Testosterone for Menopause: What It Helps, What It Doesn't, and What the FDA Just Said

Testosterone has become one of the most talked-about menopause treatments of 2026. Social media calls it the missing piece of HRT, telehealth clinics sell it for energy and brain fog, and off-label prescribing to women in the US has roughly tripled in five years.

On September 17, 2026 the US Food and Drug Administration held its first public meeting on testosterone for menopausal women. The FDA received more than 1,320 public comments beforehand, and at the meeting it said it "stands ready to have discussions with drug sponsors" about an approved product for women.

So is testosterone the menopause breakthrough people say it is? The honest answer: it works well for one specific problem, the evidence for everything else is weak, and how you get it matters a lot. This guide covers all three.

Quick answer

• The one proven use: low sexual desire that bothers you (called hypoactive sexual desire disorder, or HSDD) after menopause. The Global Consensus Position Statement calls this the only evidence-based reason to prescribe testosterone to women.
• Not proven: energy, mood, memory, brain fog, bone strength, or muscle. Clinical trials have not shown a benefit for any of these.
• Dose: about one-tenth of a man's dose, applied to the skin, aiming for blood levels in the normal female range.
• In the US: no testosterone product is FDA-approved for women. Doctors prescribe small doses of men's gels off-label, or use compounded products.
• What the FDA meeting means: nothing changes today. The FDA is inviting drug companies to run the long-term studies it would need before approving a product.

Why testosterone matters for women at all

Testosterone isn't only a male hormone. Before menopause, the ovaries and adrenal glands make it every day, and it plays a real part in sexual desire, arousal, and the health of sexual tissues. The British Menopause Society puts it plainly: "premenopausal women produce both testosterone and estrogen physiologically."

Levels fall gradually with age. They fall much more sharply after surgical menopause (removal of both ovaries) or menopause caused by medical treatment, and those women often notice the change in libido most.

There is a catch, though, that shapes everything below. A low testosterone blood result alone is not a reason to treat. The BMS points out that many women with low levels have no distressing symptoms at all, and that blood levels don't reliably match how someone feels. Treatment is based on symptoms, and blood tests are used for safety.

What testosterone actually helps

Low sexual desire after menopause: yes

This is where the evidence is solid. A 2019 meta-analysis in The Lancet Diabetes & Endocrinology pooled 36 randomised trials with 8,480 women. In postmenopausal women, testosterone improved:

• sexual desire
• arousal
• orgasm
• pleasure and responsiveness
• sexual distress (it went down)

On average that works out to about one extra satisfying sexual event per month compared with placebo. That sounds modest, and for some women it is. For others who had lost interest in sex entirely and found that distressing, it makes a real difference. Averages hide a wide range of responses.

Energy, mood, memory, muscle and bone: not proven

This is the gap between the evidence and the marketing. The BMS's May 2026 guidance for clinicians states that randomised trials "have not demonstrated the beneficial effects of testosterone therapy for cognition, mood, energy and musculoskeletal health." The FDA meeting reached the same conclusion: the evidence is strongest for low sexual desire, and benefits for energy, mood, memory and muscle need more study.

That doesn't mean women who report feeling sharper or more energetic on testosterone are imagining it. It means no one has yet shown in a controlled trial that testosterone causes those changes. A UK trial called ESTEEM is now testing testosterone's effect on overall menopause quality of life in 400 women, which should give the first proper answer.

If fatigue, low mood, or brain fog are your main symptoms, those are well worth treating, but they usually point elsewhere first: estrogen-based menopausal hormone therapy, sleep, thyroid, iron, or depression.

Who is a good candidate

Current guidance from NICE (NG23), the BMS, and the International Society for the Study of Women's Sexual Health lines up closely. Testosterone is worth considering when:

1. Low sexual desire is the main problem, and it bothers you. Low desire on its own isn't a disorder. It becomes one when it causes you distress.
2. Other causes have been looked at. Relationship strain, stress, depression, and medications (especially SSRI and SNRI antidepressants) all lower libido, and testosterone won't fix them.
3. Estrogen HRT has been tried first. NICE and the BMS both recommend a trial of standard HRT before adding testosterone. Many women find their libido returns once hot flashes, poor sleep, and vaginal dryness are treated.
4. Painful sex has been treated. If sex hurts because of vaginal dryness, desire drops for good reason. Vaginal estrogen treats the cause directly. Our vaginal health guide covers the options.

