While some studies suggest low dose testosterone can be helpful for women, especially during menopause, its use is still considered off-label.

In females, testosterone is an important hormone that’s sometimes overlooked. It plays a key role in sexual desire, bone health, muscle strength, thinking ability, and mood.

Currently, regulatory agencies in many countries, including the United States, haven’t approved specific testosterone formulations for females.

Consequently, testosterone prescriptions approved for males are sometimes used off-label for females under careful medical supervision. Off-label use is when a drug that’s approved to treat one condition is used to treat another condition.

Let’s review some reasons why females might consider low dose testosterone therapy.

Before menopause, females produce three times as much testosterone as estrogen (although this is still much lower than males).

However, as females age or undergo procedures like oophorectomy (removal of the ovaries), testosterone levels can decline either gradually or abruptly.

According to a 2020 guide and review of research, some studies suggest that adding testosterone to estrogen replacement therapy can improve sexual function and overall well-being in postmenopausal people.

The review notes that when combined with estrogen as part of hormone replacement therapy (HRT), low dose testosterone may:

  • improve sexual desire, pleasure, arousal, and orgasm
  • enhance self-image
  • improve somatic symptoms, such as muscle aches and joint pain
  • increase bone density
  • enhance cognitive performance
  • increase blood flow to the genitals
  • improve mood, motivation, and energy

While not approved for females in the United States, testosterone has been used for more than 60 years in England and Australia to alleviate symptoms of perimenopause and menopause. In the United States, it’s used off-label under careful medical supervision.

Still, the use of androgens in postmenopausal people is highly controversial. (Androgens are hormones that play a role in male traits and reproduction.) Views differ among sexual medicine experts and professional societies. This can sometimes make getting insurance coverage more difficult.

What are the symptoms of low testosterone in females?

No matter your sex or gender, testosterone plays an important role in your body’s overall health. In females and other estrogen-dominant bodies, low levels of testosterone can lead to a variety of symptoms, including:

  • low mood and dissatisfaction
  • unexplained fatigue
  • changes in sexual function, such as reduced libido (sex drive)
  • changes in cognition (thinking, reasoning, and memory)
  • vasomotor symptoms, such as hot flashes and night sweats
  • bone loss
  • decreased muscle strength
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Some evidence suggests that using testosterone can help treat sexual dysfunction, such as hypoactive sexual desire disorder (HSDD), which is marked by distress from a reduced interest in sex.

More research needs to be done, but one study from 2010 found that participants saw significant improvement in sexual function and reduced personal distress over symptoms. No large differences were reported in estradiol levels or unwanted physical changes.

While testosterone is widely available for males, currently there is no Food and Drug Administration-approved source of testosterone for females.

If you’re interested in treating a low libido with testosterone, talk with a doctor to see whether it might be a viable option for you.

Get involved

Want to learn more about how testosterone can affect females? Check out ClinicalTrials.gov. Make sure to always discuss participation in any clinical trial with your primary healthcare professional.

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Some people assigned female at birth may choose to take low dose testosterone as part of their gender affirming care.

Taking low dose testosterone may allow for subtle masculinizing effects, like a deeper voice and increased muscle mass, without a fuller transition to a masculine appearance.

Low dose testosterone may also allow for gradual physical changes, giving individuals time to assess the effects before deciding on further treatment.

Sometimes called a “microdose,” low dose testosterone might be around 20 milligrams per week for injectables, adjusted accordingly for other forms like creams or patches. A microdose is typically smaller than standard HRT doses.

To prevent unwanted hair growth, a 2020 review suggests that testosterone can be combined with 5-alpha-reductase inhibitors. These inhibitors block the conversion of testosterone into a more potent form, which is responsible for hair growth. You can also consider permanent hair removal methods.

Nonbinary people can also use nandrolone, an injectable steroid, to increase muscle mass without excessive hair growth. However, its safety profile is not well studied for medical use, as most data comes from its misuse in athletes.

According to a 2019 position statement from the Brazilian Society of Endocrinology and Metabolism, testosterone therapy in females can sometimes lead to masculinizing symptoms and abnormal bleeding in the uterus. There are also concerns about breast cancer and cardiovascular risks.

Possible side effects of high testosterone in females may include:

  • acne and oily skin
  • increased facial and body hair growth
  • deepening of the voice
  • changes in body odor
  • menstrual changes, including stopping periods
  • clitoral enlargement
  • breast atrophy (shrinking of breast tissue)
  • breast sensitivity changes
  • increased muscle mass and strength
  • redistribution of body fat
  • headaches
  • nausea or vomiting
  • changes in skin color or texture, such as darkening or thickening
  • mood changes, including increased aggression or irritability

Serious side effects of high testosterone in females may include:

  • cardiovascular issues, such as heart attack and stroke
  • liver problems, including liver damage or disease
  • increased risk of blood clots
  • infertility due to suppressed ovulation

Though testosterone is essential to the health and well-being of all bodies, there is limited research on its supplementation in females. Early research has shown some benefits of low dose testosterone therapy include postmenopausal care, gender affirming care, and more.

It’s crucial to discuss testosterone supplementation with a knowledgeable doctor. They can provide personalized advice, regularly monitor hormone levels, and ensure that any supplementation is done safely and effectively.