Although testosterone is commonly thought of as a male hormone, it also plays an essential role in women’s health. Women naturally produce testosterone in their ovaries and adrenal glands, and it contributes to sexual function, mood, bone health, muscle tone, and overall energy. However, testosterone levels gradually decline with age and drop more sharply after menopause. This decrease can lead to symptoms such as reduced libido, low mood, fatigue, difficulty concentrating, and a general loss of vitality. . Surgical menopause cause even more significant and permanent drop in testosterone levels.
Why Testosterone Matters for Women
In postmenopausal women, lower testosterone levels can affect multiple aspects of wellbeing. Research shows that supplementing with small, carefully controlled doses of testosterone may improve several areas of sexual function, including desire, pleasure, arousal, and satisfaction. Many women also report better mood, motivation, concentration, and energy once their testosterone levels are restored to healthy, physiological ranges. Some studies suggest possible additional benefits, such as enhanced cognitive performance, better urogenital health, and increased bone density, especially when testosterone is used in combination with oestrogen as part of hormone replacement therapy (HRT). Women often describe feeling more emotionally balanced and physically resilient when therapy is managed properly.
How Testosterone Works in the Female Body
In women, testosterone acts both directly and indirectly by serving as a precursor for estrogen. It affects reproductive tissues, muscles, bones, and the brain.
• The ovaries and adrenal glands are the main production sites.
• Smaller amounts are made in tissues such as the skin and muscles.
• Around two-thirds of circulating testosterone is bound to sex hormone-binding globulin (SHBG), and a smaller portion to albumin.
• Only a tiny fraction — known as free testosterone — is biologically active and available to tissues.
• In women, some testosterone is converted into estradiol, by aromatase.
• Dynamic regulation of testosterone levels in women are lower than in men, but does have some fluctuation. For instance, testosterone levels can increase slightly during the ovulatory surge, explaining why some women have heightened sexual desire during ovulation.
• High testosterone aromatisation into estrone especially with insulin resistance and high inflammation may contribute to breast cancer in postmenopausal women.
• Even after menopause, when estrogen levels drop significantly, the ovaries continue to produce small but important amounts of testosterone.
Why Testosterone Therapy May Be Needed
Declining testosterone can cause Hypoactive Sexual Desire Disorder (HSDD) — a persistent lack of sexual desire that leads to distress. For women affected by HSDD, testosterone therapy can help restore both sexual interest and satisfaction, improving confidence and quality of life.
Although Functional Medicine doctors have observed for almost two decades that prescribing testosterone creams can improve mood, motivation, concentration, energy levels, and overall physical well-being, the Global Consensus Position Statement on Testosterone Therapy for Women—endorsed by leading medical societies¹—states that the only evidence-based indication for testosterone therapy in women is the treatment of hypoactive sexual desire disorder (HSDD) in postmenopausal women.
When prescribed carefully, testosterone therapy can:
• Enhance sexual desire and arousal
• Improve pleasure and orgasmic satisfaction
• Reduce distress associated with low libido
• In some cases, improve mood, focus, and energy
What the Global Consensus Says — Brief Summary
The Global Consensus provides practical, evidence-based guidance for healthcare professionals. It emphasizes that therapy must be individualized, monitored, and prescribed only when clinically indicated.
Key points include:
• Testing and diagnosis: Testosterone levels decline naturally with age but remain measurable. Blood testing should use accurate methods.
• No specific cut-off level: Diagnosis of Hypoactive Sexual Desire Disorder relies on symptoms, not on a single blood test testosterone result.
• Who benefits: Only postmenopausal women with HSDD are shown to benefit.
• Safety: When used at physiological doses, testosterone is safe and well tolerated, with no adverse effects on heart, liver, or metabolic function.
• Side effects: Mild effects such as acne or slight hair growth may occur, but serious androgenic effects are extremely rare when properly dosed.
• Monitoring: Levels should be checked before therapy, again after 6 weeks, and every 4–6 months.
Testosterone and Musculoskeletal Health
Several studies have explored whether testosterone improves bone strength, muscle tone, or body composition in postmenopausal women. Most of these studies, however, have had very small sample sizes, and nearly all participants were also receiving estrogen therapy. As a result, it is difficult to determine whether any observed benefits were due to testosterone alone.
