Testosterone Therapy Is Trending—for Women. Here’s What to Know

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Cate Hall’s sex drive tanked when she hit 40. After months of trying—and failing—to boost it, she read a pamphlet in a doctor’s office about the effects of low testosterone in women, including low libido, lack of energy, loss of strength and muscle tone, and cognitive difficulties, like trouble concentrating. “I just had sort of an ‘aha’ moment,” says Hall, a 41-year-old in Berkeley, Calif. “It clicked that that might be what was going on, because there was such a good match between the things I was experiencing and the symptoms of low testosterone.”

Hall scheduled an appointment with a specialist, and in 2024 started testosterone replacement therapy (TRT)—receiving regular small doses of the hormone that’s almost synonymous with male health. Within about a week, she started noticing improvements across most aspects of her life. “The cognitive effects were very dramatic,” she says; it quickly resolved her brain fog and memory problems. “I feel sharper now mentally than I did 10 years ago.” She has less anxiety and more confidence, gets at least eight hours of sleep a night (compared to six pre-testosterone), and has welcomed back the energy she needs to exercise regularly. She’s also lost 6% of her body fat since starting TRT—and her libido improved. “I honestly think it has been, by far, the biggest quality-of-life improvement I've ever made for myself,” she says.

Hall’s story isn’t unique: Cisgender women across the internet are touting the anecdotal benefits of testosterone therapy, and some experts say those stories match what they’re hearing in their offices. Many describe being asked about TRT multiple times a day. “There’s been increasing attention to it,” says Dr. Kathleen Jordan, chief medical officer of Midi Health, a virtual care clinic focused on navigating perimenopause and menopause. “We call it the ‘book club effect’—women who have tremendous outcomes share it with their friends, and then we see friends of our patients coming in to inquire about similar solutions.”

But can testosterone therapy for women really lead to such profound health improvements? We asked experts to explain its potential benefits—and limitations.

What exactly is testosterone therapy?

Contrary to popular perception, testosterone isn’t simply a male hormone. While women have smaller amounts than men, testosterone plays an important role in regulating the menstrual cycle, maintaining bone density and muscle mass, and enhancing cognitive health, mood, sexual function, and energy. “After 30, our testosterone levels decrease,” Jordan says. “And by the time we're in midlife, in the premenopause and menopausal phase, they’re down to about 25% of what they were when we were younger.”

Enter testosterone replacement therapy. More than 30 different testosterone products are approved for men by the U.S. Food and Drug Administration (FDA), but the agency has never approved testosterone for women. However, doctors can still prescribe it off-label to women they feel would benefit. Historically, testosterone was used in combination with estrogen and progesterone, hormones that decline with age. But these days, it’s also prescribed as a standalone treatment, says Dr. Traci A. Kurtzer, a gynecologist at the Northwestern Medicine Center for Sexual Medicine and Menopause, opening the door to people who can’t or don’t want to take other hormones for various reasons.

Read More: 8 Signs You’re in Perimenopause

To determine if a woman is a good candidate for TRT, doctors typically start by checking hormone levels to make sure someone “isn’t already coming in on the high side of normal,” Kurtzer says. (Testosterone levels under 20 ng/dL in women 50 and older are typically considered low.) It’s also important to check sex hormone binding globulin, or SHBG, because if it’s high, “any exogenous testosterone we give someone is just going to be bound up,” she says. “It’s not going to be useful to them, so it becomes kind of wasted.” The exact dose that women take varies, but the goal is to achieve the same level of testosterone they would have had in their premenopausal years.

There are a few forms of testosterone, including pellets injected under the skin, pills taken orally, and topical gels and creams. Doctors typically prefer a cream or gel that’s applied to the skin, usually to the back of the thigh, calf, or buttocks. Women need to take 1/10th of the dose men take, which can be difficult to estimate, so many get their prescriptions from compounding pharmacies that specialize in custom dosing. The downsides of using a compounding pharmacy are that their products aren’t FDA-approved, and dosing can be inconsistent. In one study, some products contained more than 20% of the prescribed dose, while others had essentially no testosterone. “It would be really nice,” Kurtzer says, “if we did have an FDA-approved product for women that was dosed appropriately.”

Potential benefits

The best evidence-based use case for TRT for women is increasing sexual function in a safe, effective way. It’s “pretty clear” that low doses of testosterone can improve libido for post-menopausal women experiencing hypoactive sexual desire disorder (HSDD), which means lack of desire without some other underlying cause, Kurtzer says. “It’s not because they hate their partner, or have pain, or because they're exhausted from working two jobs and can’t focus.” According to one research review, TRT improved the frequency of sexually satisfying events, arousal, and orgasm in surgically and naturally postmenopausal women.

