Testosterone Therapy for Menopause: A Complete Guide to What It Treats, How It's Dosed, and What to Expect
Testosterone declines progressively during perimenopause and menopause. By the time a woman reaches menopause, her circulating testosterone is typically about half of what it was in her twenties—a decline that contributes to many of the symptoms women experience during the menopause transition.
The strongest evidence for testosterone therapy in menopausal women is for hypoactive sexual desire disorder (HSDD), formally endorsed by the 2019 Global Consensus Position Statement. Clinical evidence and patient-reported outcomes also support broader benefits for mood, energy, motivation, sleep, joint discomfort, cognitive function, and body composition.
The medical landscape is changing. The 2025 American Urological Association guideline on Genitourinary Syndrome of Menopause and the 2026 British Menopause Society clinician toolkit on testosterone replacement both represent recent institutional updates that bring formal guidance closer to current clinical practice in this space.
Testosterone for menopausal women is dosed at approximately one-tenth of male doses, most commonly as a transdermal cream starting at 0.5 mL daily. The goal is to maintain circulating testosterone within the normal premenopausal female range.
Joint pain, mood changes, energy loss, and body composition shifts are commonly under-recognized as hormone-related during the menopause transition. Many women have been told these symptoms are unrelated to menopause when, in fact, they reflect the broader hormonal disruption that estrogen, progesterone, and testosterone decline produce together.
Testosterone therapy is most effective as part of a coordinated approach to menopausal hormone therapy that may also include estrogen and (for women with a uterus) progesterone. The three hormones address different aspects of the menopausal disruption.
For menopausal women on GLP-1 medications for weight management, testosterone takes on additional clinical relevance: it helps preserve the lean muscle mass that rapid weight loss can otherwise erode.
Pellet therapy is not recommended for menopausal women. Most documented serious side effects of testosterone in women have occurred with pellets, which deliver doses well above the female physiological range and cannot be adjusted once implanted. Transdermal cream is the preferred delivery method.
All testosterone therapy for women in the United States is currently off-label. Treatment should be done under physician supervision with appropriate hormone testing and ongoing monitoring.
Why Testosterone Matters During Menopause
The conversation about menopause is changing, finally. For decades, menopausal women received minimal hormonal care—their symptoms attributed to "just getting older," their hot flashes managed in isolation while the broader hormonal disruption went largely unaddressed. Estrogen, when discussed at all, was discussed cautiously and often avoided. Testosterone, in most clinical conversations, was barely mentioned.
That picture is shifting. Researchers, clinicians, and women themselves are increasingly recognizing that menopause is not a collection of independent symptoms—it is a coordinated hormonal transition that affects multiple body systems simultaneously, driven by the decline of estrogen, progesterone, and testosterone together. Each of these hormones plays a distinct biological role, and the changes women experience during the menopause transition reflect the simultaneous loss of all three.
Testosterone has been the most overlooked of the three. Cultural and medical assumptions long classified it as a "male hormone," obscuring the fact that testosterone is the most abundant biologically active hormone in the female body—higher in absolute concentration than estrogen at every life stage before menopause. Women's ovaries and adrenal glands produce testosterone throughout life. Testosterone contributes to libido, mood, energy, motivation, cognitive function, muscle mass, bone density, joint comfort, and cardiovascular function.
When testosterone declines during perimenopause and menopause, all of these systems are affected. The clinical consequences extend far beyond the libido changes that are the most commonly recognized symptom of low testosterone in women.
What Happens to Testosterone During the Menopause Transition
Women's testosterone production peaks in the mid-20s and declines progressively from there. The decline is gradual rather than abrupt: circulating levels drop approximately 50 percent between the mid-20s and natural menopause, with continued decline thereafter [1].
For most women, this decline begins to produce noticeable symptoms during the perimenopause—the years leading up to the final menstrual period, typically beginning in the late 30s or 40s and lasting an average of 4 to 8 years. During this window, ovarian hormone production becomes increasingly erratic before declining more definitively at menopause itself.