A useful detail: oral estrogen can blunt testosterone's effect. Estrogen tablets raise sex hormone-binding globulin (SHBG), a protein that binds testosterone and keeps it inactive. The BMS notes that switching from tablets to an estrogen patch or gel can raise free testosterone on its own, sometimes enough that no added testosterone is needed.

How it is prescribed

The form: skin, not tablets

Guidelines agree on transdermal testosterone, a gel or cream rubbed into the skin. The 2019 meta-analysis found that oral testosterone raised LDL ("bad") cholesterol, while testosterone through the skin did not. Oral forms aren't recommended.

The dose: about a tenth of a man's

Where no women's product is licensed, doctors prescribe a man's testosterone gel at roughly one-tenth of the male dose, which comes to about 5 mg a day. In practice that means a fraction of a sachet or a single pump every other day. The goal is to bring levels back into the normal range for a premenopausal woman, not above it.

In Australia, New Zealand and South Africa, a 1% testosterone cream designed for women (AndroFeme) is licensed. The UK regulator has granted it marketing authorisation, and the BMS expects the pump-pack version to reach UK pharmacies during 2026.

Applying it

Per BMS guidance:

• Apply to clean, dry skin on the lower abdomen or upper thighs, and let it dry before dressing.
• Wash your hands straight after.
• Don't let partners or children touch the area until it has dried. Testosterone can transfer through skin contact.
• Avoid washing the area for 2 to 3 hours.
• Rotate where you apply it to avoid local hair growth.

Monitoring and timelines

• Before starting: a total testosterone blood test, to make sure your levels aren't already high.
• At about 3 to 6 weeks (or at your first review, often 2 to 3 months): a repeat test to check you're within the female range.
• Then every 6 to 12 months while you stay on it.
• Give it 3 to 6 months to judge whether it's working. The Global Consensus advises stopping if there is no benefit by 6 months.

Unlike men on testosterone, women on physiological doses don't need routine blood counts or cholesterol checks.

Side effects and risks

When blood levels stay in the female range, side effects are uncommon. The BMS lists the most common as:

• Excess hair growth (face, chin, or where the gel is applied)
• Acne
• Weight gain

These usually go away when the dose is lowered or stopped. Scalp hair loss, a deeper voice, and clitoral enlargement are rare at physiological doses. They are much more likely when levels climb too high, and a deepened voice may not reverse.

The bigger open question is long-term safety. Meta-analyses have found no serious adverse events at physiological doses, but most trials lasted under two years, and women at high risk of heart disease were usually excluded. The FDA named three specific gaps at its September meeting:

1. Cardiovascular disease - existing studies are short and often not randomised.
2. Breast cancer - studies of women's own natural testosterone levels have given conflicting results.
3. Safety beyond 24 months - there is very little data past two years.

Who should avoid it or take extra care

• Pregnancy or breastfeeding
• Active liver disease
• A history of hormone-sensitive breast cancer (specialists sometimes make exceptions, with full discussion)
• High baseline testosterone
• Competitive athletes, who need levels kept well within the female range

For how testosterone fits alongside the rest of hormone therapy, see our guide to the risks of HRT.

Pellets and compounded testosterone: a different story

Much of the recent growth in US testosterone use isn't gels at physiological doses. It's pellets implanted under the skin and compounded creams from specialty pharmacies, often sold through wellness and telehealth clinics.

Menopause societies and regulators recommend against both, for concrete reasons:

• Pellets can't be adjusted or removed once placed. They release testosterone for months, often at levels well above the female range. At the FDA meeting, supraphysiological levels (500 ng/dL and higher) were flagged as carrying unknown long-term risks, and pellets as a route that can deliver them.
• Compounded products aren't standardised. Strength can vary from batch to batch, they haven't been tested for safety and effectiveness the way approved drugs are, and there is no reliable system for reporting side effects.
• They are often marketed for unproven uses such as energy, weight loss, or anti-ageing.

If a clinic suggests testosterone pellets, or wants to start testosterone without a baseline blood test and a plan for follow-up tests, get a second opinion.

What the FDA meeting changes, and what it doesn't

What happened: On September 17, 2026, the FDA's Office of Women's Health and its drug evaluation centre co-hosted a public workshop on testosterone for menopausal women. US health officials called it "unacceptable" that American women lack a testosterone product approved for them. The FDA signalled it is open to approving one and invited drug companies to talk.

