Why more women are using testosterone

What you probably already know: Testosterone use among women — especially middle-aged women — is booming. Women naturally produce the hormone, which aids in the regulation of libido, mood and muscle and bone health, but its levels gradually decline with age. This natural drop is more dramatic for women than men and can be more pronounced around the time of menopause, leading many women to seek testosterone therapy. Testosterone has become an extremely hot topic in women’s health because conversations surrounding perimenopause, menopause and hormone imbalance are no longer taboo, says Dr. Andrea Caamano, director of medical affairs at The HRT Club, a digital health platform helping connect people with hormone replacement therapy. 

Why it matters: More buzz about testosterone’s role in women’s health means more research, Caamano says. This is important because many claims about its positive impacts on mood, muscle strength and focus lack the support of large scientific studies. Extensive research has, however, established that restoring a post-menopausal woman’s testosterone levels to where they were in their late 30s can improve libido. But many women who swear by the positive effects of testosterone are taking much higher doses than what their bodies naturally produced earlier in their lives. The FDA has not yet approved a testosterone product specifically for women, pointing to a lack of long-term safety data, particularly regarding the risks of cardiovascular disease and breast cancer.

What it means: “Without guidelines, providers are left to make educated judgment calls on dosing and formulations,” says Caamano, adding that no universal reference range exists to determine “normal” testosterone levels for women and lab results can be inconsistent. A woman’s menopausal state and age further complicate treatment, leading providers to mostly treat patients based on their symptoms, rather than just testosterone levels alone. There simply is no one-size-fits-all solution. Caamano advises women to learn about the various available formulas — patches, creams, gels and injections — and to be aware of side effects, including mood swings. Too high a dose can cause common side effects such as facial hair growth, acne and a deepening voice, though these are often reversible. “Some signs to look out for are increases in hematocrit (amount of blood made of red blood cells) as well as increases in LDL (bad cholesterol) and decreases in HDL (good cholesterol),” Caamano says. “It is extremely important to have routine blood work done as part of the monitoring.” 

What happens next: Australia offers a licensed testosterone cream for women. While women in the U.S. wait for the lengthy FDA approval process to catch up, groups like the International Society for the Study of Women’s Sexual Health recommend approximately 1/10th the standard male dose to treat low libido. “The risk with using these off-label methods is excess testosterone use since it is hard to measure 1/10th of a dose,” Caamano says. “It is also risky to use compounded formulas, as oftentimes there is little known about what is actually in the treatment.” So, what are some safe, scientifically backed alternatives for women experiencing menopausal symptoms? “Healthy life choices are the way to go,” Caamano says. “Exercise, eat whole, minimally processed foods and incorporate soy isoflavones into the diet. Dress in layered, breathable fabrics. Get enough rest and incorporate sleep hygiene into the schedule. Speak to a health care provider about using estrogen and progesterone if needed.”