Testosterone for menopause is not a general treatment for fatigue, ageing or every change in sexual function. The evidence supports considering it for some postmenopausal women with hypoactive sexual desire disorder (HSDD)—low desire that causes distress—after a careful assessment. The average benefit is modest, and long-term safety remains uncertain.
WHO May Benefit From Testosterone For Menopause?
The 2019 Global Consensus Position Statement on the Use of Testosterone Therapy for Women concluded that testosterone can improve sexual function in postmenopausal women with HSDD. Its recommendations drew on placebo-controlled trials, generally lasting at least 12 weeks. The benefits included improvements in desire, arousal, orgasm, pleasure and sexual responsiveness, as well as reduced sexual distress. On average, treatment added about one satisfying sexual event per month beyond the comparison treatment.
That is a meaningful option for some people, not a guaranteed or dramatic change. The guidance does not extend the finding to women without sexual dysfunction or to every type of sexual difficulty. A 2021 clinical guideline from the International Society for the Study of Women’s Sexual Health (ISSWSH), developed by a multidisciplinary panel, recommends considering systemic transdermal testosterone when HSDD is not primarily explained by modifiable factors or issues such as relationship or mental health concerns. The assessment should consider the whole person, not just a hormone result.
A blood testosterone level cannot diagnose HSDD: no threshold reliably separates women with and without sexual dysfunction. A clinician may check a baseline level before treatment, but mainly to identify an already-high result and provide a reference for monitoring. A “low” result alone does not establish that testosterone is the cause of low desire or that treatment is appropriate.
How Treatment Is Monitored
Guidelines recommend a transdermal treatment—applied to the skin—at a dose intended to keep testosterone within the usual premenopausal physiological range. In many countries, this means using a small, carefully adjusted amount of a product approved for men, off-label. Off-label prescribing is a clinician’s use of an approved medicine for a purpose or population not included in its product approval; it calls for a clear discussion of the rationale, benefits and uncertainties.
Before starting, ask how your clinician will set the dose and check for signs of excess testosterone. Total testosterone is monitored to avoid levels above the premenopausal range; it is not a target to push higher. The ISSWSH guideline also emphasizes follow-up and informed, shared decision-making. A 2025 position statement from the Latin American Association of Gynecological Endocrinology recommends an initial monitoring check within three to six weeks. The exact schedule may depend on local guidance and your clinician’s plan.
Pellets and injections can produce excessive levels, and guidelines do not recommend them for this use. Compounded testosterone products are also not recommended: reliable evidence about their effectiveness and safety is lacking. Ask specifically which formulation is being proposed and how your levels and response will be reviewed.
Known Risks And What Remains Unclear
Short-term trials of physiological-dose transdermal testosterone found a moderate benefit and few androgen-related side effects; the ISSWSH guideline reported no serious adverse events in this setting. That does not settle long-term safety. Data are insufficient to establish effects over time on cardiovascular health, cancer or cognition. The absence of a clear short-term safety signal should not be mistaken for proof of long-term safety.
If you are weighing treatment, discuss both the potential improvement in desire and distress and the limits of what is known. A clinician can help assess whether HSDD fits your experience and whether other relevant factors deserve attention. Seek medical advice rather than starting or adjusting testosterone on your own.
Why Approval And Formulations Differ By Region
Approval depends on national regulators, so the treatment options are not the same everywhere. The 2021 ISSWSH guideline reported that Australia was then the only country with a nationally approved testosterone product for HSDD in women; it described no such product in the United States. It also noted that a testosterone patch had previously been approved in Europe for a narrower group—women with surgically induced menopause taking estrogen—but was later withdrawn by its manufacturer. These are the guideline’s reported circumstances, not a guarantee of today’s local availability or rules.
As a result, clinicians in many places may consider a male-approved product off-label, while access and prescribing requirements vary. Check current local guidance with a qualified clinician or regulator. The central evidence-based case for testosterone remains specific: carefully assessed postmenopausal HSDD, physiological-dose transdermal treatment, and monitoring—not hormone replacement for menopause in general.