Why there's no approved product yet: It isn't a new question. In 2004, an FDA advisory committee declined to back a testosterone patch for women, citing a lack of long-term safety data. Since then, few companies have been willing to pay for the multi-year trials the FDA requires. The BMS notes that industry's reluctance to fund these studies has been as big a barrier as the safety questions themselves.

What it means for you right now: Nothing about access changes this year. US prescribing stays off-label. Any approved product is years away, because it would first need the long-term trials the FDA described. Public comments on the workshop are open until October 19, 2026.

What it may mean later: An approved women's product would come with a standard dose, proper labelling, quality control, and more willingness from insurers to cover it. It would also make it easier to spot the clinics selling high-dose pellets for unproven uses.

Non-testosterone options for low libido

Testosterone isn't the only treatment for HSDD. In December 2025, the FDA expanded the approval of flibanserin (Addyi) to include women under 65, making it the first FDA-approved medicine for HSDD after menopause. It is a daily, non-hormonal tablet that acts on brain chemistry.

Other approaches with good evidence:

• Sex therapy or couples therapy, which the guidelines recommend alongside any hormone treatment
• Treating vaginal dryness and pain with vaginal estrogen or moisturisers
• Reviewing medications that lower libido
• Treating sleep problems, depression, and hot flashes, all of which suppress desire

How Femora helps

Low libido during menopause rarely comes alone. It sits alongside sleep, mood, hot flashes, and vaginal symptoms, and any treatment decision depends on that whole picture.

In Femora you can log symptoms day by day, including libido, mood, sleep, and hot flashes, and see how they change after starting or adjusting HRT. If you do try testosterone, a few months of logs give you and your clinician something concrete to judge at the 3 to 6 month review, rather than relying on memory. The menopause symptom score is a quick way to see your baseline before an appointment, and our guide to starting HRT explains what to track in the first few months.

Frequently asked questions

Does testosterone help with menopause symptoms? It helps with one symptom that has strong evidence: low sexual desire that causes distress. Trials have not shown it helps hot flashes, energy, mood, memory, or bone and muscle strength. Estrogen-based HRT remains the main treatment for most menopause symptoms.

Is testosterone FDA-approved for women? No. As of September 2026, no testosterone product is FDA-approved for women in the US. Doctors prescribe small doses of men's products off-label. The FDA held a public meeting on September 17, 2026 and said it is open to approving a women's product, but that would need long-term safety trials first.

How much testosterone do women take? About one-tenth of a man's dose, typically around 5 mg a day of testosterone through the skin as a gel or cream. The aim is blood levels within the normal range for premenopausal women.

How long does testosterone take to work for libido? Some women notice changes within a few weeks, but guidelines advise allowing 3 to 6 months to judge fully. If there is no benefit by 6 months, it should usually be stopped.

What are the side effects of testosterone for women? The most common are excess hair growth, acne, and weight gain, which usually reverse with a lower dose. Scalp hair loss, a deeper voice, and clitoral enlargement are rare at physiological doses but more likely if levels go too high.

Are testosterone pellets safe for women? Menopause societies don't recommend them. Pellets can't be removed or adjusted once placed and often produce levels well above the normal female range, where long-term risks are unknown.

Do I need to be on estrogen HRT to use testosterone? Guidelines recommend trying standard HRT first, because treating estrogen deficiency often improves libido on its own. Testosterone can work without estrogen, but androgen side effects such as acne and hair growth are more common, so it is usually added to HRT.

Should I get my testosterone level tested to see if I need it? A low level alone isn't a reason to treat, because blood levels don't match symptoms well. Testing is used before and during treatment to keep levels safe, not to diagnose the need for it.

The bottom line

Testosterone for women isn't a fad, and it isn't a cure-all. For postmenopausal women whose low sexual desire is distressing, it is one of the best-studied options available, used at the right dose, through the skin, with blood tests. For energy, mood, and memory, the trials haven't shown a benefit yet. The FDA meeting is a sign that proper, approved products may finally come to US women, but not soon.

If you're considering it, start the conversation with your clinician about the symptom that bothers you most, not the hormone, and bring your notes.

Download Femora to track your menopause symptoms and see what changes with treatment.