Testosterone for Menopause: What the Evidence Shows

The short version

One use has trial support: low sexual desire that causes distress after menopause. Pooled randomized trials found about one extra satisfying sexual event per month compared with control, and the 2019 global consensus calls this the only evidence-based indication.
No testosterone product is approved for women in the US. FDA held a public workshop on September 17, 2026, took comments through October 19, and listed knowledge gaps. No approval decision came out of it.
For muscle, bone, thinking, mood and energy, the randomized trials at physiologic doses have not shown a benefit. A 2026 review pooled three trials (244 women) on cognition and found nothing significant, which its authors describe as too little evidence rather than proof of no effect.
Dose changes the picture. In a 24-week trial, only the top injected dose, which pushed total testosterone to about 210 ng/dL, beat placebo for lean mass and power. The lower doses did not.
Short trials at physiologic doses found acne and hair growth and no serious events, but there are no safety data beyond 24 months. A 2026 conference abstract reported 3.8% versus 0.5% cardiovascular events; it is observational, unpublished and cannot show cause.
Testosterone declines gradually with age rather than dropping at menopause, and no blood level has been shown to diagnose a deficiency in women.

The evidence at a glance

Social media credits testosterone with everything from libido to muscle to brain fog. This table sorts the claims by what randomized trials and expert panels have actually found.

Claim	What the evidence shows	Evidence type
Low sexual desire after menopause	Benefit, modest in size. About one more satisfying sexual event per month than control in postmenopausal women (8 trials, 3,238 women). The only indication the 2019 consensus supports^1,2	Meta-analysis of randomized trials
Muscle mass and strength	No significant effect on lean mass, body fat or strength at physiologic doses². No added walking-distance gain over exercise alone in a 2025 hip-fracture trial³	Randomized trials, mostly small
Bone density and fractures	No effect on bone density at 12 months in the trials pooled by the consensus². No fracture data. A 51-woman conference abstract reported spine gains when testosterone was added to estrogen⁴	Randomized trials, plus unpublished observational data
Brain fog and cognition	No significant improvement in a 2026 meta-analysis of 3 trials (244 women). The authors call the evidence insufficient, not negative⁵	Meta-analysis, small trials
Mood, wellbeing, energy	No effect on general wellbeing or depressed mood in the consensus review². The British Menopause Society says trials have not shown benefit for cognition, mood, energy or musculoskeletal health⁶	Randomized trials
Long-term heart and breast safety	Unknown. No safety data beyond 24 months, and trials excluded high-risk women². A 2026 conference abstract of 3,164 matched women per group reported 3.8% versus 0.5% cardiovascular events⁷	Observational, not peer-reviewed

Source note: Susan Davis is senior author of the 2019 meta-analysis, lead author of the consensus statement and the speaker in the 2025 conference talk quoted below. The FDA notice and the British Menopause Society reach compatible conclusions on their own.^8,6

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Where testosterone stands in the United States

No product is approved for women. The FDA states that, unlike estrogen products, testosterone has no approved indication for menopausal women. It is approved for low sexual desire in women in Australia, New Zealand, the UK and South Africa.⁸ US clinicians prescribe gels made for men off-label, or compounded products. Women often have to divide a dose designed for men, and most insurers do not cover it.⁹

Use is rising. One study cited by JAMA found US testosterone prescribing rose 2.6-fold over a decade, mostly among midlife women.¹⁰ A UC San Diego study reported by AARP found prescriptions for women up 58.7% from 2024 to 2025.¹¹

FDA opened the question in September 2026. It announced a public workshop on August 18 and held it on September 17, with a comment docket (FDA-2026-N-5479) open until October 19. The docket received 2,296 comments.⁸ FDA said the gaps include the role of testosterone in sexual function, cognition, mood and musculoskeletal health, how to measure and interpret blood levels, and the lack of long-term safety data, especially for cardiovascular and breast cancer risk.^12,8 At the workshop FDA issued a call to action to drug sponsors, researchers and payers, and said a regulatory package needs a defined patient population and clear endpoints.¹³ The workshop was convened to inform research and drug development, and no approval followed.¹²

In the UK, NICE and the British Menopause Society advise a trial of conventional hormone therapy before testosterone is considered.⁶

Does testosterone fall at menopause?

