Testosterone Therapy for Women: What to Expect
Women make testosterone too. In fact, before menopause, women produce more testosterone than estrogen by volume. Levels fall gradually through the 30s and 40s, and they drop sharply after the ovaries are removed. Here is what treatment looks like.
What it can help with
The strongest evidence for testosterone in women is for low sexual desire that bothers you, in women around and after menopause. That is the use supported by international medical consensus. Some women also report better energy, mood, and muscle tone, though the research there is thinner. And testosterone is not a replacement for estrogen. Hot flashes, sleep and bone protection usually need estrogen and progesterone, so testosterone is most often added to a broader hormone plan.
No testosterone product is FDA-approved for women in the United States. Prescribing it for women is off-label, which is legal and common when it is backed by evidence and your informed consent. Testosterone is a Schedule III controlled substance. In Texas it requires an in-person evaluation, and we prescribe it to Texas patients only.
The goal: low and steady
For women, the target is a testosterone level in the normal female range. Not the male range. Women's doses are a small fraction of men's, and the medication is very concentrated, so a correct dose looks like a surprisingly small amount. That is on purpose. Use exactly what is on your personal dosing sheet, never more. More does not mean better results. It means more side effects.
Timeline
Some women notice a difference this soon. Many don't, and that is normal.
Give it about three months before judging whether it is working for you.
If you have not had a meaningful benefit by six months, we will talk about stopping.
Side effects to watch for
- Higher libido than you expected
- Acne
- Oily skin or oily scalp
- More body hair or new facial hair
- Irritability
- Fluid retention
These usually ease when the dose is adjusted. Let us know.
- Thinning hair on the scalp
- Deepening or hoarse voice
- Enlargement of the clitoris
- Aggression
- Stronger body odor
- High red blood cell count on labs
Call us promptly. Voice changes and clitoral enlargement may not reverse, which is why we keep doses conservative and monitor closely.
Lab monitoring
We check labs before you start, a few weeks to a few months in, and then on a regular schedule once you are stable. Your plan lists your exact schedule. Monitoring usually includes:
- Total testosterone and free testosterone
- Sex hormone binding globulin (SHBG)
- Complete blood count, to watch red blood cells
- Comprehensive metabolic panel, including liver function
- Lipid panel and thyroid function
Labs keep you safe. But how you feel matters just as much, so we look at both together.
Safety
- Pregnancy. Testosterone can harm a developing baby. Do not use it if you are pregnant, could become pregnant without reliable contraception, or are breastfeeding.
- Not for anyone under 18.
- Creams and gels transfer. If yours is topical, wash your hands after applying and keep the area covered until dry. Children and pets are especially sensitive.
- Store it securely. Keep it locked and out of reach. Never share it. It is a controlled substance.
- Tell us about any history of breast or uterine cancer, heart disease, blood clots, liver disease, or polycystic ovary syndrome before starting.
If your plan uses injections, our self-injection guide walks you through it step by step.
- Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660-4666.
- Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2019;7(10):754-766.
- Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Sex Med. 2021;18(5):849-867.
This page is general education, not medical advice, and it does not replace a visit with your own clinician. Your diagnosis, treatment and any medication instructions come from your individual care plan. Reviewed by Jessica Boggs, MSN, APRN, FNP-C, ENP-C.
5301 Alpha Road, Suite 34, Dallas, TX 75240 · (469) 653-3124 · contact@navarahealthtx.com · navarahealthtx.com
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