Testosterone for women: the hormone that is yours too

Testosterona en mujeres: la hormona que también es tuya

Your body already makes it

There is something your body does well that almost nobody has told you about.

Your ovaries and your adrenal glands produce testosterone every day of your adult life. It is not a borrowed hormone. It is not something only men have. It is yours, it is human, and through your reproductive years it circulates in your blood in larger amounts than estrogen.

That sentence tends to surprise people. We are used to the female hormone conversation revolving around estrogen and progesterone, with testosterone showing up as a lab error or something to be corrected. It is neither. It is part of the team.

What is it doing there? It takes part in sexual desire, in the arousal response, in maintaining muscle, in bone density, and in how your brain processes motivation. It does not work alone — no hormone does — but it is not decorative either.

And here is the practical part: if that hormone is yours, then the question is not whether you "should have testosterone." You already do. The question is what happens when it falls, and what can be done about it with real evidence in hand.

What happens over the years (and what does not)

There is a widespread misunderstanding worth taking apart here, because taking it apart saves you anxiety.

Many people believe female testosterone collapses at menopause, the way estrogen does. It does not. The testosterone decline is gradual and early: it begins around the mid-twenties and continues steadily decade after decade. By the time natural menopause arrives, much of the decline has already happened, and the menopausal event itself does not produce the sharp drop seen with estrogen.

There is one important exception worth naming clearly: when the ovaries are surgically removed, the drop is abrupt, because one of the two factories disappears at once. That situation is different and deserves its own clinical conversation.

Why does the distinction matter? Because it changes how you read your own symptoms. If you are 46 and notice desire has changed, you are not looking at a switch that flipped last month. You are looking at a long slope — and long slopes can be accompanied.

What the evidence does show

This is the good part, and it is solid.

In 2019, a team at Monash University published in Lancet Diabetes & Endocrinology the most complete review that exists on this subject. They gathered 36 randomized, blinded trials with 8,480 women, and also searched unpublished data in FDA and European Medicines Agency drug registration files so as not to be left with only what got published. That last detail matters: it is the mark of a team that went looking for the inconvenient results too.

The results in postmenopausal women, compared with placebo:

All of those differences were statistically significant. And there is a safety finding that deserves to be stated exactly as it stands: no serious adverse events were recorded across the body of trials.

Beyond that headline, the most frequent effects were the ones you would expect from an androgen: a higher likelihood of acne and hair growth. A small overall weight increase was also recorded. These are things you watch for, and they generally respond well to adjusting the dose.

Look closely at the distress row. It does not only measure whether something "works" in the body: it measures whether the person stops suffering over the problem. In sexual health that is often the column that truly counts.

Why the route changes everything

Here is a practical finding you can use in a conversation with your physician tomorrow.

That same meta-analysis separated the trials by how the testosterone was given, and found a clear difference in the cholesterol profile:

• Oral route (pill): raised LDL cholesterol and lowered HDL and triglycerides.
• Non-oral route (cream, gel, patch): neutral lipid profile. No such effect.

It is the same molecule. What changes is the path it takes before reaching your bloodstream. Testosterone taken by mouth passes through the liver first in high concentrations and alters lipoprotein production there. What enters through the skin skips that step.

That is why the authors concluded, in so many words, that non-oral administration is preferred. And it is why, when you hear about cream, gel or injection rather than a pill, it is not a trend: it is a decision with data behind it.

What the global consensus says

The same year, eleven international medical societies jointly signed a consensus position statement on this topic. Among them are the Endocrine Society, the International Menopause Society, the North American Menopause Society, and the Latin American Federation of Climacteric and Menopause Societies.

Eleven societies agreeing on something is not an everyday event. What they agreed can be summarized like this:

• There is one single indication supported by evidence: low sexual desire causing distress, in postmenopausal women.
• Doses should approximate the physiological concentrations of a premenopausal woman. Never male doses.
• Blood levels should be monitored to avoid concentrations above the physiological range.
• For any other symptom, current evidence is not sufficient to recommend it.

