Testosterone for Women: Do You Really Need It?
Conversation Takeaways
Testosterone is an important hormone in women, but not every woman needs testosterone therapy.
The strongest evidence supports testosterone for certain women experiencing distressing low sexual desire.
The research is much less convincing for improving energy, mood, brain fog, and muscle strength.
Some women report feeling dramatically better on testosterone, while others notice little difference.
Understanding what's contributing to your symptoms matters more than finding the next hormone to try.
Apparently, Testosterone Is Having Its Moment
Well, ladies, apparently we've found another hormone that might solve all our problems.
For a while, estrogen was having its moment in the spotlight. Then progesterone joined the conversation, and now testosterone seems to be making a rather dramatic entrance, complete with promises of better energy, stronger muscles, improved concentration, renewed motivation, and, of course, a sex drive that might make us feel like we're 25 again.
And judging by some of the conversations happening online, you would think testosterone had arrived wearing a superhero cape.
Now, before anyone gets upset with me, I'm not against testosterone therapy. There are women who benefit from it, and there is legitimate medical evidence supporting its use in certain circumstances. But after nearly 30 years of caring for women, I've learned that whenever one particular treatment starts getting credit for solving just about everything, it's probably time for us to have a conversation.
Because here's what I'm seeing in my own clinical practice.
Many women are asking about testosterone because their libido has declined, and they want to feel that part of themselves again. But I'm also hearing from women who are exhausted, struggling to concentrate, feeling unmotivated, or wondering why they still don't feel like themselves even though they're already taking estrogen and progesterone.
And then they hear that testosterone might be the missing piece.
It's a reasonable question, especially when your girlfriend tells you she started testosterone and suddenly has energy, motivation, and a sex drive she hasn't experienced in years.
But is testosterone really the answer to all those symptoms?
That's what I want us to talk about today, because there's an important difference between what we're hearing from women who use testosterone and what the medical research has actually demonstrated.
And if you've been trying to connect the dots between your symptoms and what's happening in your body, I also want to invite you to my free five-day experience, Feel Like Yourself Again. It's designed to help you begin understanding the story your body has been telling, rather than constantly guessing about what might be wrong.
First, Testosterone Isn't Just a Male Hormone
Yes, ladies, we have testosterone too.
Women produce testosterone through their ovaries and adrenal glands, along with the conversion of other hormones in tissues throughout the body. Although we produce substantially less testosterone than men, it still plays a role in female physiology, including sexual function and the activity of muscle and bone tissues.
And here's something interesting. Testosterone can also be converted into estrogen in certain tissues, which reminds us that our hormones aren't operating independently of one another.
But just because testosterone plays a role in these biological processes doesn't automatically mean that giving a woman more testosterone will improve every symptom associated with them.
That's an important distinction, especially when we're talking about energy, concentration, mood, and muscle strength.
We also need to understand that testosterone levels don't suddenly fall off a cliff when a woman reaches menopause. Levels generally change across adulthood, and the relationship between testosterone and menopause is different from what happens with estrogen.
So the idea that every woman going through menopause automatically becomes testosterone deficient and needs replacement simply isn't supported by the evidence.
Why Is Everybody Suddenly Talking About Testosterone?
This isn't just another social media trend that caught my attention.
On September 17, 2026, the FDA held a public workshop specifically examining testosterone use in menopausal women. The discussion included its potential effects on sexual function, cognition, mood, muscle and bone health, and the unanswered questions surrounding long-term cardiovascular and breast safety.
And testosterone prescribing is increasing.
A recent analysis found that testosterone prescribing rates among American women increased approximately 2.6-fold between 2016 and 2025, with women ages 45 to 64 accounting for more than 62% of prescriptions in 2025.
So women are definitely interested, and healthcare providers are increasingly prescribing it.
But an increase in prescriptions doesn't necessarily mean the scientific evidence has expanded to support every reason women are taking it.
And that brings us to the most important part of today's conversation.
What Does the Research Actually Say?
Let's start with libido, because this is where we have the strongest evidence and where I hear the most questions from my own patients.
Testosterone therapy has been shown to improve sexual desire and certain aspects of sexual function in some postmenopausal women who have a condition called hypoactive sexual desire disorder, or HSDD.
