Menopause & midlife

Testosterone in Women: Prescribing and Monitoring

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No testosterone product is approved for women in the United States, so it is prescribed off-label for hypoactive sexual desire disorder, typically at a small fraction of a male dose. Clinicians confirm the diagnosis first, aim to keep levels in the normal female range, and recheck blood levels and side effects like acne over time.

Last updated: July 2026

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Can women even be prescribed testosterone?

Testosterone can be prescribed to women, but in the United States it is always off-label. No testosterone formulation is approved for women by the US Food and Drug Administration, so clinicians who prescribe it for low desire use products approved for men at much smaller doses, on the order of one-tenth, roughly 10%, of a male dose, or, less ideally, compounded preparations 1.

The global consensus statement supports this off-label use only for postmenopausal women with hypoactive sexual desire disorder and recommends against compounded and pellet forms because their dosing is unreliable 1. Some countries have approved a female-specific product, but availability varies. The takeaway is that a prescription is possible and legitimate, yet it sits outside formal approval and calls for a careful, informed discussion.

How do clinicians decide who is a candidate?

Candidacy starts with the diagnosis, not the prescription. Distressing low desire affects roughly 1 in 10 women, yet only a subset have a true disorder, so before considering testosterone a clinician checks whether the problem is better explained by relationship strain, depression, medication side effects such as those our guide on antidepressants and sexual side effects covers, fatigue, or pain during sex 2.

Vaginal dryness and pain from genitourinary syndrome of menopause are common culprits that respond to local estrogen rather than testosterone, as the North American Menopause Society emphasizes 3. A Cochrane review found the sexual-function benefit of added androgens is limited to postmenopausal women, reinforcing this narrow candidacy 4. Only after that groundwork does a testosterone trial make sense.

How is the dose chosen and given?

Dosing aims to restore a normal female level, not to exceed it. Because approved female products are scarce, clinicians typically use a small amount of a transdermal gel or cream made for men, at a female-range dose 1. Because a woman's own testosterone declines gradually from the twenties into the menopausal years, the aim is a younger-adult range rather than an overshoot 1.

The target keeps total testosterone within the range normally seen in younger women, far below male levels; our guide on testosterone levels in women explains those numbers. Skin gels are preferred over pellets or injections, which the global consensus advises against because they can push levels too high 1. A trial usually runs a defined window, commonly 3 to 6 months, to judge whether it helps 1.

What monitoring and side effects should be expected?

Monitoring focuses on keeping levels safe and catching side effects early. A clinician usually measures baseline testosterone and rechecks it after starting, aiming to avoid supraphysiologic levels that raise the risk of unwanted effects 1.

At female-range doses, side effects are typically mild and reversible, most often acne or a small increase in body or facial hair; higher-than-intended levels can cause a deeper voice or scalp hair changes that may not fully reverse 1. Long-term safety data are limited because most trials lasted only 6 to 12 months, so effects on the breast and heart are not well characterized 14. Regular follow-up, rather than a one-time prescription, is the norm, with benefits and levels reviewed every 3 to 6 months.

When testosterone prescribing needs a menopause specialist

A clinician is the right partner for both the decision and the follow-through. Because testosterone for women is off-label, unapproved in the US, and useful only for a specific diagnosis, a gynecologist, menopause specialist, or primary care clinician is best placed to confirm the diagnosis, choose a female-range approach, and arrange monitoring.

They can also revisit other contributors to low desire, since hormones are only part of the picture; our overview of the evidence for testosterone and libido sets expectations, and low desire in a relationship covers non-hormonal factors. Gale can help you prepare for that conversation.

Common questions

No. There is no testosterone product approved for women by the US Food and Drug Administration, so it is prescribed off-label. Clinicians usually adapt a male transdermal product at a much smaller, female-range dose, and global consensus guidance supports this only for postmenopausal women with a diagnosed desire disorder.

Most often a small amount of a transdermal gel or cream. Skin preparations are generally preferred over pellets or injections, which consensus guidance advises against because they can push levels too high. Compounded preparations are also discouraged because their dosing is unreliable.

With blood levels and symptom checks. A clinician typically measures testosterone before starting and rechecks it to keep levels within the normal female range and avoid overshooting. Follow-up visits also watch for side effects like acne or extra hair, and the plan is reviewed every few months rather than left on autopilot.

Usually a few months. A trial is often given a defined window, commonly 3 to 6 months, to judge whether desire improves. If there is no meaningful benefit in that time, stopping is a reasonable option to discuss with your clinician.

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When to review testosterone therapy

  • —New or worsening acne, unwanted facial or body hair, or scalp hair loss while on testosterone is a reason to seek clinician review of your levels.
  • —A deepening voice or clitoral enlargement is a reason to seek prompt clinician review, as these effects may not fully reverse.
  • —No improvement in desire after a several-month trial is a reason to revisit the plan with your clinician.
  • —Low mood or thoughts of self-harm are reasons to seek mental health support; in the US you can call or text 988 for the Suicide and Crisis Lifeline.

This article is general health education, not medical advice. Prescribing and monitoring testosterone in women is off-label and should be managed by a gynecologist, menopause specialist, or primary care clinician.

References

  1. 1.Davis SR, et al. (International consensus, endorsed by The Endocrine Society and International Menopause Society) (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Journal of Clinical Endocrinology & Metabolism. doi:10.1210/jc.2019-01603 ✓Global Consensus Position Statement that testosterone for women is off-label for HSDD in postmenopausal women, dosed to the female physiological range, given as a transdermal preparation rather than pellets or injections, with baseline and follow-up level monitoring and advice against compounded forms.
  2. 2.American College of Obstetricians and Gynecologists (2019). Female Sexual Dysfunction: ACOG Practice Bulletin, Number 213. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000003324 ✓ACOG practice bulletin describing the stepwise evaluation of female sexual concerns, the prevalence of distressing low desire, and the need to identify other causes before treatment.
  3. 3.The North American Menopause Society (Menopause Society) (2020). The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. doi:10.1097/GME.0000000000001609 ✓NAMS position that genitourinary syndrome of menopause causes dryness and pain treated with local vaginal estrogen rather than testosterone, a common contributor to check before starting testosterone.
  4. 4.Nastri CO, Lara LA, Ferriani RA, et al. (2013). Hormone therapy for sexual function in perimenopausal and postmenopausal women. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD009672.pub2 ✓Cochrane review finding the sexual-function benefit of added androgens is seen in postmenopausal women, with limited long-term safety data.

4 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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