What testosterone does for women in perimenopause
Short answer
Testosterone is not just a male hormone. Women make it too, in the ovaries and adrenal glands, and it plays a real role in sexual desire, energy, mood, and muscle. Levels decline gradually with age, and by the time a woman reaches menopause her testosterone is roughly half what it was in her twenties.
The catch is that no testosterone product is FDA-approved for women in the United States. Anyone prescribed testosterone here is getting it off-label, and prescribing has climbed sharply in the past few years as more clinicians and patients ask about it.
On this page
What testosterone actually does in a woman's body
Testosterone contributes to sex drive, the ability to reach orgasm, muscle mass, bone density, and a general sense of drive or vitality. It works alongside estrogen and progesterone, not against them, and all three shift through perimenopause as ovarian hormone production becomes erratic.
The best-established use is for low sexual desire that causes personal distress, a condition doctors call hypoactive sexual desire disorder, or HSDD. That is where the clinical trial evidence is strongest. Claims about testosterone fixing energy, brain fog, or mood are much less settled, and worth reading skeptically (see our evidence and risks page).
Why there is no FDA-approved product for women
Several companies tried to bring a female-specific testosterone patch or gel to market in the 2000s and 2010s. The FDA rejected them, largely over long-term safety data, particularly cardiovascular and breast cancer risk in postmenopausal women, that regulators felt was not yet sufficient.
In 2026 the FDA issued guidance on a development pathway for a new female-specific formulation, which is a meaningful sign of movement, but as of today nothing has been approved. Until one is, testosterone for women in the US means an off-label prescription, usually a men's product used at a fraction of the dose.
Why prescribing has surged
A 2026 analysis found testosterone prescribing for US women rose about 2.6-fold between 2016 and 2025, with the sharpest acceleration from 2022 onward. Midlife women aged 45 to 64 now account for well over half of all prescriptions, and telehealth clinics focused on menopause care have made testosterone easier to ask about and access than it was a decade ago.
That growth is not, by itself, proof the drug is being used well. Researchers who tracked the trend flagged that a lot of this off-label use is happening without the monitoring and dose limits the specialist guidelines call for, which is exactly why understanding the evidence before starting matters.
- Prescribing rose from about 50 to over 130 per 100,000 eligible women between 2016 and 2025.
- The 45-64 age group has the highest exposure rate, roughly double the overall population rate.
- Growth has been driven largely by telehealth and menopause-focused clinics, not traditional endocrinology.
Where testosterone fits with other perimenopause treatment
Testosterone is usually considered after, or alongside, estrogen therapy, not instead of it. The 2019 Global Consensus Position Statement, backed by more than a dozen medical societies, recommends testosterone specifically for postmenopausal HSDD after other causes of low desire have been ruled out, and only with proper baseline and follow-up testing.
If low libido is your main concern, it is worth reading about the range of options, hormonal and non-hormonal, before deciding testosterone is the right starting point.
When to see a doctor
- Persistent low sexual desire that causes you distress, especially if it is a change from your baseline.
- Before starting any testosterone product, since baseline bloodwork and monitoring matter for safety.
- New acne, voice changes, or unusual hair growth while on testosterone, which can signal too high a dose.
Frequently asked questions
What does testosterone do for women?
It contributes to sexual desire and arousal, muscle mass, bone density, and overall energy. The strongest clinical evidence is for improving low sexual desire in postmenopausal women; effects on energy, mood, and cognition are much less proven.
How much does female testosterone decline by menopause?
Levels decline gradually starting in a woman's twenties and thirties, roughly independent of when menopause happens. By the time of menopause, testosterone is typically about half of what it was at peak reproductive age.
What dose of testosterone do women take?
Doses are a small fraction of a typical male dose, since the goal is to restore levels to a normal premenopausal range, not raise them above it. Specific dosing should be set and monitored by a prescriber using bloodwork, not a fixed amount you choose yourself.
Is testosterone the same as HRT?
Testosterone therapy is sometimes grouped under hormone therapy broadly, but it is a separate hormone from the estrogen and progesterone used in standard HRT, and it is prescribed off-label rather than through an FDA-approved product.
Sources
- Urology Times - FDA provides guidance on development pathway for testosterone therapy for womenurologytimes.com - 2026
- JACC: Advances - Accelerating Testosterone Prescribing for U.S. Womenjacc.org - 2026
- Endocrine Society - Global Consensus Position Statement on the Use of Testosterone Therapy for Womenendocrine.org - 2019
Keep reading
- TestosteroneHow women actually get a testosterone prescription
- TestosteroneThe evidence and risks, honestly
- SymptomsLow libido in perimenopause
- Hormone therapyIs HRT safe now?