Now, HSDD doesn't simply mean you're not interested in sex as often as you used to be. It refers to persistent or recurrent low sexual desire that causes personal distress and isn't better explained by another medical condition, medication, relationship concern, or other contributing factor.
And I think that distinction matters.
A woman who isn't particularly interested in sex right now but isn't bothered by it doesn't necessarily have a medical problem that needs treatment.
But for the woman who misses that part of herself, feels distressed by the change, and wants to explore what might help, testosterone may be a reasonable treatment to discuss after a thorough evaluation.
The research shows that testosterone can improve sexual desire, arousal, and satisfaction in appropriately selected women, although the average improvement is modest rather than miraculous.
And I think women deserve to know that. We don't need to oversell a treatment for it to be valuable.
But what about all those other symptoms?
What about the woman who wants testosterone because she's exhausted by two o'clock every afternoon? Or the woman who can't concentrate during meetings and feels like her brain has 27 tabs open, with three of them playing music?
What about the woman who says she just doesn't have the drive or motivation she used to have?
This is where the research becomes much less convincing.
At this point, we don't have strong clinical evidence that testosterone therapy reliably improves general fatigue, mood, cognitive function, or overall well-being in women.
That doesn't mean no woman has ever experienced those improvements. It means that when researchers study testosterone therapy in groups of women, the evidence hasn't consistently demonstrated those benefits.
The same is true for muscle strength and bone health. Although testosterone has physiological roles in those tissues, we don't currently have sufficient evidence to recommend testosterone therapy specifically to improve muscle strength or prevent bone loss in women.
And I want to be careful here because there's a difference between saying something hasn't been proven to work and saying it absolutely cannot work.
Research continues to evolve. But until we have better evidence, we need to be thoughtful about what we're promising women.
But Michele, Women Online Say Testosterone Changed Their Lives
I know, and I find those conversations fascinating.
When I was reading through discussions on Reddit, particularly in communities where women are talking about perimenopause and menopause, I noticed something interesting.
Some women described feeling significantly better after starting testosterone. They talked about improvements in libido, energy, motivation, and their overall sense of well-being.
Others had a completely different experience. They tried testosterone hoping it would help with fatigue, brain fog, or low desire, and they didn't notice much improvement at all.
And then there were women trying to figure out whether they should even ask their healthcare provider about it.
What I found interesting wasn't simply that women were having different experiences. It was how many were hoping testosterone would restore something they felt they'd lost.
Their energy. Their motivation. Their interest in intimacy. That feeling of being themselves.
And I understand that.
When you've spent months or years feeling exhausted, mentally foggy, or disconnected from your body, and you hear another woman say that something finally helped her, of course you're going to be interested.
But here's where we need to be careful.
Your friend's experience is real, but it doesn't automatically predict what will happen in your body.
Perhaps testosterone genuinely contributed to her improvement. Perhaps she was also sleeping better, adjusting her estrogen therapy, exercising differently, or experiencing changes in other areas of her life.
Sometimes we can identify what made the difference, and sometimes we can't.
That's why I don't dismiss women's personal experiences, but I also don't use individual success stories as a substitute for clinical evidence.
We need both the willingness to listen to women and the discipline to examine what the research actually supports.
The Plot Twist: What If Testosterone Isn't What's Missing?
Let's imagine a woman who's 49 years old.
She's successful in her career, manages a busy household, and is the person everyone depends on when something needs to get done.
She's been experiencing perimenopausal symptoms and recently started hormone therapy. Her hot flashes have improved, she's sleeping a little better, and she's no longer feeling quite so irritable.
But she's still exhausted, struggles to concentrate, and has very little interest in sex.
Then she hears about testosterone and wonders whether adding it might finally make everything better.
Now, I would absolutely want to explore her concerns about sexual desire, particularly if the change is distressing to her.
But I would also want to know more about the rest of her health.
Is she actually getting restorative sleep? Is she eating enough to support her energy needs? What does her physical activity look like? Is she dealing with chronic stress, and have other potential contributors to fatigue, such as thyroid dysfunction, iron deficiency, sleep apnea, or medication effects, been considered when appropriate?
Because here's something I've noticed after caring for women for nearly three decades.
Many of us have become exceptionally good at functioning while exhausted.
We manage careers, families, aging parents, relationships, and endless responsibilities, and somewhere along the way, we start treating our own recovery as something we'll get around to when everything else is finished.