Not the way estrogen does. The FDA notice describes a gradual decline with age: levels in the late 40s are roughly half those in the early 20s, bottom out in the late 50s, and then stabilize or rise modestly from the 60s.⁸ The notice also says that measuring testosterone is difficult and that the link between blood levels and clinical outcomes is not well established.⁸

The consensus statement found no blood cutoff that separates women with and without sexual dysfunction, and it advises against using a testosterone blood level to diagnose low desire.² Davis told the 2025 Menopause Society meeting that no blood level has been linked to a deficiency syndrome, and that the immunoassays most clinicians can access are imprecise in the female range.¹⁴ Mass spectrometry is more accurate, but reference ranges vary between laboratories.¹⁴

As a result, the diagnosis of low desire rests on clinical assessment, not on a lab value.

Low sexual desire: the one use the trials support

The 2019 consensus found that testosterone at physiologic doses improves sexual function in postmenopausal women with hypoactive sexual desire disorder (HSDD), a persistent loss of desire that causes distress. The gains were about one additional satisfying sexual event per month, plus improvements in desire, arousal, orgasm, pleasure and responsiveness, and less distress. It rated the evidence Level I, Grade A, and called HSDD the only evidence-based indication.²

The pooled data: the underlying meta-analysis covered 36 randomized trials of 8,480 women, most treated for 4 to 6 months (range 12 weeks to 2 years). Sexual desire rose by a standardized mean difference of 0.36 (95% CI 0.22 to 0.50) against placebo or a comparator.¹
The limits of the effect: Davis calls the benefit statistically significant but modest. Placebo responses have complicated trials, as in a 2011 gel trial by BioSante.¹⁰
Who it applies to: the findings mainly apply to women with HSDD, not women without sexual dysfunction. They do not apply to injections, pellets, products that push levels above the physiologic range, or compounded products.²
The cause matters: testosterone may not address causes such as relationship conflict, medication effects, chronic illness or pain. The consensus says a full assessment and correction of contributing factors should come first.^10,2

A non-hormonal option now has an FDA label for this. In December 2025 FDA expanded flibanserin (Addyi), a daily nonhormonal pill first approved in 2015 for premenopausal women, to postmenopausal women younger than 65 with HSDD.¹⁵ Efficacy in naturally postmenopausal women was shown in a 24-week randomized, placebo-controlled trial called SNOWDROP.¹⁶

Muscle and strength: no benefit at physiologic doses

The consensus reviewed the few trials that measured muscle. They were small, all participants were also taking estrogen, and none included women with osteoporosis. At physiologic doses it found no significant effect on lean mass, body fat or muscle strength.² The 2019 meta-analysis agreed, though few women contributed data, and most trial arms had fewer than 20 participants.^1,14

The dose caveat. A 24-week randomized trial in 71 women with hysterectomy (with or without ovary removal) tested weekly injections at four doses against placebo. Women were also on transdermal estradiol. Average total testosterone reached 78 to 128 ng/dL in the lower-dose groups and 210 ng/dL in the top-dose group, against 19 ng/dL on placebo. Only the top-dose group beat placebo for lean body mass, chest-press power and loaded stair-climb power. Androgenic adverse events were reported as infrequent.¹⁷ The consensus aims for levels in the premenopausal range and does not recommend injections that overshoot it.² In this trial, then, the muscle gains appeared only at levels the guideline advises against.

Weekly injections of testosterone enanthate for 24 weeks in 62 analyzable women after hysterectomy, all on transdermal estradiol (Huang et al., Menopause 2014). Only the top dose differed from placebo for lean body mass, chest-press power and loaded stair-climb power.

