Women Are Being Told They Need Testosterone. Do They?

Testosterone is having a moment in women's health.

Scroll long enough and you'll probably see some version of:

Tired?

Testosterone.

Low libido?

Testosterone.

Brain fog?

Testosterone.

Can't build muscle?

Testosterone.

Don't feel like yourself?

Your testosterone must be low.

And here's where I want to make something very clear:

Testosterone absolutely matters in female physiology.

Women produce and use androgens.

The problem isn't talking about testosterone.

The problem is taking a real hormone with real physiology and turning it into the newest explanation for every symptom women experience in midlife.

The FDA held a public workshop on testosterone use in menopausal women on September 17, 2026, specifically because use is growing while major evidence gaps remain.

So let's talk about what we actually know.

Do women naturally have testosterone?

Yes. Women naturally produce testosterone and other androgens, although circulating concentrations are generally much lower than in men.

Testosterone in women comes from the ovaries and adrenal-related androgen production and metabolism.

It can influence tissues involved in:

• sexual function

• bone

• muscle

• the brain

• skin and hair

• other physiological processes

So the idea that testosterone is a “male hormone” is biologically inaccurate.

Just like estrogen isn't exclusively a “female hormone.”

Both sexes produce both.

The concentrations, sources and physiological context differ.

Why is testosterone for women suddenly everywhere?

Part of the reason is that menopause care itself is finally receiving more attention.

For decades, many women's menopausal symptoms were dismissed or undertreated.

Now we're having more conversations about:

• estrogen

• progesterone

• vaginal estrogen

• sexual health

• bone health

• cardiovascular health

• genitourinary syndrome of menopause

• testosterone

That increased attention is a good thing.

But women's health has a habit of swinging between two extremes.

First:

“Your hormones don't matter.”

Then:

“Every symptom is a hormone deficiency.”

Neither is particularly helpful.

Is testosterone FDA-approved for women?

As of September 2026, there is no FDA-approved testosterone product specifically indicated for women in the United States.

That doesn't mean testosterone is never prescribed to women.

Clinicians can prescribe testosterone products off-label in certain circumstances.

Off-label prescribing itself isn't inherently inappropriate. Many medications are legitimately prescribed off-label when clinical evidence supports their use.

But it does mean women should understand the evidence, dosing challenges and uncertainties involved.

What condition has the strongest evidence for testosterone therapy in women?

The clearest evidence is for certain postmenopausal women with hypoactive sexual desire disorder, or HSDD, after an appropriate biopsychosocial evaluation.

HSDD isn't simply:

“My libido isn't as high as it used to be.”

Sexual desire is influenced by an enormous number of factors:

• relationship dynamics

• stress

• sleep

• medications

• depression

• anxiety

• pain during sex

• vaginal dryness

• pelvic-floor dysfunction

• menopause

• body image

• chronic illness

• life circumstances

A hormone isn't automatically the explanation.

That's why low sexual desire deserves context before it gets turned into a testosterone prescription.

Does testosterone improve libido in women?

Evidence supports a moderate beneficial effect on sexual function for appropriately selected postmenopausal women with HSDD when testosterone is maintained within physiological female ranges.

That's very different from:

“Every woman with low libido needs testosterone.”

Treatment should begin with understanding what is actually contributing to the sexual concern.

For someone whose libido has disappeared because sex hurts from vaginal dryness, treating the pain and genitourinary symptoms may be far more relevant.

For someone whose libido changed after starting an SSRI, that's another conversation.

For someone experiencing relationship distress, testosterone isn't couples therapy.

Physiology matters.

Context matters too.

What about testosterone for energy?

This is where the evidence gets much thinner.

Women are increasingly being marketed testosterone for:

• energy

• motivation

• mood

• brain fog

• cognition

• muscle

• “vitality”

• general well-being

But the existence of androgen receptors doesn't prove supplementation improves all of these outcomes.

The FDA's 2026 workshop specifically highlighted evidence gaps involving testosterone's effects on cognition, mood, musculoskeletal health and long-term safety.

That doesn't mean testosterone has no effects in these areas.

It means:

We don't yet have enough high-quality evidence to make some of the broad promises being made online.

Can a blood test tell you if you need testosterone?

This is one of the most important parts of this conversation.

A laboratory value should not be interpreted in isolation.