Several factors accelerate the loss of testosterone:
- Bilateral oophorectomy (surgical removal of both ovaries) removes approximately 50 percent of a woman's testosterone production immediately. Surgical menopause produces a more abrupt and substantial drop in testosterone than natural menopause.
- Premature ovarian insufficiency (POI), which affects approximately 1 percent of women under 40, produces an early decline in all ovarian hormones including testosterone.
- Chronic illness or treatment with certain medications, including some corticosteroids, opioids, and oral contraceptives, can reduce androgen production or availability.
- Adrenal insufficiency reduces production of DHEA, the adrenal precursor to testosterone, further compounding the ovarian decline.
The clinical implication: a woman in her early 50s with surgical menopause and adrenal insufficiency may have substantially lower testosterone than a similarly-aged woman with natural menopause, and her symptoms may correspondingly be more severe.
Symptoms of Low Testosterone During Menopause
Many symptoms attributed to menopause more broadly are at least partially driven by testosterone decline. Recognizing this matters clinically: it means that estrogen replacement alone may not address everything, and that some symptoms women experience reflect specifically testosterone-related changes.
Sexual Function and Desire
The most clinically recognized manifestation. Many menopausal women experience:
- Reduced libido and sexual interest
- Less responsive arousal
- Reduced intensity or absence of orgasm
- Reduced sexual fantasy or thought
- Personal distress about these changes
When these symptoms cause meaningful distress, they may meet criteria for hypoactive sexual desire disorder (HSDD), the indication with the strongest formal evidence for testosterone therapy.
Mood and Energy
Testosterone receptors are present throughout the brain, particularly in regions involved in mood regulation, motivation, and reward. Menopausal women with declining testosterone commonly report:
- Persistent fatigue and reduced stamina
- Low motivation and difficulty initiating tasks
- Mood changes including increased irritability or low mood
- Loss of "spark" or drive
- Reduced sense of well-being
These symptoms are often attributed to estrogen decline alone, but testosterone plays a meaningful role in each of them. Treating only estrogen and progesterone without addressing testosterone leaves part of the picture unaddressed.
Cognitive Function
Many menopausal women describe "brain fog"—reduced cognitive clarity, slower processing, difficulty with word retrieval, problems with focus and concentration. Testosterone receptors are present throughout the brain, and verbal memory in particular has shown improvement on testosterone therapy in trials of women undergoing surgical menopause. The cognitive dimension of menopause is biologically coherent and clinically reported, even where formal trial evidence is still being built.
Joint Discomfort
One of the most consistently under-recognized symptoms of declining hormones in women. Many menopausal women report joint discomfort that emerges during perimenopause—shoulder pain, finger stiffness, hip discomfort, knee aches—and is frequently dismissed as unrelated to hormones. Testosterone receptors are present in joint tissue, and many women report meaningful improvement in joint comfort on appropriately dosed testosterone therapy. This single symptom often becomes a powerful indicator of testosterone's broader role in women's musculoskeletal health.
Body Composition and Muscle Loss
Menopause initiates what is increasingly understood as a sarcopenic trajectory: estrogen withdrawal sets the muscle-loss process in motion, and the parallel decline in testosterone accelerates it. The result is progressive loss of metabolically active tissue that contributes to:
- Loss of lean muscle mass and strength
- Increased body fat percentage, particularly central/visceral fat
- Reduced metabolic rate
- Worsening insulin sensitivity over time
Testosterone therapy directly addresses one of the hormonal drivers of this trajectory. The 2019 Global Consensus Position Statement notes that testosterone in postmenopausal women is associated with improvements in lean mass and bone density alongside its effects on sexual function [1].
Bone Density
Testosterone contributes to bone formation and density. While estrogen is the dominant hormonal regulator of bone health in women, testosterone provides a complementary contribution. For women in early menopause, the combined decline of both hormones accelerates bone loss—one of the major long-term health consequences of the transition.
Cardiovascular and Metabolic Function
A 2024 observational study by Davis and colleagues found that higher testosterone in postmenopausal women was associated with higher HDL cholesterol and lower triglyceride levels [2]. This adds to the broader picture of testosterone's contribution to cardiovascular and metabolic health in women, complementing estrogen's better-established cardiovascular effects.