Which, as we all know, is approximately never.
Then we reach midlife, our biology begins changing, and suddenly the strategies that allowed us to keep pushing through don't work quite as well anymore.
Sometimes hormone therapy can make a meaningful difference. But it doesn't automatically resolve every factor contributing to how we feel.
And I don't want a woman to miss an important piece of her health because we've become so focused on finding the next hormone.
Is Testosterone Safe for Women?
This is another area where I think we need to be thoughtful rather than fearful.
Research suggests that appropriately dosed testosterone therapy has a generally reassuring short-term safety profile in carefully selected women, but we still have unanswered questions about long-term cardiovascular and breast safety.
Testosterone can also cause side effects, including acne, increased facial or body hair, and scalp hair thinning. Excessive exposure can lead to effects such as voice deepening, some of which may be irreversible.
And something many women don't realize is that there currently isn't an FDA-approved testosterone product specifically indicated for women in the United States.
That doesn't mean testosterone cannot be prescribed appropriately. Off-label prescribing is common in medicine when supported by evidence and clinical judgment.
But it does mean the formulation, dose, and monitoring matter. Professional guidelines generally recommend appropriately dosed transdermal therapy when indicated and caution against pellets, injections, and compounded products that can produce unpredictable or excessive exposure.
So if you're considering testosterone, I want you to understand why you're taking it, what benefit you're hoping to achieve, and how your provider plans to monitor your treatment.
Okay Michele, What Do I Actually Do?
If you've been wondering whether testosterone might help you, I don't want you to leave this conversation thinking you shouldn't ask your healthcare provider about it.
I absolutely think you should.
But rather than walking into your appointment asking for testosterone because you've heard it's the missing piece, start by describing what's actually happening in your life.
If your sexual desire has changed and it's bothering you, say that. Ask whether testosterone therapy might be appropriate and what other factors should be considered.
If your biggest concerns are fatigue, mood, or brain fog, ask what might be contributing to those symptoms and what treatments have evidence supporting their use.
And here's a question I especially want you to think about.
What would feeling better actually look like in your everyday life?
Would it mean having enough energy to enjoy dinner with your family instead of collapsing on the couch? Would it mean feeling mentally present at work? Or perhaps it would mean wanting to be intimate with your partner again?
Those are meaningful outcomes, and they're much more useful than simply chasing a hormone number.
Because ultimately, we're not treating a laboratory result. We're caring for a woman who has a life she wants to enjoy.
The Conversation I Really Want Women to Have
I'm genuinely encouraged that women are talking more openly about testosterone, menopause, sexual health, and the changes that happen during midlife.
For far too long, many women were left to navigate these changes with very little information or support.
But I also don't want us replacing one oversimplified message with another.
For years, women were told that their symptoms were simply part of getting older and that they needed to learn to live with them.
Now, in some corners of the internet, every symptom seems to have a hormone attached to it, and every hormone seems to have a treatment promising to make us feel like ourselves again.
First, estrogen was presented as the answer. Now testosterone is being promoted as the missing piece.
And I wonder what we'll be talking about next year.
Perhaps we'll discover that our mitochondria need their own personal life coach.
I'm kidding, of course, but I hope you understand what I'm getting at.
I don't want women spending the next decade chasing one treatment after another, hoping the next one will finally make everything better.
I want us to become more knowledgeable about our biology, understand what our symptoms might be telling us, and recognize when medical treatment is appropriate.
And that's why I created my free five-day experience, Feel Like Yourself Again: Learn to Read the Story Your Body Has Been Telling.
Over five days, I'll help you begin connecting the dots between your symptoms, your biology, and the everyday patterns that influence how you feel, so you can become a more confident participant in your healthcare.
Because the question isn't simply whether your testosterone is low.
The better question is what's contributing to how you feel, and what does the evidence tell us might actually help?
And that, my friend, is how we move from chasing the next answer to truly understanding our health.
Until next time, remember:
Know your body. Lead your life.
Michele
Research and Resources
FDA Public Workshop: Testosterone Use in Menopausal Women, September 17, 2026
Global Consensus Position Statement on Testosterone Therapy for Women
ISSWSH Clinical Practice Guideline for Testosterone Therapy in Women
This conversation is intended for education and does not replace individualized medical evaluation or treatment.
