Testosterone in Women: Symptoms, Benefits, and the Role of Testosterone Therapy for Women

Key Takeaways

• Testosterone in women is essential for sexual health, mood, cognition, muscle strength, bone health, and overall well-being.
• Declining levels may contribute to low testosterone in women symptoms, including fatigue, low libido, brain fog, mood changes, and insomnia.
• A female hormone imbalance involving testosterone may affect multiple body systems, not just sexual function.
• Current guidelines primarily support testosterone therapy for women for HSDD, but research suggests broader benefits.
• Studies have identified numerous benefits of testosterone for women, including improved sexual function, mood, muscle strength, and quality of life.
• Research continues to evaluate whether testosterone replacement therapy for women is safe and beneficial long-term.

In early 2025, the FDA removed the black box warning for testosterone use in men which was previously thought to be associated with an increased risk for cardiovascular events.[1] This language was removed and supported by a large study that confirmed its benefits.[1,2] It was a rigorous randomized controlled trial that determined there was no increased cardiovascular events or prostate cancer risk in hypogonadal men who were supplemented with topical testosterone. 

While this decision represented progress in hormone medicine, women continue to face significant barriers to treatment. There is currently no FDA-approved testosterone replacement therapy for women, despite evidence showing that testosterone levels decline throughout life and may contribute to symptoms associated with a female hormone imbalance involving testosterone.[3]

• Low Testosterone in Women Symptoms
• Testosterone Is the #1 Circulating Hormone in Women
• Benefits of Testosterone for Women
• Is Testosterone Safe for Women?
• Testosterone Therapy for Women in Clinical Practice
• Frequently Asked Questions
• Conclusion: The Future of Testosterone Replacement Therapy for Women

Low Testosterone in Women Symptoms

As women age, many report symptoms of fatigue, a decrease in mental clarity and memory, mood changes including increased feelings of anxiety and depression, difficulty regulating body temperature fluctuations and hot flushes, joint pain, insomnia, urinary incontinence, vaginal dryness and painful intercourse, and decreased libido that have been linked to androgen deficiency.[4,5]

These low testosterone in women symptoms are often dismissed as normal aging despite their significant impact on quality of life. 

For years, clinical practice guidelines have offered limited support for testosterone replacement in women. 5 Current recommendations primarily focus on women diagnosed with Hypoactive Sexual Desire Disorder (HSDD), recommending off-label therapy while maintaining physiologic testosterone levels of 42-72 ng/dl (less for postmenopausal women).[3,5,6]

According to Uloko et al., nearly half of American women suffer from this sexual disorder, and HSDD testosterone treatment has been shown to be effective in symptom improvement.[6]

However, growing evidence suggests that low testosterone in women symptoms extend beyond sexual health and may affect multiple body systems.[7]

Testosterone Is the #1 Circulating Hormone in Women

Understanding Female Hormone Imbalance and Testosterone

In their publication disbanding myths associated with testosterone replacement, Glaser & Dimitrakakis reported that testosterone is the highest circulating hormone in women, even ten times higher than estradiol throughout their lifetime.[8]

This is because testosterone is highly selective to androgen receptors (AR) that are located in almost all female tissues including the:

• Brain
• spinal cord
• Bone and bone marrow
• Breast
• Blood vessels
• Peripheral nerves
• Heart
• Lung
• Gastrointestinal tract
• Endocrine glands
• Ovaries
• Uterus
• Vaginal tissue
• Skin
• Synovium
• Adipose tissue
• Skeletal muscle.[5]

As women age and hormone levels decline, these tissues lose the protective benefits of testosterone, contributing to symptoms associated with female hormone imbalance testosterone deficiency and potentially increasing the risk of chronic disease.[5,7]

Benefits of Testosterone for Women

Providers are taught to rely on guideline experts when treating patients that suffer with hormone deficiencies. However, the authoritative bodies do not support replacement in women who are exhibiting symptoms of deficiency.9 The ambivalence to support hormone replacement in women is steeped in allegations that there is insufficient data or no long-term studies to support its use.[9]

The literature tells a different story. 

