I am a 30-year board-certified physician and Menopause Society certified physician. A lot of my patients are asking about testosterone…

When people think of testosterone, they often think of it as a “male hormone.” But women also make small amounts of testosterone, and it plays a role in energy, mood, and sexual health. Some doctors and patients wonder if giving testosterone to women could help with certain health problems. The American College of Obstetricians and Gynecologists (ACOG), a group of doctors who are experts in women’s health, has clear rules about when and how testosterone should be used. Let’s break down what they say in a way that is easy to understand.

When is testosterone used for women?

According to ACOG, testosterone therapy should only be used in women who have gone through menopause and who are struggling with something called hypoactive sexual desire disorder (HSDD). HSDD is when a woman has very little or no interest in sex, and it causes her stress or problems in her life. Before starting treatment, women should be carefully checked by a doctor and evaluated for other conditions. Estrogen vaginal cream can help with vaginal dryness and pain with intercourse. Pelvic floor physical therapy can also help with physical sexual issues. Patients are then advised about the risks, since the long-term effects of testosterone therapy in women are not fully known. Some side effects from testosterone are male-pattern hairloss, dark facial hair, cliteromegaly, and anger issues.

Is there an FDA-approved testosterone for women?

Right now, there is no FDA-approved testosterone medicine made just for women in the United States. This means that if a woman needs testosterone, medicines made for men can be prescribed in a dose 1/10 the male dose or have a pharmacy make a special version, called a compounded medicine. But these choices can be tricky. The dose may be too high, or the medicine may not absorb well, which can cause side effects. That’s why caution and close follow up is needed.

What about other uses for testosterone?

Some people wonder if testosterone might help with things like stronger bones, sharper thinking, or better energy. But ACOG does not recommend testosterone for these purposes. They also do not support using DHEA (a hormone supplement) for sexual symptoms, except in its approved vaginal form.

How is testosterone given?

Doctors usually recommend a low dose of testosterone, just enough to bring levels back to what they would normally be in younger women. This might look like a compounded cream with a pea-sized amount rubbed into the skin on the ankle.

Oral (pill) forms are not recommended because they can cause bad cholesterol changes and don’t absorb well. The exact dose should be personalized, and doctors adjust it based on lab tests and how the patient feels.

What about lab tests?

Lab tests are an important part of therapy, but ACOG says that a blood testosterone level alone cannot diagnose HSDD. Instead, the diagnosis is based on symptoms and a full evaluation.

• Testosterone levels are checked at 3–6 weeks after starting treatment.
• After that, tests are done every 6 months
• The goal is that testosterone levels stay in a safe range (20–80 ng/dL).

When to stop?

If a woman does not see any benefit after 6 months, or if she has any side effects, therapy should be stopped. The goal is always to use the lowest dose for the shortest time that helps.

The bottom line

Testosterone therapy for women is not a “one-size-fits-all” solution. It is only recommended for certain postmenopausal women with HSDD, and it requires careful monitoring by a doctor. Safety always comes first, and ongoing follow-up is key to making sure the treatment helps without causing harm.