Rise of testosterone use in postmenopausal women raises risks

Women are increasingly turning to testosterone for libido and wellness, but experts warn of exaggerated claims and potential side effects.

Illustration by Yifei Fang

By Laila Azzahra and Anna Fadiah

Five years ago, Dr. Risa Kagan, a Berkeley-based OB-GYN, rarely had postmenopausal patients interested in testosterone therapy. Many women were hesitant, associating the hormone with masculinity and fearing potential side effects like body hair growth or a deepened voice.

Today, she sees a stark contrast. "Every patient is coming in asking," Dr. Kagan said. Across the U.S., women's health providers are witnessing a surge in demand for testosterone, fueled by menopause influencers on social media platforms like Instagram and TikTok. Even actress Kate Winslet recently praised testosterone for helping her "feel sexy again."

However, despite the growing enthusiasm, experts caution that testosterone's benefits are often exaggerated. While research supports its effectiveness in improving libido for some women, claims about its ability to enhance mood, cognition, muscle strength, and heart health remain largely unproven.

Understanding testosterone's role in women

Testosterone is commonly associated with men, but it plays a vital role in women's health as well. The hormone, primarily produced by the ovaries and adrenal glands, contributes to reproductive functions, including egg production during the menstrual cycle.

Beyond reproduction, researchers are still unraveling testosterone's broader impact on women's health. The presence of testosterone receptors in organs such as the heart, brain, muscles, and bones suggests its significance, but scientists have yet to fully understand its mechanisms.

Typically, women's testosterone levels peak in their 20s and gradually decline over time. However, studies indicate that levels may rise again in their 70s, suggesting a possible link to longevity.

Despite this, not all women experience a loss of libido due to declining testosterone. Some maintain a strong sex drive even with low testosterone levels, while others struggle with diminished desire despite having normal or high levels. Because of this variability, measuring testosterone levels alone provides limited insight into a woman's sexual or overall health.

How testosterone impacts women's health

For postmenopausal women diagnosed with low sexual desire, testosterone therapy has been shown to improve libido, arousal, orgasm frequency, and overall sexual satisfaction. However, Dr. Kagan warns that the effects are often subtle rather than dramatic.

Sexual function is influenced by multiple factors, including physical discomfort, mental health, and relationship dynamics. Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University, emphasizes that many women benefit most from a combination of testosterone therapy and sex therapy. "Testosterone can wake up that part of the brain, but therapy leads to more lasting improvements," she said.

Beyond libido, many women report increased energy, improved mood, enhanced cognitive function, and greater muscle strength with testosterone use. However, clinical studies have yet to confirm these effects conclusively. In some trials, women receiving placebos reported similar benefits, suggesting that factors like psychological reassurance and validation play a role.

How testosterone is administered

Medical guidelines recommend applying testosterone as a gel to the back of the calf or thigh for sexual health benefits. However, accessing testosterone therapy remains a challenge for women, as the U.S. Food and Drug Administration (FDA) has not approved testosterone products specifically for female use. While the FDA has approved 31 testosterone treatments for men, no equivalent options exist for women.

As a result, women seeking testosterone therapy must navigate limited and sometimes inconsistent options. Some use men's testosterone gel, carefully rationing doses to match female needs. Others turn to compounding pharmacies, though the potency of these formulations can vary. A third option is importing female-specific testosterone gel from Australia, the only country that has approved it for women.

None of these approaches are covered by insurance, leaving many women to pay out of pocket, often at a cost of $10 or more per month.

Potential risks and side effects

When taken in appropriate doses that do not exceed typical premenopausal testosterone levels, side effects are rare. However, excessive or prolonged testosterone use can lead to several unwanted effects, some of which may be irreversible.

Common side effects include:

Hair thinning on the scalp
Excessive hair growth on the face and body
Deepening of the voice
Acne
Enlargement of the clitoris
Increased aggression and irritability

Additionally, high testosterone levels can thicken the uterine lining, leading to vaginal bleeding and a heightened risk of endometrial cancer. The body also converts excess testosterone into estrogen, which can further complicate hormonal balance.

The dangers of testosterone pellets

Experts strongly advise against the use of testosterone pellets, which are implanted under the skin and release high doses of the hormone over time. These pellets are commonly offered at anti-aging clinics and medical spas, but they pose significant risks due to their potency.

Unlike gels, which allow for dose adjustments, pellets cannot be removed once inserted. Women experiencing severe side effects must endure them until the hormone levels naturally decline. In some cases, irreversible changes, such as voice deepening and clitoral enlargement, have been reported.

The need for better treatment options

Despite growing interest in testosterone therapy for women, significant gaps remain in research and regulatory approval. Many experts advocate for more comprehensive studies to clarify the hormone’s benefits and risks. They also urge the FDA to approve safe, standardized testosterone treatments for women, similar to those available for men.

As the conversation around menopause and hormone therapy evolves, experts emphasize the importance of informed decision-making. While testosterone can offer meaningful benefits for some women, it is not a universal solution, and its effects beyond libido remain uncertain. Women considering testosterone therapy should consult with experienced healthcare providers to weigh the potential benefits against the risks.

For now, the excitement around testosterone continues to grow, but experts caution against viewing it as a miracle cure for aging and wellness.