The Evidence Picture: What's Endorsed, What's Emerging
Understanding the evidence for testosterone therapy in menopausal women requires acknowledging the difference between "well-established for a specific indication" and "actively being studied but not yet formally endorsed."
Well-Established: HSDD in Postmenopausal Women
The 2019 Global Consensus Position Statement, published by ten international medical societies, formally endorses testosterone therapy for HSDD in postmenopausal women based on robust randomized controlled trial evidence [1]. A meta-analysis of 36 studies including over 8,400 women has demonstrated improvements in sexual desire, arousal, orgasm, and satisfying sexual events with testosterone therapy versus placebo [3].
This indication has the strongest evidence base, and it is the framework most major medical bodies use when discussing testosterone for women.
Emerging: The Broader Symptom Picture
For mood, energy, motivation, cognitive function, joint comfort, and body composition, the evidence is structured differently. Formal randomized trials have generally focused on sexual function endpoints because that is where the regulatory and pharmaceutical incentives have aligned. Trials measuring the broader symptom picture have been smaller, shorter, and methodologically less rigorous.
This is changing. The British Menopause Society's 2026 Tool for Clinicians on testosterone replacement in menopause acknowledges that randomized trials have not yet definitively demonstrated effects on cognition, mood, energy, and musculoskeletal health, while explicitly noting that "some individuals report improvement of these symptoms" and that better-designed trials with these health issues as primary outcomes are needed [4]. The framing reflects a real shift: the limits of current trial evidence are now being characterized as a research gap to be filled rather than a reason to assume the effects don't exist.
The 2025 American Urological Association/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause—the first comprehensive guideline of its kind—similarly represents a recent institutional recognition that menopause-related hormonal changes have effects extending well beyond what existing guidelines had previously addressed [5]. The trajectory is the same: formal medical guidance catching up with clinical practice.
What This Means Practically
For menopausal women considering testosterone therapy, the practical implication is that:
- For libido and sexual function complaints meeting HSDD criteria, the evidence is robust and well-established.
- For the broader symptom picture (mood, energy, cognition, joints, body composition), the biological case is strong, the clinical evidence is consistent, and many women experience meaningful benefit—even though the formal randomized trial evidence is still being developed.
- The decision should be made with a clinician familiar with current evidence who can discuss what is well-supported and what is reasonable to try based on individual symptoms and goals.
Who Should Consider Testosterone Therapy During Menopause
Based on current biological understanding and clinical evidence, testosterone therapy may be reasonable to discuss with a clinician for menopausal women who:
- Have hypoactive sexual desire disorder (HSDD) with documented personal distress
- Are postmenopausal (natural or surgical) and experiencing reduced libido, energy, mood symptoms, or sexual dysfunction
- Have undergone bilateral oophorectomy or experienced premature ovarian insufficiency
- Are in perimenopause with significant symptoms that have not responded adequately to other interventions
- Are on estrogen and progesterone replacement and continue to experience low energy, low motivation, or persistent symptoms despite adequate estrogen therapy
- Are experiencing joint discomfort, cognitive symptoms, or body composition changes that may reflect declining androgens
Testosterone therapy is not appropriate for women who are:
- Pregnant or breastfeeding (absolute contraindication)
- Trying to conceive
- Diagnosed with active hormone-sensitive cancers (breast, endometrial) without specialist input
- Diagnosed with polycystic ovary syndrome (PCOS) with elevated baseline androgens
- Experiencing undiagnosed vaginal bleeding (workup needed first)
- Severely compromised in liver function
- Experiencing significant baseline acne or hirsutism suggesting androgen excess
Perimenopausal use of testosterone is somewhat more nuanced than postmenopausal use, because hormone levels can fluctuate more substantially during this window and ovarian function has not yet definitively ceased. Decisions in this context benefit from a clinician familiar with perimenopausal hormonal complexity.
How Testosterone Is Prescribed for Menopausal Women
The dominant delivery method—and the one recommended by most expert clinicians who actively prescribe testosterone for women—is a transdermal cream applied to skin once daily.