Show the numbers

Group	Average total testosterone (ng/dL)	Beat placebo on lean mass and power
Placebo	19	Control
3 mg a week	78	No
6.25 mg a week	102	No
12.5 mg a week	128	No
25 mg a week	210	Yes

The 2025 hip-fracture trial. STEP-HI randomized 129 women aged 65 and older (average 79) after hip fracture repair to supervised exercise plus testosterone gel, exercise plus placebo gel, or usual care. After 24 weeks, six-minute walking distance had improved by 42.7 meters with testosterone and 40.5 meters with placebo, a difference that was not significant.³ The testosterone group did use walking aids less and improved more on a short-distance performance measure. The lead investigator said those findings need more study.¹⁸

The trial that targets this question directly. PAMELA, a Monash University randomized trial, gave healthy postmenopausal women aged 55 to 70 testosterone cream or placebo for 6 months to test whether it prevents muscle and bone loss.¹⁹ Preliminary results presented at the International Menopause Society congress showed no significant effect on lower-limb muscle power, grip strength or static balance.¹⁰

For muscle, the evidence-backed tools are different ones: how often and how heavy to lift, protein intake and, with a small and uncertain lean-mass gain in pooled trials, creatine.

Bone: no density gain in the trials, and no fracture data

The consensus found no effect of testosterone on bone density at the spine, total hip or femoral neck at 12 months (Level I, Grade A). The caveats are the same: small studies, concurrent estrogen, no women with osteoporosis.² Davis noted that some analyses show a weak link between testosterone levels and bone density, with wide confidence intervals and no clinical fracture data.¹⁴

A new signal, with strong labels. A small analysis presented at The Menopause Society's 2026 meeting followed 51 postmenopausal women treated at one private hospital. Bone density was scanned at the start and after a year on each regimen, estrogen alone and then estrogen plus testosterone. Lumbar spine scores improved after testosterone was added, while hip and femoral neck stayed roughly stable. The work was not randomized, had not been published in a peer-reviewed journal, and did not measure fractures.⁴ JAMA's reporter also noted that bone evidence is not well established.¹⁰

For comparison, a supervised heavy-lifting and impact trial raised lumbar spine density in women with low bone mass in 8 months; the details are in our exercise dose guide. For the broader bone picture, see osteoporosis after menopause.

Brain fog, mood and energy

A 2026 systematic review from University College London's Menopause Mind Lab looked at five studies of testosterone and cognition in menopause. A meta-analysis of the three randomized trials that could be pooled (244 women) found no statistically significant cognitive improvement with testosterone. The authors say the evidence is too limited to draw firm conclusions and that the result should not be read as proof of no effect.^5,20 Women in perimenopause were missing from the trials.⁵

The consensus found no effect on general wellbeing (Grade A) and none on depressed mood (Grade B), and judged the evidence insufficient to support testosterone for cognition.²
In a Davis trial, the one significant cognitive benefit was verbal recall, worth about 1.6 extra words. Executive, spatial and numerical function did not improve.¹⁰
The British Menopause Society states that randomized trials to date have not shown benefit for cognition, mood, energy or musculoskeletal health.⁶
Davis told the 2025 meeting that she saw no justification for prescribing testosterone to treat depression, cognitive decline or fatigue.¹⁴

A trial built for these questions is running. ESTEEM, funded by the UK's NIHR, randomizes over 400 women who are on standard hormone therapy and still symptomatic to 1% testosterone cream or placebo.^21,6 The primary outcome is menopause-related quality of life over 12 months, and secondary outcomes include sleep, anxiety and everyday memory. The trial is scheduled to run until 2028.²¹

