Women are turning to testosterone, but what does the science actually say?

Source: The Conversation – UK

A recent BBC report described women posing as men to get hold of testosterone gel, hoping to improve their menopause symptoms, because female testosterone products are not easily available to them. But why is the appetite for this predominantly male hormone exploding and are there risks involved?

Testosterone is usually thought of as the defining male hormone. It is linked to puberty, muscle development and reproductive function. But this overlooks an important biological reality. Women also produce testosterone, and it plays important roles throughout the body.

Although blood concentrations are typically about ten to 15 times lower than in men, testosterone remains biologically active in women.

Women make testosterone in their ovaries and adrenal glands, and the body also makes it by changing other hormones in fat, skin and muscle. Some of this testosterone is then used to make oestradiol, the main form of oestrogen in women of reproductive age.

But testosterone is not simply an oestrogen reservoir. It also acts directly on tissues throughout the body, including the bones, muscles, heart and blood vessels, and the brain. This has led researchers to look more closely at how testosterone may affect women’s health.

Similar to men, testosterone declines gradually across the reproductive lifespan, although patterns vary between individuals. This fall begins well before menopause, and unlike oestrogen, it doesn’t fall sharply at menopause as the ovaries decline.

Measuring how far it’s fallen is its own problem. Female levels are so low that routine blood tests have historically struggled to measure them reliably, making it hard to precisely define “normal” concentrations.

So why are increasing numbers of women interested in testosterone therapy after menopause?

What the evidence says

Because testosterone is known to influence sexual desire, one of its most studied uses in women is for hypoactive sexual desire disorder (HSDD) – persistent low sexual desire that causes distress.

A 2019 meta-analysis of 36 randomised trials found that carefully dosed testosterone can improve sexual desire and satisfaction in some postmenopausal women. International clinical guidelines recognise testosterone therapy as an evidence-based treatment for HSDD, the only condition in women for which there is enough clinical evidence to recommend testosterone therapy.

Sexual desire is shaped by relationships, stress, fatigue and mental health as much as by any single hormone. Testosterone is one input among several rather than a master switch.

Beyond sexual desire, high-quality clinical trial evidence in women is largely absent. But this does not necessarily mean testosterone has no broader influence on women’s health.

Randomised trials are the best way to establish whether a treatment causes a particular effect, but they cannot capture everything that happens in everyday medical practice. Patients may have other health problems or take several medicines, making it harder to know whether an improvement is due to testosterone or something else.

Testosterone is not a replacement for standard menopause hormone therapy. When it is prescribed, it is usually alongside oestrogen – and sometimes progesterone. Some women report that even after their conventional HRT (hormone replacement therapy) has been optimised, they still do not feel that their symptoms are fully addressed, and that adding testosterone makes a noticeable difference.

Women and doctors using testosterone in routine menopause care report improvements beyond sexual function. A recent UK study of 510 women at a specialist menopause clinic found that after four months on testosterone gel, women reported improvements in mood, cognitive symptoms and libido. These findings are interesting, but do not prove that the testosterone treatment caused these changes.

Real-world evidence should not replace randomised trials, but neither should the absence of large trials mean that these observations be simply dismissed. Instead, they can help identify effects worth testing in the clinical trials that are still needed.

A market that’s only just catching up

The evidence for using testosterone in women is strongest for sexual desire, but products made specifically for women have been much slower to arrive. In the US, for example, there’s still no approved testosterone product for women.

Of the three major sex hormones produced by the ovaries, oestrogen and progesterone have widely licensed products for women. Testosterone has been much slower to follow, with female-specific products still limited in many countries. This is despite evidence that testosterone can be used safely in women when given at doses designed to keep levels within the physiological female range.

International guidelines have recognised the lack of suitable products for women and called for testosterone treatments designed specifically for them. The issue is now receiving attention from regulators. In September 2026, the US Food and Drug Administration held a public workshop examining evidence gaps and the need for future drug development in this area.

Australia has led the way with Androfeme, a testosterone cream, being formally registered in 2020, specifically for female use. The UK granted it a marketing authorisation in July 2025, but it is not yet routinely available through the NHS.

The workaround has been men’s gel, measuring out a tenth of a sachet by eye. This is a less precise way to deliver a hormone for which the therapeutic dose is so small. If too much is applied, testosterone can rise above the desired range, increasing the likelihood of side-effects, such as acne and increased facial or body hair.

More importantly, evidence on the long-term safety of testosterone in women remains limited, particularly for heart disease, stroke and breast cancer, because trials have generally been short and often excluded women at higher risk of these conditions.

Demand continues to climb despite these uncertainties. NHS prescriptions to women in England rose roughly tenfold between 2015 and 2022, and in the US, testosterone prescribing has almost tripled over the past decade. The need for licensed female-specific testosterone products cannot be ignored, not just to improve access but to allow testosterone in women to be studied with the same scientific rigour it deserves.

Daniel Kelly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Original source: https://analysis1.mil-osi.com/2026/10/01/women-are-turning-to-testosterone-but-what-does-the-science-actually-say/