Transdermal Cream (Preferred)
Testosterone cream is compounded by 503A pharmacies in custom strengths for women and applied to the inner thigh, lower abdomen, or forearm.
- Typical starting dose: 0.5 mL daily, with individual adjustment based on lab response
- Approximately one-tenth of male dosing
- Advantages: Predictable absorption, easy to dose, easily adjustable up or down, lowest risk of supraphysiologic peaks, easy to stop if needed
- Small risk of skin transfer to partners or children, mitigated by rotating application sites and washing hands
Compounded Capsules or Troches
Oral or sublingual options used by some clinicians.
- Advantages: Convenient daily dosing without skin application
- Limitations: Oral testosterone has historically been associated with potential liver effects; troches produce less predictable absorption than transdermal
Pellet Therapy (Generally Not Recommended)
Subcutaneous testosterone pellets implanted every 3 to 6 months. Used by some practitioners, but most experts in women's testosterone therapy advise against them.
Why pellets are problematic for menopausal women:
- Pellets cannot be adjusted or stopped quickly once implanted
- They often produce testosterone levels well above the female physiological range, particularly in the weeks immediately after implantation
- They are responsible for most of the documented serious side effects in women, including irreversible voice changes, clitoral enlargement, and significant hirsutism
- Major endocrine and urologic societies do not recommend pellet therapy for women
If a clinician offers pellets as the only option, that is a sign their toolbox for women's testosterone therapy is incomplete.
Injectable Testosterone
Not appropriate for menopausal women at standard male doses. Some practitioners use very small weekly injections, but this is uncommon, harder to titrate than transdermal, and not standard practice.
Dosing and Monitoring
The fundamental principle of testosterone dosing in menopausal women is to keep circulating levels within the normal premenopausal female range. The reference range for total testosterone in adult women is approximately 15 to 70 ng/dL, with most clinicians targeting the upper end of this range for symptomatic women.
Typical starting and monitoring approach:
- Baseline assessment before starting therapy: comprehensive hormone panel including total and free testosterone, estradiol, progesterone, DHEA-S, thyroid function, and other relevant markers
- Starting dose: 0.5 mL transdermal cream daily, with adjustment based on individual response
- Follow-up testosterone level at 4 to 6 weeks to verify therapeutic range
- Periodic re-testing every 6 months while on therapy
- Clinical re-evaluation for response and any side effects at each follow-up
Goal: Symptomatic improvement with circulating testosterone within the female physiological range. Doses producing levels above the upper limit of the female reference range substantially increase the risk of side effects without proportionate benefit.
For most menopausal women, dose adjustment is based on the combination of lab values and clinical response. Lab values alone are not sufficient. Some women feel best at the low end of the reference range, others at the high end. Tracking how the patient feels alongside the lab numbers is essential.
For a deeper treatment of hormone testing, see our Complete Female Hormone Panel.
Testosterone Plus Estrogen and Progesterone: The Integrated Menopausal Hormone Approach
Testosterone therapy in menopausal women is usually most effective as part of a coordinated hormone replacement approach rather than as monotherapy. The three primary hormones address different aspects of the menopausal disruption:
- Estrogen primarily addresses hot flashes, night sweats, vaginal dryness, sleep disruption, bone protection, and cardiovascular tissue health. The 2025 AUA Genitourinary Syndrome of Menopause guideline now formally recommends local low-dose vaginal estrogen for menopausal symptoms affecting the vulva, vagina, and lower urinary tract [5].
- Progesterone is essential for women with a uterus on estrogen (for endometrial protection) and contributes to sleep, anxiety reduction, and mood stability.
- Testosterone primarily addresses libido, mood, energy, motivation, lean tissue preservation, joint comfort, and cognitive symptoms.
Many menopausal women benefit from a coordinated regimen of all three. The integrated approach generally produces better overall symptom relief than addressing any single hormone in isolation.
The 2025 AUA guideline reinforces a related point: vaginal estrogen is recommended for women with vulvovaginal symptoms, recurrent urinary tract infections, dryness, or pain with intercourse, and is often prescribed alongside systemic hormone therapy for women experiencing multiple symptom domains. For many menopausal women, comprehensive hormonal care involves multiple interventions targeting different symptom domains.