Testosterone has been given to women for years with studies dating back to 1937 and there are commercially approved testosterone products formulated for women in other countries.[8,10]

Sexual Health Benefits

Even low-dose topical therapy has been shown to improve:

• Sexual desire
• Sexual function
• Overall well-being

These findings help explain why HSDD testosterone treatment remains the most widely accepted indication for therapy.[11]

Additional Benefits of Testosterone for Women

Research has identified numerous additional benefits of testosterone for women, including:

• Reduced beta-amyloid plaque deposition associated with Alzheimer's disease
• Reduced osteoporosis risk
• Reduced breast cancer incidence
• Improved lipid profiles
• Improved glucose metabolism and insulin sensitivity
• Reduced obesity risk
• Increased muscle strength and functional capacity
• Improved mood
• Reduced irritability
• Reduced anxiety
• Improved overall well-being

These broader benefits of testosterone for women suggest that its role extends well beyond sexual health.[8,10]

Is Testosterone Safe for Women?

One of the most common questions patients and providers ask is: is testosterone safe for women?

The concern surrounding testosterone therapy often stems from rumors about adverse effects rather than evidence from clinical studies.

In a meta-analysis of 36 randomized controlled trials, the primary side effects reported were:

• Acne
• Increased hair growth

Importantly, participants generally remained in treatment, suggesting benefits outweighed these mild adverse effects.[11]

Is Testosterone Safe for Women Long-Term?

Other than mild skin changes and hair growth, researchers have not found conclusive evidence linking transdermal testosterone replacement to:

• Deep vein thrombosis (DVT)
• Pulmonary embolism (PE)
• Cardiovascular disease
• Diabetes mellitus
• Liver damage
• Cancer
• Voice deepening
• Hair loss

These findings continue to support the question, is testosterone safe for women, particularly when therapy is appropriately monitored.[8,10]

Testosterone Therapy for Women in Clinical Practice

Testosterone Replacement Therapy for Women: What the Research Shows

In her practice, renowned breast cancer specialist Dr. Rebecca Glacier has multiple IRB approved trials that span as long as ten years studying the long-term data on testosterone replacement given to women in supraphysiologic levels.[5]

These studies followed women for as long as ten years and utilized subcutaneous testosterone pellets.

Doses were individualized based on:

• Body weight
• Clinical response
• Symptom improvement

At 4 weeks after insertion, serum testosterone levels were approximately 300ng/dl. At the 14-week mark, serum levels decreased to around 175ng/dl, corresponding with when women reported symptoms of androgen deficiency returning. 

Other than mild facial hair growth and sebaceous gland activity, there were no adverse effects reported.[5] 

These findings contribute to the growing body of evidence supporting testosterone therapy for women and suggest that symptom-guided treatment may provide meaningful clinical benefits.

Conclusion: The Future of Testosterone Therapy for Women

There are currently weak recommendations for low dose off label testosterone therapy for women with Hypoactive Sexual Desire Disorder (HSDD) however this is only a start for its benefits and protective abilities.[4,6-9,12-14] 

The many symptoms that women report as they age, including common low testosterone in women symptoms, should be handled with more compassion and clinical deduction from available literature.

To properly address hormonal deficiencies, providers should have more direction to turn to than weak guidelines pointing to treatments that include anti-depressants or studies not authored by authoritative figures that financially benefit from pharmaceutical interests.[9,13]

As research continues to evolve, clinicians should recognize that testosterone in women is not an anomaly but an essential component of female physiology. Understanding the role of testosterone in women, identifying symptoms of deficiency, and evaluating the potential benefits of therapy may help improve quality of life and reduce the burden of chronic disease. 

Want to Learn More About BHRT?

Understanding the role of hormones such as testosterone is essential for helping patients address the symptoms of aging, improve quality of life, and reduce the burden of chronic disease.

If you want to deepen your knowledge of bioidentical hormone replacement therapy and learn evidence-based strategies for hormone optimization, consider joining WorldLink Medical's Mastering the Foundations of BHRT course. This comprehensive training provides clinicians with practical, research-backed education on hormone physiology, replacement strategies, and patient-centered care.

