08/22/2025
Testosterone, normally thought of as a male hormone, is produced by women for their entire lives. It peaks in women’s twenties. Then there is a gradual decline over time with an actual rise again in women’s seventies. It is produced both by the ovaries (even after menopause) and by the adrenal glands. Make no mistake – menopause has become big business. Social media in general, and celebrity influencers have brought menopause out of the closet and testosterone therapy for women is one of their topics.
Unfortunately, many of these folks are “selling” something, whether it be supplements, lifestyle, books, access to their mailing lists, and even the ability to obtain hormones easily online without even an examination. There is an especially tremendous amount of “buzz” about testosterone. There are claims that it can boost mood, cognition, muscle strength, and heart health – none of which have been substantiated with good, scientific research. What has been demonstrated is that women who have an entity known as HSDD (hypoactive s*xual desire disorder) have been shown to increase one s*xually satisfying event per month with the use of topical testosterone in doses meant for women.
Let’s take a closer look at HSDD. Many of my menopausal patients will report a diminished interest in s*xual activity. Many of these patients have been with the same partner for many decades. It is essential to find out if part of the couple’s problem may stem from a male factor (prostate issues, ED, etc.) or relationship conflicts (perhaps needing a marriage counselor). The majority of such patients will come in and ask me, “I love my husband. We’ve been married for thirty years. I’m just not that interested in s*x. Is there something wrong with me?” Neither they nor their partner seem upset (the medical term for this is distress). I often find myself explaining that, as higher order primates, now that she can no longer procreate, why would she assume that her urges to copulate would be as great. The society often has her believing that every other couple is “swinging from the chandeliers,” and she is the only one that is not as interested as she was in her youth. I assure her this is not the case.
However, the occasional patient who has diminished desire, and this is causing her distress, constitutes what is known as HSDD. The use of topical testosterone therapy for women has been shown to statistically improve that (as mentioned above to the order of one extra s*xually satisfying event per month). Some patients often complain to me that there are so many medications to enhance male s*xuality, and yet very little for women. They complain that women’s health research is not a priority. When it comes to this issue nothing could be further from the truth. If pharmaceutical companies could invent a female Vi**ra, they would absolutely do so because the profitability of such would be tremendous. The problem is that a woman needs to utilize testosterone in the form of a patch or a cream or gel twenty-four hours a day, seven days a week, whereas men take a blue pill and twenty minutes later have an er****on like they were twenty years old.
In fact, as early as 2004, Proctor and Gamble spent tremendous resources to develop the Intrinsa Patch. The FDA denied its approval in spite of showing that one improved s*xually satisfying event per month in the clinical trials. There were concerns about cardiovascular safety and breast health safety. In 2017, Biosante brought Libigel forward. Although there was improvement in s*xual satisfaction in women with HSDD, it was not statistically greater than the placebo group and thus did not meet requirements for FDA approval.
However, many healthcare providers have resorted to compounded versions of testosterone. Sometimes these are administered as long-acting pellets that are placed under the skin, often by anti-aging providers or sometimes even in day spas. Too much testosterone above the normal range for women can result in some serious and often non-reversable side effects including acne, irritability, aggression, thinning of hair on the head while increasing hair growth on the face and chest, deepening of the voice, and enlargement of the cl****is. Furthermore, since testosterone is converted by adipose tissue to a form of estrogen known as estrone, high testosterone levels can also lead to a thickening of the uterine lining and vaginal bleeding and increase the risk for endometrial precancers and cancers.
Some practitioners are prescribing FDA approved formulations for men and advising women to use one tenth the amount. I have been reluctant to do so because I have seen errors in the amount applied resulting in the above-mentioned side effects. More recently, the FDA in Australia has approved a formulation of testosterone cream specifically for women for hypoactive s*xual desire disorder. This, therefore, is quality-controlled because it is not compounded. It is also formulated specifically for women. Thus, in my patients who will potentially benefit from testosterone therapy, this has been the formulation that I have been utilizing. I feel confident in its safety, both in terms of quality and dosing. It has been my experience thus far that approximately 50% of the patients to whom I have prescribed this seem to have benefit, whereas the other 50% seemed to notice little change.
Hopefully, this is helpful in reducing some of the confusion that has been promulgated by social media and its devotees regarding testosterone therapy for women.