Testosterone and GLP-1 Medications: A Note for Menopausal Women on Weight Loss Drugs
A meaningful portion of menopausal women are now on GLP-1 receptor agonists (semaglutide, tirzepatide, and others) for weight management. This creates a specific consideration that the broader testosterone literature has not historically addressed.
The body composition issue. GLP-1 medications are remarkably effective at producing weight loss, but studies suggest that 25 to 40 percent of the weight lost during GLP-1 therapy may come from lean muscle mass if not actively addressed.
For menopausal women, this matters substantially. Menopause has already initiated a sarcopenic trajectory before GLP-1 therapy begins—estrogen withdrawal and testosterone decline have already started reducing lean tissue. GLP-1-driven weight loss accelerates an existing process. The result can be significant fat reduction alongside meaningful loss of metabolically active tissue.
Where testosterone fits. Testosterone is one of the most direct hormonal interventions for muscle preservation in women. Its decline is a key driver of midlife sarcopenia, and its restoration—where clinically appropriate—provides a biologically coherent way to shift the composition of GLP-1-driven weight loss toward fat rather than lean tissue.
For menopausal women on GLP-1 medications who are also experiencing other testosterone-related symptoms (low libido, mood changes, joint pain, energy loss), the case for combining testosterone therapy with GLP-1 medication is particularly strong. For a deeper treatment of how hormone replacement therapy and GLP-1 medications work together, see our analysis of HRT and GLP-1 combination therapy in menopause.
Side Effects and What to Expect
At physiologic doses with appropriate monitoring, testosterone therapy in menopausal women is generally well-tolerated. Side effects are usually mild and reversible at proper doses.
Possible side effects:
- Mild acne—the most common; usually resolves with dose adjustment
- Mild increase in facial or body hair—most common in genetically predisposed women; usually reversible
- Hair changes on the scalp—some women experience improvement, others occasional thinning
- Voice changes (deepening)—rare at physiologic doses; important to recognize early because voice changes can be irreversible if dose is not promptly reduced
- Mood changes—usually positive (improved mood, more motivation), occasionally irritability at higher doses
- Clitoral enlargement—rare at physiologic doses; can be irreversible if not addressed
- Mild skin or hair greasiness
- Skin reaction at application site for transdermal products
The single most important safety principle: the dose makes the difference between benefit and harm. Properly dosed transdermal therapy with regular monitoring rarely produces significant side effects. Most documented serious adverse effects in women have occurred with pellet therapy or self-administered male-dose products.
How Long Does It Take to Work?
Different effects emerge on different timelines in menopausal women:
- Mood, energy, and sleep: Many women notice changes within 2 to 4 weeks
- Libido and sexual function: Full effects typically emerge over 6 to 12 weeks
- Cognitive clarity: 4 to 12 weeks for most who respond
- Joint comfort: 4 to 12 weeks for most
- Body composition (lean mass, fat distribution): Months to a year of consistent therapy
- Bone density: Measurable changes typically take 12 months or more
Most clinicians recommend trying testosterone therapy for at least 3 to 4 months before evaluating overall response. Menopausal women who show no improvement on any dimension after 6 months of appropriately dosed therapy may be considered non-responders.
Common Concerns About Testosterone for Menopausal Women
Several beliefs about testosterone therapy in menopausal women are commonly held but inconsistent with current clinical evidence.
"Testosterone will make me look masculine or grow a beard." Not at physiologic doses. The doses used in women are approximately one-tenth of male doses and designed to keep circulating levels within the normal premenopausal female range. Visible masculinizing changes require supraphysiologic dosing, which is not the goal of properly conducted therapy.
"Testosterone is just for sex drive." Sexual desire has the strongest formal trial evidence, but testosterone receptors are present throughout the brain, bone, muscle, joint tissue, and cardiovascular system. The effects on mood, energy, motivation, cognitive function, joint comfort, and body composition are biologically coherent and consistently reported clinically.