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References

1. U.S. Food & Drug Administration website staff. US FDA website. Drug Safety and Availability. FDA issues class-wide labeling changes for testosterone products. Written and updated February 28,2025. Accessed February 9, 2026. https://www.fda.gov/drugs/drug-safety-and-availability/fda-issues-class-wide-labeling-changes-testosterone-products 
2. Lincoff AM, Bhasin S, Flevaris P, Mitchell LM, Basaria S, Boden WE, Cunningham GR, Granger CB, Khera M, Thompson IM, Wang Q, Wolski K, Davey D, Kalahasti V, Khan N, Miller MG, Snabes MC, Chan A, Dubcenco E, Li X, Yi T, Huang B, Pencina KM, Travison TG, Nissen SE. Cardiovascular safety of testosterone-replacement therapy. The New England Journal of Medicine. 2023;389(2):107-117. PMID: 37326322. https://doi.org/10.1056/NEJMoa2215025 
3. Hall JE. Evaluation and management of postmenopausal hyperandrogenism. UpToDate. Original written date unknown.  Last update December 23, 2025.  Accessed February 9, 2026. https://www.uptodate.com/contents/evaluation-and-management-of-postmenopausal-hyperandrogenism/print?search=testosterone%20women&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3 
4. Bolour S, Braunstein G. Testosterone therapy in women: a review. International Journal of Impotence Research. 2005;17(5):399-408. PMID: 15889125. https://doi.org/10.1038/sj.ijir.3901334
5. Glaser R, Kalantaridou S, Dimitrakakis C. Testosterone implants in women: pharmacological dosing for a physiologic effect. Maturitas. 2013;74(2):179-184. PMID: 23265303. https://doi.org/10.1016/j.maturitas.2012.11.004 
6. Uloko M, Rahman F, Puri LI, Rubin RS. The clinical management of testosterone replacement therapy in postmenopausal women with hypoactive sexual desire disorder: a review. Journal of Impotence Research. 2022;34(7):635-641. PMID: 36198811. https://doi.org/10.1038/s41443-022-00613-0 
7. Abedi AR, Allameh F, Hosseini S, Ghahestani SM, Tadayon N. Review of the literature on different aspects of testosterone therapy for women. Journal of Iranian Medical Council. 2023;6(1):38-44. DOI: 10.18502/jimc.v6i1.11840.  https://dx.doi.org/10.18502/jimc.v6i1.11840 
8. Glaser R, Dimitrakakis C. Testosterone therapy in women: myths and misconceptions. Maturitas. 2013;74:230-234. PMID: 23380529. https://doi.org/10.1016/j.maturitas.2013.01.003 
9. Davis SR, Baber R, Panay N, Bitzer J, Perez SC, Islam RM, Kaunitz AM, Kingberg SA, Lambrinoudaki I, Liu J, Parish SJ, Pinkerton J, Rymer J, Simon JA, Vignozzi L, Wierman ME. Global consensus position statement on the use of testosterone therapy for women. Climacteric. 2019;104(10):4660-4666. PMID: 31498871. https://doi.org/10.1210/jc.2019-01603  
10. Donovitz GS. A personal prospective on testosterone therapy in women-what we know in 2022. Journal of Personalized Medicine. 2022;12(8):1194. PMID: 35893288. https://doi.org/10.3390/jpm12081194 
11. Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systemic review and meta-analysis of randomized controlled trial data. Lancet Diabetes Endocrinology. 2019;7(10):754-766. PMID: 31353194. https://doi.org/10.1016/S2213-8587(19)30189-5 
12. Alabama State Board of Medical Examiners. Recommended guidelines for testosterone replacement therapy in females. Written and last updated February 20, 2025. Accessed February 9, 2026. https://www.albme.gov/uploads/pdfs/TRT_GuidelinesFem.pdf 
13. Shifren JL. Overview of sexual dysfunction in females:management. UpToDate. Original written date unknown. Last updated January 26, 2026. Accessed February 9, 2026. https://www.uptodate.com/contents/overview-of-sexual-dysfunction-in-females-management/print?search=testosterone%20women&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 
14. VA Pharmacy Benefits Management Services and National Formulary Committee. Transdermal testosterone (off label) for hypoactive sexual desire disorder (HSDD) in postmenopausal females summary guidance. Written and last updated March 2025. Accessed February 9, 2026. https://www.va.gov/formularyadvisor/DOC_PDF/CFU_Testosterone_HSDD_Postmenopausal_Females_Criteria_Mar_2025.pdf