Testosterone is often labelled a “male hormone,” yet women produce meaningful amounts of it too. Levels naturally decline through perimenopause and menopause, and for some women this drop affects libido, energy, mood, cognitive clarity, muscle strength, and overall vitality.

Despite its importance, testosterone therapy for women remains under-discussed, misunderstood, and—in some places—difficult to access. This guide brings together trusted evidence so you can feel informed, confident, and empowered in conversations about your health.

What Does Testosterone Do in Women?

Although often overlooked, testosterone supports many aspects of women’s health. Because testosterone receptors exist throughout the body, its effects extend far beyond libido. Healthy testosterone levels help support sexual desire and arousal, but they also influence cognitive clarity, mood stability, energy levels, and musculoskeletal health.

Testosterone contributes to:

• Sexual desire, arousal, and orgasm

• Mental clarity, focus, and cognitive performance

• Emotional steadiness, motivation, and resilience

• Muscle mass, strength, and physical stamina

• Bone density and skeletal health

• Vaginal, vulval, and urinary tissue integrity

Because levels begin declining from early adulthood and fall further during menopause, many women notice gradual or sudden changes in how they feel. After surgical menopause, the drop is more abrupt.

Symptoms of Low Testosterone

Low testosterone can present differently for each woman, but commonly includes:

• Reduced sexual desire or pleasure

• Difficulty with arousal or orgasm

• Fatigue, low stamina, or “running on empty”

• Emotional changes: anxiety, irritability, or low mood

• Brain fog, reduced focus, or forgetfulness

• Loss of muscle tone or slower recovery

• Declining bone density

• Vaginal dryness or discomfort

• Urinary frequency or pelvic floor changes

A low blood test result alone does not confirm deficiency. It’s the combination of symptoms + hormone levels that guides treatment decisions.

When Is Testosterone Therapy Recommended?

International guidelines support testosterone therapy for postmenopausal women with Hypoactive Sexual Desire Disorder (HSDD)—persistent low sexual desire causing personal distress—when other factors have been considered and estrogen therapy alone has not helped.[1][4]

Beyond this, growing research and clinical experience show additional potential benefits for mood, cognition, energy, and musculoskeletal health.[8][10][11][12]

How Testosterone Therapy Is Used

Women typically use:

• Transdermal creams or gels (Androfeme™, Testogel™, Tostran™)

• Occasionally, implants releasing hormone gradually for months (not available in New Zealand as HRT)

Transdermal therapy is preferred because oral testosterone negatively affects cholesterol.[2][6][8]

Application is simple: a small amount of cream is rubbed into clean, dry skin on the lower abdomen, thighs, or buttocks. It usually takes 4–12 weeks to notice improvements, with full effects developing over 3–6 months.

What Benefits Does Testosterone Therapy Offer?

1. Sexual Function (Strongest Evidence)

Across multiple RCTs and meta-analyses involving more than 8,000 women, testosterone provides significant, consistent improvements in sexual desire, arousal, orgasm, satisfaction, and reduced sexual distress.[1][2][3][4][5][6][7]

These benefits form the foundation of current clinical guidelines.

2. Mood and Cognitive Function

Emerging evidence suggests testosterone may support mood, motivation, and cognitive clarity, including improvements in memory and executive function.[10][11][12]

Many women describe a renewed sense of mental sharpness and emotional steadiness once levels are restored.

3. Musculoskeletal Pain and Physical Function

Some studies report reductions in muscle and joint pain and improvements in stamina, particularly when testosterone is used alongside estrogen therapy.[8]

4. Vaginal, Vulval, and Urinary Health

Testosterone may improve:

• Vaginal lubrication

• Comfort during sex

• Clitoral sensitivity

• Orgasm intensity

• Urinary symptoms

It may be especially helpful for women on aromatase inhibitors.

5. Bone and Muscle Health

Testosterone supports:

• Osteoblast activity (bone-building cells)

• Muscle mass and strength

• Prevention of sarcopenia (age-related muscle loss)

Studies show higher natural testosterone levels are associated with higher bone density, and testosterone combined with estrogen improves bone density more than estrogen alone.[6][8]

6. Heart and Metabolic Health

Early evidence suggests testosterone may improve:

• Blood vessel dilation (vasodilation)

• Blood pressure

• Insulin sensitivity

• Aerobic capacity

Although promising, long-term cardiovascular data remain limited.

Risks, Side Effects, and Safety

Most women tolerate testosterone well at doses appropriate for female physiology. Side effects are usually mild and improve with dose adjustments.

Common effects include:

• Acne or oilier skin

• Slight facial hair growth

• Increased hair at the application site

• Mild bloating, headaches, or constipation

• Slight weight gain (~0.5 kg)

Hirsutism explained:
Hair growth in patterns more typical for men (chin, upper lip). Rare at female doses and often reversible.

