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More than 20 years after menopausal hormone therapy fell out of favor, it is having a renaissance. There is better clarity on the benefits and risks of estrogen and progesterone for women of a certain age. Women are also demanding more attention to their needs. All of this helps to explain the exploding popularity of a related supplement: testosterone. Social media would like us to believe that if estrogen can relieve a woman’s hot flashes, testosterone can make her hot in bed. But is it true?
Like estrogen and progesterone, testosterone occurs naturally in women and men, although relative levels of these hormones differ by biological sex. Women have about one-tenth the amount of testosterone that men have. Estrogen and progesterone are particularly important for female reproductive functioning. But surprisingly, “testosterone is not necessarily any less important,” says obstetrician and gynecologist Jill Liss, who’s on the faculty at the University of Colorado Anschutz medical school.
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In women and men, testosterone affects strength and body composition. It also influences brain pathways tied to sexual motivation and reward and increases blood flow and sensitivity. “We have extremely good data on the effects of testosterone on nearly all aspects of sexual function in women,” says OB-GYN James Simon of the George Washington University School of Medicine and Health Sciences. When used on the skin in a cream or gel, testosterone can increase desire, arousal, orgasmic function and sexual responsiveness, according to a 2019 Global Consensus Position Statement by experts in menopause and sexual health.
So far, so hot in bed. But experts caution that not every woman should go out and get testosterone. The 2019 paper recommended it only for postmenopausal women suffering from very low sexual desire that causes distress (clinically called hypoactive sexual desire disorder, or HSDD). A 2021 companion paper offering clinical guidelines extended the supplement recommendation to women at late reproductive ages who are unlikely to get pregnant. Testosterone supplements for a woman who might get pregnant are dangerous because they bring a risk of masculinization of female fetuses. And in any case, treatment “should keep someone in the normal range for women of reproductive age” for the hormone and not go higher, says Sharon Parish, an internist at Weill Cornell Medicine. She researches menopause and sexual health and is a co-author of both papers.
“Testosterone can be a useful tool. I certainly prescribe it, but it is not a panacea of youth and strength.” —Jill Liss OB-GYN
Also, despite the focus on menopausal women in research and treatment, testosterone is really “menopause-adjacent,” Liss says. Estrogen drops off a cliff at menopause, but testosterone often starts to decline a decade earlier, by the early 40s. In addition to risks to female fetuses if someone that age gets pregnant, higher doses of testosterone, beyond typically occurring levels, can cause virilization: a deeper voice, excessive facial hair and receding hair at the top of the head, plus changes in muscle mass. To date, no studies have found associated cardiovascular or cancer risks, but, notably, none have extended past 24 months.
Furthermore, testosterone therapy is not where clinicians start when treating low libido, Liss says. HSDD requires a full evaluation of possible physical, psychological and social causes. Standard menopausal therapy such as estrogen supplementation can help improve sexual function by reducing pain and discomfort. And additional testosterone doesn’t help everyone, perhaps because it circulates in low doses in women to begin with. “The effects of testosterone in women may be small and therefore difficult to demonstrate” compared with the effects in men, Simon says.
Nor is there good evidence yet of other reputed benefits in women such as sharper cognition, general well-being or improved bone density. As is often the case, the buzz about testosterone on social media has gotten ahead of the science, Liss says. “Testosterone can be a useful tool. I certainly prescribe it, but it is not a panacea of youth and strength.”
Even if women want testosterone, it’s not very easy to get. There were black-box warnings about cancer on female hormone therapy until the U.S. Food and Drug Administration recently removed them. They were based on one 2002 study that was halted early because of an observed increased risk of breast cancer and heart disease. Researchers and the agency now think the warning was an overreaction because the study focused on older, sicker individuals. Testosterone was not part of that particular research, but it suffered guilt by association.
In 2004 a testosterone patch for women who had had hysterectomies was shown to be effective, but it was rejected by the FDA, mainly over concerns about cardiovascular risks, even though such harms had not been clearly shown, Simon says. Barriers to approval for a testosterone product for women in the U.S. are now so high that few drug companies have since tried to surmount them.
Because of all this, women in the U.S. have only a few options. They can go online (with physician oversight) to get the world’s only approved testosterone product for women, made by a drug company in Australia called Lawley Pharmaceuticals. Or physicians can (and do) prescribe products intended for males but instruct their patients carefully on reducing dosage appropriately. (“Compounded” testosterone, a preparation handmade by pharmacists, is not recommended, because its potency can vary dramatically.)
Testosterone may not quite live up to the hype, but it is clearly helping some women and their partners.
Editor’s Note (3/24/26): This article was edited after posting to improve clarity.