That last point is the one most often left out when somebody wants to sell you something. We would rather tell you: if you are promised that testosterone will fix your fatigue, your mood, your memory or your body composition, you are being promised more than the evidence supports today.

So your expectations are the right ones

Three things worth being clear about before starting, said plainly and without drama:

One. The effect on desire is real and measurable, but it is a moderate effect, not a switch. In the trials women improved consistently; no honest description of that data speaks of spectacular transformations.

Two. Outside sexual health, the ground is less firm. The meta-analysis found no effects on body composition, musculoskeletal health or cognitive measures — though the authors note that the number of women contributing data for those outcomes was small. "We found no effect" and "there is no effect" are not the same sentence, and it deserves to be said with that precision.

Three. A systematic review published in Annals of Internal Medicine in 2024 evaluated treatments for genitourinary syndrome of menopause — dryness, pain with intercourse, urinary symptoms — and concluded that vaginal testosterone may provide no benefit for those specific symptoms (low certainty). For vaginal dryness and pain, vaginal estrogen and other options have better support. Different problems with different solutions.

None of this invalidates what came before. It bounds it. And a well-bounded treatment is a treatment you can trust.

The real problem: the dose

This is the point where the most can go wrong, which is why we are giving it in full.

In the United States there is no testosterone product with an FDA-approved indication for women. None. That means everything in use is either a male product prescribed off-label, or a preparation formulated by a licensed pharmacy at a female dose.

Why does that matter so much? Because a woman needs roughly one-tenth of the male dose. Pulling that fraction out of a product designed for men, accurately, is not something you improvise. And the evidence is clear that risk shows up precisely when female physiological concentrations are exceeded: that is where androgenic effects and lipid changes grow.

Put another way: in this treatment, the dose is not a technical detail. The dose is the treatment. A well-monitored physiological dose and an excessive one are not the mild and strong versions of the same thing — they are two different things, with different safety profiles.

Which is why this is not a product to buy online and use on your own. It is a treatment that requires a licensed physician to decide whether it applies, at what dose, and to review how you are doing.

How this is done well

If after reading all this the conversation seems relevant to you, here is how it is done sensibly:

First, name the problem correctly

The supported indication is not "having low desire." It is having low desire and being distressed by it. If your desire dropped and it does not bother you, there is nothing to treat. That distinction is yours to make, not the lab's.

Second, rule out what competes

Low desire has many causes and several are more common than low testosterone: dryness and pain with intercourse, thyroid, low iron stores, depression, broken sleep, sustained stress, the relationship itself, and several commonly used medications. A good physician looks there first. If any of that is in play, treating it may resolve the problem without touching a single hormone.

Third, start low and review

Female physiological dose, applied to the skin, and a scheduled review. International consensus recommends monitoring blood levels precisely so as not to overshoot.

Fourth, put a deadline on the trial

If after a few months of well-run treatment there is no change, the correct conclusion is to stop, not to raise the dose. That is one of the decisions that separates a serious program from the rest.

Who is this NOT for?

This section is not negotiable, and we write it in full even though it does not sell.

• If you are pregnant, trying to conceive, or breastfeeding. Testosterone has no place here.
• If you have a hormone-sensitive cancer, active or in your history, without your oncology team having explicitly reviewed and approved it.
• If you have significant liver disease or uncontrolled lipid abnormalities.
• If your main symptom is vaginal dryness or pain with intercourse. That problem has better tools, and vaginal testosterone did not show clear benefit for it.
• If what you are after is weight loss, muscle gain or more energy. The evidence does not support those uses. There are better routes and we will tell you about them.
• If you already have severe acne or hair growth that bothers you, because that is precisely what can increase.
• If your low desire has a clear untreated cause — thyroid, depression, sleep, a medication, the relationship. That comes first.