Safety: what is known and what is not

Question	What the data show
Side effects at physiologic doses	Mild acne and body or facial hair growth in some women. No alopecia, clitoromegaly or voice change². The meta-analysis also found a weight increase of about 0.5 kg (5 trials, 2,032 women) and no serious adverse events¹
Cholesterol	Oral testosterone worsens HDL and LDL and is not recommended. Transdermal and injectable forms at physiologic doses showed no significant adverse lipid effect in the short term²
Blood pressure, glucose, HbA1c	No increase²
Blood clots	A nonsignificant trend toward more deep vein thrombosis. The contribution of concurrent estrogen cannot be excluded²
Heart attack, stroke, death	Data too limited to assess. Trials excluded women at high cardiometabolic risk, were short, and mostly included estrogen users²
Breast	No increase in mammographic density. Short-term transdermal use does not appear to change breast cancer risk. Long-term risk is not known, and women with prior breast cancer were excluded from the desire trials²
Duration	No safety data exist beyond 24 months of physiologic-dose treatment²

These findings describe doses that keep levels in the premenopausal range. Ben-Yehuda, a UC San Diego professor of medicine, said supraphysiologic levels are more often offered at wellness clinics or through telehealth.¹⁰

The 2026 cardiovascular signal. At The Menopause Society's October 2026 meeting, Jiang and colleagues presented a retrospective analysis of a US electronic health record network. After matching, 3,164 postmenopausal women aged 45 and older who started testosterone were compared with 3,164 who did not. First cardiovascular events (heart attack, stroke, heart failure and others) occurred in 3.8% of the testosterone group and 0.5% of the comparison group, a hazard ratio of 8.08 (95% CI 4.72 to 13.82). The gap persisted when women on testosterone plus hormone therapy were compared with women on hormone therapy alone (3.2% versus 0.5%).^7,11 Women with prior cardiovascular disease were excluded, and follow-up averaged nearly three years.^11,22

Three outside UK academics said this is a signal worth taking seriously but not proof. When it was presented there was no published paper. The design is observational, so unmeasured factors such as cholesterol could explain the gap, residual confounding cannot be ruled out, and absolute risk was low in both groups.²² Ben-Yehuda noted that a lack of short-term harm does not rule out long-term effects, since atherosclerosis develops over decades. Davis cautioned the other way: an observational finding that older women with the lowest testosterone had more cardiovascular events may mean low levels mark poorer health, not that supplementing would prevent events.¹⁰

What the consensus recommends when testosterone is used

Measure baseline total testosterone before starting (mass spectrometry preferred), repeat it 3 to 6 weeks after starting and then every 6 months while watching for signs of androgen excess, aiming to stay within the premenopausal range.²
Stop treatment if there is no benefit by 6 months.²
Pellets, injections and other products that cause supraphysiologic levels are not recommended. Compounded products are not recommended unless no authorized equivalent exists. Using an approved male formulation at female doses is considered reasonable when no female product exists.²
Systemic DHEA is not recommended for low desire.²

What we still do not know

Safety beyond 24 months, especially for the heart and breast. FDA lists this as a central gap.^2,12
Whether the 2026 cardiovascular signal is real. It needs prospective data and a peer-reviewed report.²²
Whether testosterone helps symptoms beyond sexual desire. ESTEEM is designed to test this, and it is scheduled to run until 2028.²¹
Whether estrogen plus testosterone protects bone better than estrogen alone, and whether any gain translates into fewer fractures. The only data are small and unpublished.⁴
What blood level, if any, should be the treatment target. The FDA notice says the link between levels and outcomes is not well established.⁸
Whether a female-specific product will reach the US market. FDA invited sponsors to develop one but has approved none.^13,8

Questions to bring to a clinician

Which symptom is the goal, and have other causes of it been checked, including medicines, sleep, mood, pain and estrogen status?
Which product and dose would be used, and how will levels be measured and how often?
What is the plan if there is no benefit by 6 months?
Is the product an approved gel at a divided dose, or a compounded product, pellet or injection?
How do my heart-disease risk factors and breast history change the balance?

Related guides:

Common questions

Is testosterone FDA-approved for women?

No. FDA states that testosterone has no approved indication for menopausal women. It is approved for low sexual desire in women in Australia, New Zealand, the UK and South Africa.⁸ FDA held a public workshop on September 17, 2026 to examine the evidence and gaps; it did not approve a product.¹²

Does testosterone drop at menopause?