"My symptoms are just from menopause—they'll go away." Many menopausal symptoms do not resolve on their own. Hot flashes can persist for a decade or longer. Libido changes, mood symptoms, joint discomfort, body composition shifts, and cognitive changes often progress rather than resolve without treatment. The hormonal disruption that drives these symptoms continues even after the menopause transition is "complete."
"Estrogen replacement should cover everything." It addresses much but not all. Estrogen therapy effectively manages hot flashes, sleep disruption, vaginal symptoms, and bone protection. It is less effective for libido changes, body composition issues, and the broader symptom picture driven by testosterone decline. For many menopausal women, optimal hormone replacement requires addressing all three primary hormones.
"Testosterone for women isn't really safe." At physiologic doses with appropriate monitoring, testosterone therapy is generally well-tolerated. Most documented serious side effects have occurred at supraphysiologic doses, particularly from pellet therapy. Properly conducted therapy has a favorable safety profile.
"My doctor said testosterone isn't appropriate for women." Many primary care physicians and gynecologists have not been trained in current testosterone therapy for women. This is increasingly recognized as a clinician training gap rather than a contraindication. Finding a clinician familiar with off-label testosterone therapy is often necessary to access this treatment.
Frequently Asked Questions
Is testosterone therapy safe during menopause?
At physiologic doses with appropriate monitoring, testosterone therapy is generally well-tolerated. Side effects are usually mild and reversible at proper doses. Safety risks increase substantially at doses exceeding the female physiological range, which is why regular hormone testing and physician oversight are essential. Long-term safety beyond 1 to 2 years has not been formally established by randomized trials, though clinical experience has not surfaced major safety signals when therapy is properly conducted.
What are the benefits of testosterone for menopausal women?
The most established benefits are for hypoactive sexual desire disorder (HSDD) and sexual function. Clinical evidence and patient-reported outcomes also support benefits for mood, energy, motivation, sleep, cognitive clarity, joint comfort, body composition, and lean muscle mass preservation. Testosterone therapy is generally most effective when used as part of a coordinated menopausal hormone approach including estrogen and progesterone.
When should I start testosterone therapy in menopause?
Most clinicians who prescribe testosterone for women start it after a comprehensive symptom assessment and baseline hormone testing has identified low or declining testosterone alongside clinically relevant symptoms. Some clinicians prefer to optimize estrogen first and add testosterone if symptoms persist; others address all three hormones simultaneously from the start. The decision depends on individual symptom profile and clinician preference.
Can perimenopausal women take testosterone?
Yes, though the evidence base and clinical experience are less developed for perimenopause than for postmenopause. The hormonal volatility of perimenopause makes assessment and dosing somewhat more complex, but many perimenopausal women with significant symptoms benefit from testosterone therapy. A clinician familiar with perimenopausal hormonal complexity is particularly valuable in this context.
How is testosterone dosed for menopausal women?
Most commonly as a transdermal cream applied once daily, with doses individualized by lab response. A typical starting dose is 0.5 mL daily. Doses are approximately one-tenth of those used in men. The goal is to keep blood testosterone within the normal female premenopausal range.
Does testosterone help with menopausal weight gain?
Indirectly, yes. Menopause initiates a shift in body composition toward increased central/visceral fat and reduced lean muscle mass. Testosterone therapy contributes to lean mass preservation and may produce favorable shifts in body composition over time, though it is not specifically a weight loss treatment. The effects are gradual and typically take months to a year of consistent therapy.
Will testosterone help with hot flashes?
Probably not directly. Hot flashes are primarily driven by estrogen withdrawal and respond best to estrogen replacement. Some women report indirect improvements in sleep and overall well-being on testosterone that may make hot flashes feel less disruptive, but testosterone is not the primary treatment for vasomotor symptoms.
Will testosterone help with vaginal dryness?
Probably not as a systemic intervention. Vaginal dryness responds best to local vaginal estrogen, formally recommended by the 2025 American Urological Association guideline on genitourinary syndrome of menopause. Testosterone has effects on the vulvar vestibule that some specialists address with compounded preparations, but for general vaginal symptoms, estrogen is more directly therapeutic.