If you are in one of these boxes and somebody sells you testosterone anyway, that somebody is not looking after your health.

How it works at SCTS1

Here is the real order, no fine print.

Once you start your program, a licensed physician reviews your case — habits, stress, sleep and medical history — and orders labs only if they consider it necessary. Eligibility is determined by medical evaluation. The conclusion may well be that testosterone is not for you, and that too is a valid outcome of the process.

We work with non-oral formulations, which is what international consensus prefers: women's testosterone gel and women's testosterone therapy injection, formulated at female doses by licensed pharmacies. All of it in English and Spanish, with continuous follow-up.

And one more thing, because it is the one that defines us: if your case points to the problem being something else, we will tell you. Your trust is worth more than a sale.

GLP-1 programs with FDA-approved medications (Wegovy®, Foundayo™, Ozempic®) from $149/month, by telemedicine, in Spanish and English

Real clinical oversight, in English and Spanish, with continuous follow-up.

Eligibility is determined by medical evaluation. Individual results vary and are not guaranteed.

Frequently asked questions

Is testosterone a male hormone?

It is a human hormone. Your body makes it every day in the ovaries and the adrenal glands, and through your reproductive years it circulates in your blood in larger amounts than estrogen. The difference from men is one of quantity, not of kind.

Does menopause make it collapse?

Not abruptly. The decline is gradual and starts much earlier: levels fall steadily from the mid-twenties onward. Natural menopause does not cause a sharp drop in testosterone. Surgical removal of the ovaries does.

What does the evidence show most clearly?

In a meta-analysis of 36 randomized trials with 8,480 women published in Lancet Diabetes & Endocrinology, testosterone significantly improved desire, arousal, orgasm, self-image and the frequency of satisfying sexual events in postmenopausal women, and reduced the distress that came with the problem. No serious adverse events were recorded.

Why cream or gel rather than a pill?

Because the route changes the profile. In that same meta-analysis, oral testosterone raised LDL cholesterol and lowered HDL. Non-oral routes — cream, gel, patch — had no such effect on lipids. That is why international consensus prefers application to the skin.

Does it help fatigue, mood or bone?

There is not enough evidence today to say so. The 2019 global consensus recognizes a single evidence-based indication: low sexual desire causing distress in postmenopausal women. Every other use sits in territory without firm data, and it should be named that way.

Is there an FDA-approved product for women?

In the United States there is no testosterone product with an approved indication for women. That is why preparations are formulated by licensed pharmacies at female doses, always under the supervision of a licensed physician who reviews your case and decides.

Do I need labs before starting?

Once you start your program, a licensed physician reviews your case — habits, stress, sleep and medical history — and orders labs only if they consider it necessary. It is not automatic and not required for everyone.

Sources

• Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754-766. — DOI · via PubMed
• 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. — DOI · via PubMed
• Danan ER, Sowerby C, Ullman KE, et al. Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause: A Systematic Review. Ann Intern Med. 2024;177(10):1400-1414. — DOI · via PubMed
• Islam RM, Bell RJ, Green S, Davis SR. Effects of testosterone therapy for women: a systematic review and meta-analysis protocol. Syst Rev. 2019;8(1):19. — DOI · via PubMed
• Gouveia M, Sanches R, Andrade S, Carmona S, Ferreira C. The Role of Testosterone in the Improvement of Sexual Desire in Postmenopausal Women: An Evidence-Based Clinical Review. Acta Med Port. 2018;31(11):680-690. — DOI · via PubMed

Your trust is worth more than a sale.

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This article is informational and is not medical advice. SCTS1 does not prescribe medications. All medical care, prescriptions and treatment plans are provided by licensed physicians through our partner platform, and preparations are dispensed by licensed pharmacies. Eligibility is determined by a licensed provider. In the United States there is no testosterone product with an FDA-approved indication for women; any use is off-label or through a compounded preparation, and must be done under medical supervision. Individual results vary and are not guaranteed.