Not sharply. Levels decline gradually with age: roughly half as high in the late 40s as in the early 20s, lowest in the late 50s, then stable or slightly higher from the 60s.⁸ That differs from estrogen, which falls steeply during the menopause transition.

Does testosterone therapy help low libido after menopause?

It can, modestly. Pooled randomized trials found about one more satisfying sexual event per month than control in postmenopausal women with low desire that causes distress.^1,2 FDA has also approved flibanserin, a nonhormonal pill, for postmenopausal women with this condition who are younger than 65.¹⁵

Does testosterone build muscle in women?

At physiologic doses the randomized trials found no significant effect on lean mass or strength.² In one 24-week trial, only the top injected dose beat placebo, and it raised total testosterone to about 210 ng/dL, far above the range guidelines aim for.^17,2 In the 2025 STEP-HI trial, testosterone gel added nothing to exercise for walking distance after hip fracture.³

Does testosterone help bone density?

The trials pooled by the global consensus found no change in bone density at 12 months, and there are no fracture data.² A 51-woman conference abstract reported higher lumbar spine scores when testosterone was added to estrogen. It was not randomized or peer-reviewed.⁴

Can testosterone help with brain fog?

Not shown yet. A 2026 meta-analysis of three randomized trials (244 women) found no significant cognitive improvement, and its authors say the evidence is too limited to conclude either way.⁵

Is testosterone therapy safe for women?

At doses that keep levels in the premenopausal range, trials up to about two years found mild acne and hair growth and no serious adverse events. No safety data exist beyond 24 months, and trials excluded high-risk women.² A 2026 conference abstract reported more cardiovascular events among women who took testosterone (3.8% versus 0.5%). It is observational and was unpublished when presented.^7,22

Should I get my testosterone level tested?

A blood level cannot diagnose low desire. The consensus found no cutoff that separates women with and without sexual dysfunction, and common immunoassays are unreliable in the female range.² Testing is used to keep levels in the premenopausal range during treatment, with mass spectrometry preferred.²

