Research indicates that testosterone replacement therapy can improve libido in menopausal women and may alleviate symptoms like mood swings and brain fog. While widely endorsed for sexual health issues, experts call for more trials on broader benefits. Only a few countries have approved women-specific testosterone products amid ongoing safety debates.
Menopause often brings debilitating symptoms such as mood swings, brain fog, and plummeting libido, prompting many women to seek hormone replacement therapy focused on oestrogen and progesterone. Emerging studies suggest testosterone, present in women at about a tenth of men's levels, could offer additional relief. "We often think of testosterone as a male hormone, but it is also found in women, just usually at a tenth of the level as in most men," says Sarah Glynne at the Portland Hospital in London, an adviser on menopause treatment guidelines for the British Society of Sexual Medicine.
Roughly half of women's testosterone comes from the ovaries, with levels peaking in their 20s and declining from the 30s onward; by middle age, ovarian production halves. This drop contributes to hypoactive sexual desire disorder (HSDD), affecting nearly half of menopausal and postmenopausal women in the US with libido struggles and intercourse pain. A European survey of over 1,800 postmenopausal women found more than a third reported reduced sex drive and over half less interest in sex. "[Testosterone] has a very important benefit for sexual function," notes JoAnn Pinkerton at UVA Health in Virginia, aiding arousal, desire, and lubrication.
Since the 1940s, studies have linked testosterone declines to low libido. A 2005 trial of 533 women with HSDD post-hysterectomy and oophorectomy showed a twice-weekly testosterone patch with oestrogen improved satisfying sexual experiences more than oestrogen alone. A 2010 study of 272 menopausal women yielded similar results. A 2019 meta-analysis of over 80 studies involving 8,480 women confirmed testosterone increased desire, satisfying activities, pleasure, arousal, orgasm, and self-image in postmenopausal women.
Organizations like the International Menopause Society, Royal College of Obstetricians and Gynaecologists, and North American Menopause Society endorse it for HSDD. Testosterone interacts with brain receptors to heighten desire. As of July, only Australia, New Zealand, South Africa, and the UK approve women-specific products; the US FDA cites insufficient long-term safety data, though some studies show no elevated risks for heart, breast, or uterine issues. "Most providers who take care of menopausal women would love to have an FDA-approved, safe and effective transdermal [testosterone] therapy for women," says Pinkerton.
Beyond libido, a 2023 analysis of seven studies suggested benefits like increased muscle mass, reduced body fat, better insulin sensitivity, and cholesterol levels. In a 2024 evaluation by Glynne's team of 510 perimenopausal and postmenopausal women on oestrogen plus testosterone, after four months, half reported fewer anxiety attacks and crying spells; 40 percent saw improvements in depression, concentration, and fatigue; and over a third noted better memory and less irritability. "What I hear most often is women saying they feel more like themselves. They feel stronger. They feel more robust," says Glynne.
Skeptics like Pinkerton highlight the lack of control groups and reliance on self-reports, possibly indicating placebo effects. "While these show promising outcomes, we don’t have efficacy or safety data in any substantial randomised controlled trial to warrant recommendations for those indications," adds Sharon Parish at Cornell University. Therapy is typically combined with oestrogen to minimize side effects like acne and excess hair growth. More trials are needed, especially for women unable to use oestrogen due to risks like breast cancer recurrence, where options remain limited.