Can I take testosterone with estrogen and progesterone?
Yes, and this is often the optimal approach. The three primary hormones address different aspects of the menopausal disruption: estrogen for hot flashes and vaginal symptoms, progesterone for endometrial protection (in women with a uterus) and sleep, and testosterone for libido, mood, energy, and body composition. Many menopausal women benefit from coordinated replacement of all three.
Should I take testosterone if I'm on Ozempic or Mounjaro?
For menopausal women on GLP-1 medications, testosterone takes on additional clinical relevance. Studies suggest that 25 to 40 percent of GLP-1-driven weight loss can come from lean muscle mass if not actively addressed. For menopausal women already on a sarcopenic trajectory, this compounds an existing process. Testosterone is one of the most direct hormonal interventions for preserving muscle during rapid weight loss. The case for combining testosterone with GLP-1 medications is particularly strong for menopausal women who are otherwise candidates for testosterone therapy.
Is testosterone safe after a hysterectomy?
Yes, generally. Women without a uterus do not need progesterone (which is required for endometrial protection in women with a uterus on estrogen) but can take testosterone alongside estrogen. Hysterectomy itself does not contraindicate testosterone therapy. If the hysterectomy included bilateral oophorectomy (removal of the ovaries), testosterone deficiency is often more pronounced and replacement may be particularly beneficial.
Will testosterone affect my breast cancer risk?
Current evidence on testosterone and breast cancer risk in menopausal women is mixed. Some observational data has suggested potential protective effects of testosterone against breast cancer; other analyses have raised concerns. The evidence is not yet sufficient to draw firm conclusions in either direction. For menopausal women with a history of hormone-sensitive breast cancer, testosterone therapy decisions should involve both the prescribing clinician and the oncology team. For women without breast cancer history, the current evidence does not contraindicate testosterone therapy at physiologic doses.
What's the difference between testosterone for menopause and pellet therapy?
Pellet therapy is a specific delivery method that most experts in women's testosterone therapy now advise against. Pellets deliver testosterone levels well above the female physiological range, cannot be adjusted once implanted, and are responsible for most of the documented serious side effects in women. Transdermal cream is the preferred delivery method, providing predictable physiologic dosing with flexibility to adjust.
Where can I get testosterone therapy for menopause?
Testosterone therapy for menopausal women is available through some gynecologists, urologists with women's health focus, endocrinologists, menopause specialists, integrative medicine practitioners, and women's-health-focused telemedicine providers. The key consideration is finding a clinician who actively prescribes testosterone for women, has experience with appropriate dosing and monitoring, and uses transdermal rather than pellet delivery. Healthspan offers testosterone therapy for menopausal women as part of our Women's Hormone Health Program.
How much does testosterone therapy cost?
Insurance coverage for off-label testosterone in women is variable and often limited. Cash prices for compounded testosterone cream typically run $30 to $80 per month. Healthspan's Women's Hormone Health Program starts at $99 per month on a three-month plan or $129 for a single month, with medication billed separately when prescribed.
How Healthspan Approaches Testosterone Therapy for Menopause
The Healthspan Women's Hormone Health Program provides physician-supervised testosterone therapy as part of a comprehensive approach to menopausal hormone health. Our program includes:
- Comprehensive baseline assessment. A complete Female Hormone Panel including total and free testosterone, estradiol, progesterone, DHEA-S, thyroid function, and other relevant markers
- Detailed clinical evaluation. Assessment of symptoms, medical history, and treatment goals to determine appropriate hormone replacement approach
- Personalized prescription. Testosterone is typically prescribed as a compounded transdermal cream at individualized dosing
- Coordinated care. For women using testosterone as part of broader menopausal hormone therapy, our clinicians coordinate the full hormonal protocol (estrogen, progesterone, testosterone) rather than treating any single hormone in isolation
- Ongoing monitoring. Follow-up labs at 4 to 6 weeks and every 6 months thereafter
- Integrated health coaching. Dedicated coach support addressing sleep, nutrition, movement, and stress as contributors to menopausal hormone health
- Coordination with GLP-1 therapy when applicable, particularly for women interested in addressing both metabolic and hormonal aspects of the menopause transition together
Membership pricing starts at $99 per month on a three-month plan or $129 for a single month. Medication is billed separately and only when prescribed.