Which Side Effects Could Be Irreversible?

While most side effects are mild and temporary, a few changes may become long-lasting if testosterone levels remain too high for too long. These outcomes are uncommon when women are monitored and doses remain within the normal female range.

Potential irreversible effects include:

• Voice deepening: caused by thickening of the vocal cords; may not fully reverse.

• Clitoral enlargement: mild fullness often improves, but significant enlargement may persist.

• Scalp hair thinning: women genetically predisposed may experience crown or temple thinning; may only partially improve.

Regular monitoring keeps these risks very low.

Cholesterol and Heart Health

Testosterone’s metabolic effects depend heavily on the route of administration:

• Oral testosterone: raises LDL (“bad” cholesterol) and lowers HDL (“good” cholesterol) → not recommended.[2][6][8]

• Transdermal testosterone: maintains a neutral lipid profile.

LDL: contributes to plaque in arteries.
HDL: helps clear LDL.

Long-Term Safety

Short-term studies (up to 24 months) show no increased risk of:

• Breast cancer

• Endometrial thickening

• Heart attack or stroke

• Blood clots

• Liver or kidney problems

Large observational data also show no increased cardiovascular risk and a lower breast cancer rate in women over 56 using testosterone.

More long-term RCTs are still needed, but current evidence is reassuring.[2][6][8]

Access and Equity in New Zealand

A significant and well-recognised inequity exists:

Testosterone therapy is publicly funded for men in New Zealand, but not for women.

This is despite robust evidence supporting its use for women with HSDD. As a result:

• Men can access subsidised testosterone

• Women must pay privately

• Androfeme (approved for women in Australia) is unfunded

This gap reflects a broader challenge in women’s health, where symptoms that profoundly affect quality of life are often deprioritised. Many clinicians and advocates believe this urgently needs updating.

Testing and Monitoring

Monitoring includes total testosterone, SHBG, and free androgen index (FAI).

When to test?

Unlike men, women do not have strong daily fluctuations in testosterone.
Best practice: Test just before your next dose (a trough level) at whatever time of day you usually apply it.

Monitoring schedule:

• Baseline

• 6–12 weeks after starting

• Every 3 months while adjusting dose

• Annually once stable

Is Testosterone Right for You?

Testosterone may be worth considering if:

• You have low libido causing distress

• Optimised estrogen therapy hasn’t fully helped

• You have symptoms of low testosterone and/or a low FAI

• Other causes—stress, sleep disruption, pain, vaginal dryness, relationship factors—have been addressed

Libido is influenced by biology, psychology, social factors, and relational connection. Testosterone works best as part of a holistic, whole-person approach.

Women Deserve Better

Women’s midlife symptoms have been minimised for too long. Testosterone therapy is not a cure-all, but for the right woman—at the right dose, with careful monitoring—it can be transformative.

Most importantly:

You deserve evidence-based care.
You deserve equitable access.
And you deserve to feel like yourself again.

References

1. Kling JM. Testosterone for the Treatment of Hypoactive Sexual Desire Disorder in Perimenopausal and Postmenopausal Women. Obstetrics and Gynecology. 2025.

2. Pinkerton JV, Blackman I, Conner EA, Kaunitz AM. Risks of Testosterone for Postmenopausal Women. Endocrinology and Metabolism Clinics of North America. 2021.

3. Jayasena CN et al. A Systematic Review of RCTs Investigating Testosterone Therapy for Female Sexual Dysfunction. Clinical Endocrinology. 2019.

4. Davis SR. Use of Testosterone in Postmenopausal Women. Endocrinology and Metabolism Clinics. 2021.

5. Johansen N et al. The Role of Testosterone in Menopausal Hormone Treatment. Acta Obstetricia et Gynecologica Scandinavica. 2020.

6. Somboonporn W et al. Testosterone for Peri- and Postmenopausal Women. Cochrane Database of Systematic Reviews. 2005.

7. Somboonporn W. Androgen and Menopause. Current Opinion in Obstetrics & Gynecology. 2006.

8. Somboonporn W. Testosterone Therapy for Postmenopausal Women: Efficacy and Safety. Seminars in Reproductive Medicine. 2006.

9. Marko KI, Simon JA. Androgen Therapy for Women After Menopause. Best Practice & Research Clinical Endocrinology & Metabolism. 2021.

10. Glynne S et al. Effect of Transdermal Testosterone on Mood and Cognitive Symptoms. Archives of Women’s Mental Health. 2024.

11. Glynne S et al. Transdermal Oestradiol and Testosterone for Menopausal Depression. British Journal of Psychiatry. 2025.

12. Yousaf M et al. Testosterone Therapy in Menopause-Associated Mood and Cognitive Symptoms. Archives of Women's Mental Health. 2025.