Women can take testosterone replacement therapy, and many do. Though no testosterone product is currently FDA-approved for use in women, doctors routinely prescribe it off-label, most commonly for postmenopausal women experiencing a persistent, distressing loss of sexual desire. The doses involved are far smaller than what men use, typically one-tenth to one-fifteenth of a standard male dose, and the goals are different too.
Why Women Are Prescribed Testosterone
The most well-supported reason for testosterone therapy in women is a condition called hypoactive sexual desire disorder, or HSDD. This isn’t a passing dip in libido from stress or relationship problems. It’s a persistent, bothersome loss of sexual desire that causes real distress and can’t be explained by another medical issue, medication, or life circumstance. Diagnosing it requires a thorough clinical assessment, not just a blood test.
In postmenopausal women with HSDD, testosterone therapy at physiological doses has strong evidence behind it. A 2019 global consensus statement published in The Journal of Clinical Endocrinology & Metabolism, endorsed by multiple international medical societies, rated the sexual function benefits as the highest level of evidence available. Women in clinical trials experienced increases in desire, arousal, orgasm, and overall sexual satisfaction, along with a reduction in sexual distress. On average, the therapy added about one additional satisfying sexual event per month compared to placebo.
For premenopausal women, the picture is less clear. The same consensus statement concluded there isn’t enough data to recommend testosterone therapy for premenopausal women for sexual function or any other purpose. That doesn’t mean it’s never prescribed in this group, but the evidence base is thin.
Normal Testosterone Levels in Women
Women produce testosterone naturally, just in much smaller amounts than men. A healthy 30-year-old woman typically has a total testosterone level between 15 and 46 ng/dL, compared to the male range of roughly 300 to 800 ng/dL. Free testosterone, the portion available for the body to use, runs between about 1.2 and 6.4 pg/mL. These levels decline gradually with age.
One important detail: there is no specific testosterone level that separates women with sexual dysfunction from those without. Two women can have the same blood level and have completely different experiences. This is why diagnosis is based on symptoms and clinical evaluation rather than a lab number alone.
How Women Take Testosterone
Because there’s no FDA-approved testosterone product designed for women, doctors typically prescribe compounded formulations or have patients use a fraction of a male product. Transdermal delivery (applied to the skin) is considered the most physiological approach, meaning it mimics the body’s own steady release of the hormone.
The most common options include:
- Topical creams or gels: Applied daily, often to the skin behind the knee or on the inner arm. When using a male gel product, women use roughly one-fifth of a single pump actuation, about the size of a black-eyed pea. Compounded creams are custom-made by specialty pharmacies at female-appropriate concentrations.
- Subcutaneous pellets: Tiny pellets inserted under the skin that release testosterone steadily over three to six months, avoiding the daily fluctuations that can come with creams. Pellets are typically replaced every three to four months once optimal dosing is established.
- Transdermal lotions: Compounded lotions applied at bedtime, often combining estradiol and testosterone.
Women who start on pellet therapy tend to stick with it at higher rates than those using topical lotions. In one comparative study, 76% of women continued with pellets versus 59% with transdermal lotion, likely because pellets eliminate the need for daily application and provide more consistent hormone levels.
Side Effects and Risks
The most common side effects are related to androgenic (masculinizing) effects. These include increased facial or body hair, acne, and in some cases perceived voice changes. Mood swings, anxiety, and weight gain have also been reported, particularly with pellet formulations. Some of these effects, especially voice deepening, can be irreversible even after stopping treatment.
The key to minimizing these risks is keeping testosterone levels within the normal female range. When levels climb above that ceiling, even without obvious symptoms, doctors recommend reducing the dose and rechecking labs within two to three weeks. The goal is to restore what the body would naturally produce, not to exceed it.
Long-Term Safety: Heart Disease and Breast Cancer
Two of the biggest concerns women have about testosterone therapy are cardiovascular risk and breast cancer. A large claims database analysis offers some reassurance on both fronts. Women receiving testosterone therapy had a 36% lower risk of major cardiovascular events compared to matched controls, and a 52% lower risk of breast cancer overall. Women aged 56 and older on testosterone had about half the risk of breast cancer compared to similar women not taking it.
The risk of blood clots was also lower in women on testosterone therapy: a 39% reduction in deep vein thrombosis and a 52% reduction in pulmonary embolism. These findings are encouraging, but they come from observational data rather than randomized trials, so they can’t prove cause and effect. Still, they suggest that physiological-dose testosterone therapy does not carry the cardiovascular or cancer risks that many women fear.
Bone and Body Composition
Beyond sexual health, testosterone plays a role in bone density and body composition. In a study of over 2,100 women aged 40 to 60, higher testosterone levels were positively associated with greater bone mineral density in the lumbar spine, with the strongest association in women aged 40 to 50. Research has also linked higher free testosterone in older women to greater lean body mass and total bone mineral density. These associations suggest testosterone contributes to musculoskeletal health in women, though the evidence isn’t strong enough for bone density alone to be a prescribing reason.
What Monitoring Looks Like
Before starting testosterone therapy, your doctor should order baseline bloodwork including total testosterone, free testosterone, estradiol, a binding protein called SHBG, liver function tests, and a fasting lipid panel. Thyroid and prolactin levels may also be checked to rule out other causes of low desire.
After starting treatment, total testosterone is rechecked at three to six weeks. Any time the dose is adjusted, labs are repeated within six weeks. Once levels stabilize, monitoring shifts to every four to six months. Liver function and lipids are rechecked annually. If your total testosterone is in the upper range but you’re still not feeling improvement, your doctor may calculate your free testosterone and check SHBG levels to get a more complete picture of what’s actually available in your bloodstream.
The target is to keep testosterone within the normal premenopausal range, roughly 15 to 46 ng/dL for total testosterone. Going above that threshold increases the risk of androgenic side effects without clear additional benefit. If supraphysiologic levels are found on bloodwork, the dose should be reduced even if you’re not experiencing noticeable side effects.