Testosterone in Women: A Critical, Overlooked Hormone

Testosterone is commonly mislabeled as a "male hormone," but this is a misconception. In fact, testosterone is the most abundant biologically active hormone in premenopausal women, often circulating at levels higher than estrogen. Its roles in women's health are wide-ranging, including vital effects on sexual function, mood, bone strength, muscle mass, and general well-being.

No FDA-Approved Testosterone Products for Women—Why?

Despite growing evidence of benefit, there are currently no FDA-approved testosterone therapies for women in the United States. By contrast, there are dozens of testosterone options for men. In clinical practice, physicians sometimes prescribe testosterone for women "off-label"—meaning they adapt products approved for men or use compounded formulations to achieve dosing appropriate for female physiology. This practice is guided by expert consensus and supported by several international medical organizations.

Evidence-Based Advantages of Treatment

Multiple clinical studies and meta-analyses have demonstrated that testosterone therapy can improve sexual function (particularly in postmenopausal women with hypoactive sexual desire disorder, or HSDD), increase bone density, support muscle mass, elevate energy and cognitive function, and improve mood and motivation. The most accepted and evidence-based use for testosterone therapy in women is the treatment of HSDD.

Common Off-Label Uses of Testosterone in Women

Testosterone is most commonly prescribed off-label for the following issues:

• Hypoactive sexual desire disorder (HSDD): Reduced sexual desire causing distress. The strongest evidence supports testosterone for this indication.

• Menopausal symptoms: Fatigue, low motivation, and concentration, as well as diminished well-being, sometimes improve with testosterone.

• Bone health: Some evidence supports benefits in maintaining or improving bone density, especially in women at risk for osteoporosis.

• Muscle mass and strength: May aid in preserving or restoring muscle mass, particularly after menopause.

• Psychological symptoms: Low mood, poor motivation, and even premenstrual dysphoric disorder (PMDD) have been treated with testosterone in select cases, though more research is needed.

  
  

The Value of Testing and Comprehensive Evaluation

Because symptoms of testosterone impairment overlap with other hormonal or medical issues, testing and personalized evaluation are essential. The diagnosis of "testosterone deficiency" in women is largely clinical; hormone levels do not always correlate with symptoms. Laboratory testing is still useful for baseline measurement, dose monitoring, and ensuring levels stay within premenopausal female ranges during therapy.

Testosterone Is Not Just a Male Hormone

Testosterone plays essential roles in the female body. It is a precursor to estrogen and is critical to the function of many tissues throughout a woman's life—not just for sex drive, but for bone, brain, muscle, and overall health. Premenopausal women have higher physiologically active testosterone than estrogen, which further dispels the myth that testosterone is predominantly a male hormone.

An Important Option in Comprehensive Hormone Therapy

Given testosterone's broad physiological activity, it should be considered as part of a comprehensive hormone therapy strategy for women, particularly those experiencing persistent symptoms not relieved by estrogen and/or progesterone therapy. While research is ongoing, evidence supports its thoughtful, individualized use.

Caveats and Patient Education

Women considering testosterone therapy should be fully informed about the off-label nature of treatment in the U.S., the evidence for and against its use, and the importance of appropriate monitoring to minimize potential side effects. It's important to find a doctor that has your whole health in mind and is not just selling a product or offering a quick fix.

At Mission Metabolic Health, we prioritize thorough assessment, individualized care, and patient education—helping patients make informed decisions about all aspects of their hormonal health, including the potential value of testosterone therapy when appropriate.

References

1. Davis, S.R., Baber, R., Panay, N., et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. The Journal of Clinical Endocrinology & Metabolism. 2019;104(10):4660–4666. doi:10.1210/jc.2019-01603.

2. Maclaran, K., & Panay, N. The clinical management of testosterone replacement therapy in women. World Journal of Men's Health. 2022;40(4): 669–687. PMID: 36239927.

3. Glaser, R. A Personal Perspective on Testosterone Therapy in Women—What We Know in 2022. Journal of Clinical Medicine. 2022;11(15):4386. doi:10.3390/jcm11154386.

4. Kingsberg, S.A., & Simon, J.A. Androgen Therapy in Women with Testosterone Insufficiency. Androgens: Clinical Research and Therapeutics. 2022;3(1):36–50. doi:10.1089/andro.2021.0030.

5. Khera, M. Trials and tribulations of testosterone therapy in women. Cleveland Clinic Journal of Medicine. 2021;88(1):44–47. doi:10.3949/ccjm.88a.20143.

6. British Menopause Society. Testosterone replacement in menopause. BMS Tool for Clinicians. December 2022.