Yet the picture gets murkier beyond that. Anecdotally, many women experience a host of benefits. Toi-Yan Littlejohn, 57, a retired firefighter in California, tried testosterone pellets and sublingual testosterone before switching to a provider at Midi Health who prescribed testosterone cream. Littlejohn had always valued an active lifestyle, but found that when she reached perimenopause, things started changing. “I mean, drastically,” she says. “I had no desire to get up, no libido, nothing.” It took some time for her and her doctor to figure out the right testosterone dosage, but once they did, she felt like the best version of herself again. “Within a week, I thought, ‘I feel so much better. I feel more clear.’ I was working out and my intensity was back, my libido was back,” she says. ‘I thought, ‘This is fantastic. Who wouldn’t do this? I need to tell more people.’”

So is TRT really all that? There’s simply not enough data to back up the hype. “We really can't say that it's not potentially helpful,” Kurtzer says. “Could it help with body composition and replacing that muscle? Could it help with physical functioning, energy, and even cognitive health and mood?” Maybe. “The problem is,” she says, “we just don't have sufficient data.”

The studies that do exist have yielded uncertain results beyond improving sexual function; plus, little is known about the long-term effects of testosterone in women. “We have no long-term studies—even using it for HSDD, the studies really are around two years,” she says. “With the idea that this is a long-term solution, what's the tradeoff? Are you now impacting that woman's overall heart disease risk? Are we increasing breast cancer risk? We have no long-term data on that.”

Read More: Menopause Is Finally Going Mainstream

More data exist for men. Large analyses have found no evidence that testosterone increases cardiovascular problems in the short- to medium-term, for example, and a person’s risk of dying early doesn’t appear to change. Another study found that TRT doesn’t increase the risk of prostate cancer, even after more than 15 years of treatment. Yet it’s hard to draw conclusions about women based on these findings, experts say, since dosage isn’t the same (though it’s usually lower) and women’s bodies work differently.

Still, Kurtzer—who has been prescribing testosterone to women for years—hopes research will one day confirm that TRT is as beneficial as some of her patients claim. “I would love for it to be true that it helps with all those things, because we don't have a lot of other solutions, and it’s frustrating for people,” she says. “I used to liken it to a drug—and I meant that facetiously—but people who were on it felt so elated and good. It’s a powerful kind of feeling. That's why I'm like, ‘Wow, if it's true and it's safe, and we can use it long term, I'm all for it.’ But at this point, we just don't know the detrimental piece of it.”

Side effects of testosterone therapy

When April Sandefer first tried TRT 10 years ago, it went well. “I felt great,” she says. But she stopped taking it when the compounding pharmacy she used went out of business. A couple years ago, she decided to start back up again, and within a few months, she noticed her hair was becoming thin and her face was breaking out. She also became aggressive at work, she says—an out-of-character development. “I said some really inappropriate things,” recalls Sandefer, 64, who lives in Oklahoma City. “My boss pulled me aside and was like, ‘April, you can't talk like that to me.’” She ended up stopping treatment. “It’s disappointing that as we get older, we just have to accept [annoying symptoms], because they don't seem to have a lot of things created for women,” she says. She doesn’t plan to try testosterone again: “It’s not worth it to me.”

Indeed, research suggests that in the short term, TRT could lead to hair growth on the face, chest, and back, as well as acne and behavioral and personality changes. That can be especially true for those receiving pellets, which typically contain higher doses than other forms of testosterone. “Once they’re in your body, you can't alter or adjust the dose or how long you're exposed to it,” Kurtzer says. “Those have typically been the people who come to us with complications, because it’s way more than their bodies can accommodate.” It takes about three to four months for testosterone pellets to metabolize out of your system, she adds, which is a long time to deal with unpleasant side effects. That's why experts including Kurtzer typically recommend against using pellets.

Read More: Why You Sweat So Much at Night—And What to Do About It

Still, experts say that one common worry about TRT in women—developing male traits—is overblown. “Concern about masculinization is disproportionate to what really happens,” Jordan says. She hasn’t seen patients develop male pattern baldness, grow a beard, or start speaking in a deeper voice, for example. Regular blood testing is helpful, she adds, and allows clinicians to make dosage adjustments if side effects like mild masculinization do occur.

“The way we approach it is we listen to women, figure out what their symptoms are and what health benefit they're seeking, and what's going to help them feel well and vital—rather than just saying it’s a blanket anti-aging treatment that all women should have,” Jordan says. “When it’s done with that sort of guidance and counseling, it can be very safe and effective.”

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