References

Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754-766. https://doi.org/10.1016/S2213-8587(19)30189-5
Davis SR, Baber R, Panay N, et al. Global consensus position statement on the use of testosterone therapy for women. J Clin Endocrinol Metab. 2019;104(10):4660-4666. Endorsed by 11 societies including the International Menopause Society, The Endocrine Society and the North American Menopause Society. https://doi.org/10.1210/jc.2019-01603
Binder EF, Bartley JM, Berry SD, et al. Combining exercise training and testosterone therapy in older women after hip fracture: the STEP-HI randomized clinical trial. JAMA Netw Open. 2025;8(5):e2510512. https://doi.org/10.1001/jamanetworkopen.2025.10512
ScienceAlert. Adding testosterone to estrogen therapy may have a surprising benefit for women's bones. Coverage of a conference abstract presented at The Menopause Society 2026 Annual Meeting, San Diego. https://www.sciencealert.com/?p=225347
University College London. No evidence testosterone improves brain fog during menopause. News release, October 30, 2026. https://www.ucl.ac.uk/news/2026/oct/no-evidence-testosterone-improves-brain-fog-during-menopause
British Menopause Society. Tool for clinicians: testosterone replacement in menopause. May 2026. https://thebms.org.uk/wp-content/uploads/2026/05/08-NEW-BMS-TfC-Testosterone-replacement-in-menopause-MAY2026-A.pdf
Healio. For postmenopausal women, testosterone therapy could be linked to higher CVD risk. November 2, 2026. Reports a conference abstract by Jiang et al., The Menopause Society 2026 Annual Meeting. https://www.healio.com/news/womens-health-ob-gyn/20261102/for-postmenopausal-women-testosterone-therapy-could-be-linked-to-higher-cvd-risk
US Food and Drug Administration. Testosterone use in menopausal women; public workshop; request for comments. Federal Register 91 FR 53417, August 18, 2026 (Document 2026-16829; docket FDA-2026-N-5479). https://www.federalregister.gov/documents/2026/08/18/2026-16829/testosterone-use-in-menopausal-women-public-workshop-request-for-comments
Reuters. Testosterone scripts for women rise, along with denials and delays. September 15, 2026 (syndicated by The Standard). https://www.thestandard.com.hk/world/article/342849/Testosterone-scripts-for-women-rise-along-with-denials-and-delays
JAMA Medical News. Feature on testosterone therapy for menopausal women, with comments from S. Davis, S. Faubion, R. Ben-Yehuda and R. Rubin. JAMA. 2026. https://jamanetwork.com/journals/jama/articlepdf/2855961/jama_schweitzer_2026_mn_260072_1792617499.36205.pdf
AARP. Study links testosterone therapy to heart risks in older women. 2026. https://www.aarp.org/health/drugs-supplements/testosterone-therapy-heart-risks-women/
US Food and Drug Administration. FDA public meeting: testosterone use in menopausal women, September 17, 2026. https://www.fda.gov/consumers/womens-health-events/fda-public-meeting-testosterone-use-menopausal-women-09172026
Holland & Knight. FDA workshop signals potential approval pathway for testosterone therapy in menopausal women. September 21, 2026 (law-firm summary of the workshop). https://www.hklaw.com/en/insights/publications/2026/09/fda-workshop-signals-potential-approval-pathway-testosterone-therapy
AJMC. Jury still out on testosterone benefit to menopause. October 31, 2025. Reports a presentation by Susan R. Davis at The Menopause Society 2025 Annual Meeting. https://www.ajmc.com/view/jury-still-out-on-testosterone-benefit-to-menopause
Contemporary OB/GYN. FDA approves expanded use of flibanserin for hypoactive sexual desire disorder in women. December 15, 2025. https://www.contemporaryobgyn.net/view/fda-approves-expanded-use-of-flibanserin-for-hypoactive-sexual-desire-disorder-in-women
Epocrates. Addyi now approved for low sexual desire in postmenopausal women. December 17, 2025 (summary of the FDA label). https://epocrates.com/online/article/addyi-now-approved-for-low-sexual-desire-in-postmenopausal-women
Huang G, Basaria S, Travison TG, et al. Testosterone dose-response relationships in hysterectomized women with or without oophorectomy: effects on sexual function, body composition, muscle performance and physical function in a randomized trial. Menopause. 2014;21(6):612-623. https://pmc.ncbi.nlm.nih.gov/articles/PMC4701202
University of Maryland School of Medicine. Using testosterone gel to treat women recovering from hip fractures provides no added benefits, clinical trial finds. News release, May 15, 2025. https://www.medschool.umaryland.edu/news/2025/using-testosterone-gel-to-treat-women-recovering-from-hip-fractures-provides-no-added-benefits-clinical-trial-finds.html
Monash University Women's Health Research Program. Prevention of muscle loss after menopause using testosterone: the PAMELA study (trial description). https://www.monash.edu/medicine/sphpm/womenshealth/research/prevention-of-muscle-loss-after-menopause-using-testosterone-the-pamela-study
Faulkner A, et al. Testosterone therapy for cognition in menopause: a systematic review and meta-analysis. Reproduction and Fertility. 2026. https://doi.org/10.1530/RAF-26-0080
ESTEEM trial: evaluating the clinical and cost-effectiveness of testosterone to improve menopause-related quality of life. ISRCTN21554333 (NIHR-funded; Cardiff University). https://www.isrctn.com/ISRCTN21554333
Science Media Centre. Expert reaction to a Menopause Society press release about testosterone therapy and cardiovascular disease in postmenopausal women. October 2026. https://www.sciencemediacentre.org/?p=58625

About this article

Every health claim above links to its source. It is general information and cannot take your personal history into account, so use it to prepare for a conversation with your own clinician.

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