Should Testosterone Be Part of Your Menopause Care?

June 10, 2026

A woman applying post-menopause hormone gel

Estrogen and progesterone are usually the focus of hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT), for women during menopause, but testosterone is gaining more attention. Could it play an important role in HRT?

“Testosterone is a key hormone for sexual desire and many women feel a sense of distress when that desire decreases or disappears during perimenopause and menopause,” says Rachel Pope, MD, an OB/GYN and Chief of Female Sexual Health at University Hospitals. Testosterone may offer some relief. “Unfortunately, there is more that we don't know about testosterone therapy for women than we do know.”

Testosterone and Libido

Testosterone is one of the hormones that naturally occurs in the female body, typically at much lower levels than in the male body. It supports sexual function by:

Helping tissues in the vulva and vagina mature during puberty.
Playing a role in menstruation and fertility.
Contributing to sexual desire, drive and arousal.

Testosterone also supports a woman’s:

Mood
Cognitive health
Bone and muscle health
Energy levels

Testosterone levels in women decline throughout their lifetime. The decrease can become more noticeable in midlife, especially if women observe significant changes in their sex drive. “This is most likely to happen as the ovaries slow down and stop functioning,” says Dr. Pope. During this time, women can experience reduced sexual desire or a complete lack of interest in sex, a condition known as hypoactive sexual desire disorder (HSDD).

Signs of low testosterone in women may include:

Low libido
Vaginal dryness
Irregular periods
Muscle and bone loss
Low energy and fatigue
Low mood or anxiety
Skin problems
Brain fog

Low testosterone isn’t the only potential cause of these symptoms. They can also be related to other health issues. A loss of interest in sex can be triggered by relationship or mental health challenges. It’s important to work with your doctor to figure out whether low testosterone may be factoring into your symptoms.

Testosterone Therapy For Women

There are no FDA-approved testosterone therapies for women, but they can be prescribed off-label if a healthcare provider thinks it’s appropriate.

“Testosterone is most commonly prescribed to treat hypoactive sexual desire disorder (HSDD), or low libido, when it causes distress for a woman,” says Dr. Pope. “It may also be prescribed for other reasons or when bloodwork shows low testosterone levels, but that is not what we have safety research for at this time,” says Dr. Pope. Most of the available research on testosterone for women focuses on how effective it can be at treating HSDD.

There has been a push from menopause influencers, including some in the medical community, to prescribe testosterone to help manage other symptoms beyond HSDD, but most medical professionals say that more research is needed before testosterone can safely be prescribed to treat other symptoms in women. “We have anecdotal evidence for its benefit with brain fog, mood, bone health and energy,” says Dr. Pope. “This is all less well understood.”

Types of Testosterone Therapy

Testosterone therapy is the best option for treating low testosterone levels, says Dr. Pope. There are no lifestyle changes that women can make to naturally support healthy testosterone levels. “There’s nothing like testosterone supplementation,” she says. “There are plant-based forms of testosterone, but we don't know if we metabolize them the same way or if you will get the desired effect.”

Testosterone therapy is available in multiple forms:

Creams
Gels
Patches
Troches
Injections
Injectable pellets

Low-dose testosterone creams and gels appear to be the safest and most common treatment for women. “We have lots of data on the effectiveness and safety of testosterone, as long as levels are kept within the normal pre-menopausal range,” says Dr. Pope. “That means we should not be using testosterone pellets, which can reach higher-than-normal doses, if we want to provide safe and effective testosterone therapy.” Until there is more convincing research, she says she’ll continue to advise women to stay away from pellets.

Risks of Testosterone Therapy for Women

There are some side effects and risks of testosterone therapy for women. “At higher levels, we see things as benign as facial hair growth and acne, but we can also see enlargement of the clitoris and voice changes.”

Testosterone therapy side effects may include:

Hair growth on the face and body (including at the site where testosterone cream is applied)
Loss of hair on the head
Acne
Weight gain
Enlarged clitoris
Changes in the voice (usually deepening)
Changes in cholesterol and triglyceride levels

Some side effects may not be fully reversible, even after testosterone therapy is stopped.

Who Should Consider Testosterone Therapy – And Who Should Avoid It?

Dr. Pope says that any perimenopausal or post-menopausal woman with HSDD should consider testosterone therapy. “For pre-menopausal women, low testosterone can typically be corrected with a change in medication,” she says. “For example, a woman could have HSDD and low testosterone because of a medication like spironolactone or the birth control pill.” For these patients, she would advise the patient to consider switching to a different medication or birth control, rather than starting testosterone. She also notes that not everyone who takes these medications experiences low sexual desire.

Before starting any kind of hormone therapy, it’s important to work toward decreasing your cardiovascular risks, including improving blood pressure, cholesterol and weight, if you can, says Dr. Pope.

She also recommends getting hormone prescriptions filled by a certified menopause or sexual medicine provider. “Don’t get hormones from a non-medical facility like a spa or from a healthcare professional who is not trained in hormone therapy,” says Dr. Pope. “If you wouldn't get any other medication from the location, then you probably should not get hormones there either.”