testosterone tested?
Testing can be part of an evaluation, but a testosterone level alone cannot diagnose low libido or explain fatigue. Your provider decides which labs make sense based on your symptoms and history. Only a full evaluation can tell what is driving how you feel.
Are testosterone pellets safe for women?
Experts do not recommend them. The Global Consensus advises against pellets and injections that raise levels above the normal female range, and against compounded testosterone when an approved option exists. Some effects of excess testosterone, such as voice changes, may not reverse.
Have the conversation with a provider
Online claims about testosterone for women move faster than the evidence. If you want a clear, careful look at your symptoms, call or text 385-361-8549, learn about our women’s hormone evaluation, or get started online.
Sources
- Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660-4666. https://pmc.ncbi.nlm.nih.gov/articles/PMC6821450/
- Kling JM, Parish SJ. Trials and tribulations of testosterone therapy in women: Importance of adhering to the evidence. Cleveland Clinic Journal of Medicine. 2021;88(1):44. https://www.ccjm.org/content/88/1/44
- Cleveland Clinic. Testosterone Therapy for Women: What To Know. https://health.clevelandclinic.org/testosterone-in-women
- American College of Obstetricians and Gynecologists. Hormone Therapy for Menopause. https://www.acog.org/womens-health/faqs/hormone-therapy-for-menopause