So far, available evidence does not support significant effects of testosterone on bone mineral density (at the spine, hip, or femoral neck), lean body mass, total body fat, or muscle strength after one year of use. Nevertheless, Functional Medicine doctors and their patients consistently report improvements in body composition, including reduced total body fat and increased lean body mass and muscle strength.
Until recently, there has been little public discussion or scientific interest in testosterone use for women—even hormone replacement therapy (HRT) in general—resulting in limited motivation among conventional medical researchers to conduct studies demonstrating testosterone’s potential benefits. In contrast, Functional Medicine practitioners have been prescribing transdermal testosterone for nearly two decades, observing notable clinical benefits in their practice.
Experts agree that more well-designed clinical trials are urgently needed to explore how testosterone might influence body composition, muscle strength, bone health, and fracture risk. The current consensus recognizes this research gap and calls for future studies to clarify testosterone’s broader regenerative potential in postmenopausal women.
Safety and Monitoring of Testosterone Therapy
When prescribed by a qualified doctor and used as a transdermal therapy (gel, patch, or cream applied to the skin), testosterone is generally safe. This route avoids the liver and keeps hormone levels steady.
Clinical data show that transdermal testosterone at physiological doses:
• Does not raise blood pressure, cholesterol, or glucose
• Does not increase short-term breast cancer risk
• Does not stimulate the uterus (endometrium)
• May cause only mild, reversible side effects such as acne or localized hair growth
Before starting treatment, doctors assess testosterone and SHBG levels to establish a baseline. Levels are checked again after 3–6 weeks, then every 4–6 months. The goal is to stay within the female reference range.Most women begin noticing benefits after 4–8 weeks, with peak improvement by around 12 weeks.
Who Should Avoid Testosterone Therapy
Testosterone therapy should not be prescribed for women who:
• Have breast or uterine cancer
• Have active liver disease
• Have significant cardiovascular disease
Conclusion
Testosterone plays a crucial role in female sexual health, vitality, and wellbeing. For postmenopausal women with hypoactive sexual desire disorder, properly prescribed testosterone therapy can significantly enhance quality of life.When used responsibly — under medical supervision and at physiological doses — testosterone therapy restores balance rather than excess, supporting women’s sexual function, mood, and energy safely and effectively.
Written by Dr Sly Nedic, Functional Medicine certified Practitioner (IFM, USA)
Resources www.8thsense.co.za
- Global Consensus Position Statement on the Use of Testosterone Therapy for Women – Endorsement by by International Menopause Society • Endocrine Society • European Menopause and Andropause Society • International Society for Sexual Medicine • International Society for the Study of Women’s Sexual Health • NAMS • Royal College of Ob/Gyns • International Society of Endocrinology • Endocrine Society of Australia • Royal Australian and NZ College of Ob/Gyns
2) REFRENCES• Buster, J, et al. Obstetrics & Gynecology https://journals.lww.com/greenjournal/toc/2005/05000 • Davis SR, et al. Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med. 2008 Nov 6;359(19):2005-17. • Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Climacteric. 2019 Oct;22(5):429-434. • El-Hage G, et al. A double-blind, randomized, placebo-controlled trial of the effect of testosterone cream on the sexual motivation of menopausal hysterectomized women with hypoactive sexual desire disorder. Climacteric. 2007 Aug;10(4):335-43. • Fernandes T, et al. Efficacy of vaginally applied estrogen, testosterone, or polyacrylic acid on vaginal atrophy: a randomized controlled trial. Menopause. 2016 Jul;23(7):792-8 • Simon J, et al. Testosterone patch increases sexual activity and desire in surgically menopausal women with hypoactive sexual desire disorder. J Clin Endocrinol Metab. 2005 Sep;90(9):5226- 33. • Somboonporn W, Bell RJ, Davis SR. Testosterone for peri and postmenopausal women. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004509.
Tags: Avoid Testosterone Therapy, breast cancer, liver disease, testosterone, Testosterone Therapy