Conclusion
The conversation about menopause is changing in important ways. For decades, women in midlife received minimal hormonal care—their symptoms attributed to inevitable aging, their hormone replacement options narrow and often avoided, the broader hormonal disruption of the menopause transition largely unaddressed. That picture is shifting, driven by updated scientific evidence, evolving clinical practice, and a growing recognition that menopause deserves better medical attention than it has historically received.
Testosterone has been the most overlooked piece of menopausal hormone therapy. Despite being the most abundant biologically active hormone in the female body before menopause, despite declining substantially during the transition, and despite contributing to symptoms across mood, energy, cognitive function, joint comfort, body composition, and sexual function, testosterone has rarely been part of standard menopausal care in the United States.
That is no longer defensible. The evidence base for testosterone in postmenopausal women with HSDD is well-established. The clinical evidence for its broader effects on mood, energy, joints, cognition, and body composition is consistent and increasingly compelling. The hormonal logic of menopause—the simultaneous decline of estrogen, progesterone, and testosterone—argues for replacement approaches that address all three rather than any one in isolation.
What menopausal women considering testosterone therapy need most is a clinician who actively prescribes it, understands appropriate physiologic dosing, monitors carefully, and is willing to think about hormone replacement as a coordinated approach rather than three separate decisions. Properly conducted, testosterone therapy for menopause can produce meaningful improvements in symptoms that estrogen alone may not fully address, and contribute to the broader healthspan goals that increasingly define how women approach the midlife transition.
The cultural and medical shift toward treating menopause with the seriousness it deserves is well underway. Testosterone therapy is an essential part of that shift.
Related Research
- Davis, S. R., Baber, R., Panay, N., Bitzer, J., Cerdas Perez, S., Islam, R. M., Kaunitz, A. M., Kingsberg, S. A., Lambrinoudaki, I., Liu, J., Parish, S. J., Pinkerton, J., Rymer, J., Simon, J. A., Vignozzi, L., & Wierman, M. E. (2019). Global consensus position statement on the use of testosterone therapy for women. Journal of Clinical Endocrinology and Metabolism, 104(10), 4660–4666. https://academic.oup.com/jcem/article/104/10/4660/5556103
- Davis, S. R., Azene, Z. N., Tonkin, A. M., Woods, R. L., McNeil, J. J., & Islam, R. M. (2024). Higher testosterone is associated with higher HDL-cholesterol and lower triglyceride concentrations in older women: an observational study. Climacteric, 27(3), 282–288. https://pubmed.ncbi.nlm.nih.gov/38334088/
- Islam, R. M., Bell, R. J., Green, S., Page, M. J., & Davis, S. R. (2019). Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. The Lancet Diabetes & Endocrinology, 7(10), 754–766. https://doi.org/10.1016/S2213-8587(19)30189-5
- British Menopause Society. (2026). Tool for Clinicians: Testosterone Replacement in Menopause. https://thebms.org.uk/wp-content/uploads/2026/05/08-NEW-BMS-TfC-Testosterone-replacement-in-menopause-MAY2026-A.pdf
- American Urological Association. (2025). American Urological Association Releases New Guideline on Genitourinary Syndrome of Menopause. https://www.auanet.org/about-us/media-center/press-center/american-urological-association-releases-new-guideline-on-genitourinary-syndrome-of-menopause
- Hemachandra, C., Islam, R. M., Bell, R. J., Sultana, F., & Davis, S. R. (2023). The association between testosterone and depression in postmenopausal women: A systematic review of observational studies. Maturitas, 168, 62–70.
- Cleveland Clinic. (2025). Testosterone Therapy for Women: What To Know. https://health.clevelandclinic.org/testosterone-in-women
- Cedars-Sinai. (2026). Testosterone Therapy for Women. https://www.cedars-sinai.org/stories-and-insights/expert-advice/testosterone-therapy-for-women
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