Testosterone Therapy in Women After Menopause: What the Science Says

Summary

The Conversation synthesises how testosterone functions in women, why some postmenopausal women seek therapy, and what the science actually shows. It notes that testosterone is biologically active in women, and that evidence for improving sexual desire in postmenopausal women exists, though not as a universal fix. It also points out that testosterone is typically given alongside standard hormone therapy and that long‑term safety data are limited. The piece discusses regulatory gaps and the slow arrival of female‑specific testosterone products, and highlights how real‑world observations at menopause clinics can guide future trials. Author: The Conversation

• Testosterone is biologically active in women, even at lower levels than in men.
• Evidence strongest for hypoactive sexual desire disorder in postmenopausal women.
• Testosterone is usually added to estrogen therapy, not used as a replacement.
• Larger, long‑term safety data are still needed and female‑specific products are emerging slowly.

Overview

The article reviews how testosterone functions in women, particularly after menopause, and why a growing number of women seek testosterone therapy. It emphasizes that, although circulating levels in women are lower than in men, testosterone remains biologically active and influences tissues across the body, including bones, muscles, cardiovascular system, and brain. Levels decline gradually with age, and unlike estrogen, do not plummet sharply at menopause. Measuring normal testosterone in women is challenging, which complicates dosing and assessment of outcomes.

Evidence and clinical use

The strongest evidence for testosterone therapy in women centers on sexual desire and satisfaction, especially in postmenopausal women with hypoactive sexual desire disorder (HSDD). A 2019 meta‑analysis of 36 randomized trials found that appropriately dosed testosterone can improve sexual desire and satisfaction in some postmenopausal women. International guidelines recognise testosterone as an evidence‑based treatment for HSDD, the only condition in women with sufficient evidence to support use. It is important to recognise that sexual desire is multifactorial, shaped by relationships, stress, fatigue and mental health, and testosterone is one input rather than a master switch.

Beyond sexual desire

High‑quality evidence for wider health effects of testosterone in women is limited. Trials are often short and participants may have other health issues or concomitant medicines, which makes it difficult to attribute improvements solely to testosterone. Real‑world observations from menopause clinics have reported improvements in mood, cognitive symptoms and libido after testosterone gel, but these studies cannot prove causation. The article argues that real‑world data should guide future trials while not replacing them.

Access, products, and safety concerns

Products specifically designed for women have lagged behind those for men. In the United States there is no approved testosterone product for women, while Australia has Androfeme, a female‑specific testosterone cream registered in 2020, with the UK granting marketing authorisation in 2025 though not routinely available on the NHS. Clinicians have sometimes used portions of men's gels as a workaround, which risks inaccurate dosing. Long‑term safety data remain limited, particularly for heart disease, stroke and breast cancer, because many trials are short and may exclude higher‑risk individuals. Regulators are beginning to address evidence gaps and the need for female‑specific products to enable rigorous testing and equitable access.

Regulatory landscape and implications

The article notes a rising demand for licensed female‑specific testosterone therapies and mentions regulatory attention, including a 2026 FDA workshop on evidence gaps and future drug development. The broader implication is that better, safer dosing and monitoring will require female‑specific formulations and robust trials that reflect the physiology and risk profiles of women after menopause. Overall, the piece urges cautious uptake, continued research, and improved regulatory pathways to ensure safe and effective use.

Conclusion

While testosterone can improve certain menopausal symptoms and sexual desire for some women, caution is warranted given limited long‑term safety data and the lack of approved female products in key markets. The article calls for more rigorous trials, female‑specific therapies, and thoughtful integration with standard menopause hormone therapy to optimise outcomes for women.