Measuring testosterone in women can be technically challenging because concentrations are much lower than typical male concentrations, and assay accuracy matters.

A number on a report also doesn't automatically establish that testosterone is causing someone's symptoms.

This is the same question I ask whenever someone says:

“My hormones are imbalanced.”

Which hormone?

Measured when?

Using what assay?

Compared with what reference range?

What symptoms?

What medications?

What reproductive stage?

What diagnosis are we actually trying to make?

Numbers need clinical context.

Is there a “low testosterone syndrome” in women?

We need to be careful here.

There isn't a universally accepted blood testosterone cutoff that allows us to look at every woman below that number and say:

“This is why you're tired, unmotivated and have low libido.”

Clinical guidelines around testosterone therapy for women have emphasized that blood testosterone concentration alone should not be used to diagnose HSDD.

That doesn't make testing useless.

Testing can be important before and during therapy for appropriate dosing and monitoring.

But:

Lab value ≠ diagnosis.

What about testosterone pellets?

Pellet therapy has become increasingly visible in wellness and hormone clinics.

A pellet is inserted under the skin and releases hormone over time.

The concern with long-acting formulations is that once administered, the dose isn't easily adjusted or removed in the way a transdermal treatment can be stopped.

Professional guidance has generally favored formulations that allow dosing within physiological female ranges and has cautioned against approaches that can produce supraphysiologic testosterone levels.

If someone is considering pellets, I would want them asking:

What dose am I receiving?

What evidence supports this formulation for my indication?

How will my levels be monitored?

What happens if my testosterone becomes too high?

How quickly can treatment be changed if I develop side effects?

Those are reasonable questions.

What are the potential side effects of testosterone in women?

Depending on dose and exposure, androgenic effects can include:

• acne

• increased facial or body hair

• scalp hair changes

• voice changes

Higher-than-physiological dosing raises additional concerns.

And we still need stronger long-term safety data, particularly around outcomes such as cardiovascular disease and breast health.

This is another reason I don't like seeing testosterone marketed like a casual wellness supplement.

It's a hormone.

Hormones have biological effects.

That's the point.

What about muscle and bone health?

Testosterone has biological roles in musculoskeletal physiology, which makes this an important research area.

But plausible biology is not the same as proven clinical benefit from supplementation.

The FDA specifically identified musculoskeletal health as an area where additional research is needed in menopausal women.

We should study it.

We just shouldn't sell the conclusion before the studies are finished.

Testosterone and menopause: where does estrogen fit?

Another thing I don't want lost in the testosterone trend is the enormous role of estrogen decline during menopause.

Hot flashes.

Vaginal dryness.

Painful sex.

Urinary changes.

Bone loss.

Sleep disruption.

Many menopausal symptoms have well-established relationships with changing estrogen physiology.

If a woman walks into a clinic with painful sex and low libido, jumping immediately to testosterone without asking whether she has genitourinary syndrome of menopause misses a major part of the physiology.

Sometimes sexual desire is affected because sex has become uncomfortable.

Treating the tissue matters.

Women deserve access AND evidence

This is where I don't want the conversation becoming:

Testosterone is dangerous and women shouldn't use it.

That's not my position.

Women deserve access to evidence-based hormonal treatment.

Women also deserve formulations designed and studied specifically for them.

In fact, the lack of an FDA-approved female testosterone product in the United States creates its own challenges.

If there's an evidence-supported clinical need, shouldn't we be doing the research necessary to develop standardized products, doses and long-term safety data specifically for women?

That's a women's-health research issue too.

Questions to ask before starting testosterone

If testosterone therapy is being recommended, consider asking:

What diagnosis are we treating?

What evidence supports testosterone for this indication?

What formulation are you recommending?

Is this FDA-approved for women or being prescribed off-label?

How will the dose be monitored?

What testosterone range are we trying to maintain?

What side effects should I watch for?

When will we reassess whether it's actually helping?

And maybe most importantly:

What other possible causes of my symptoms have we considered?

That's informed consent.

Frequently Asked Questions

Should women take testosterone?

Testosterone can be appropriate for selected women, particularly some postmenopausal women with HSDD after appropriate evaluation. It isn't currently supported as a universal treatment for menopausal symptoms.

Is testosterone FDA-approved for women?

As of September 2026, there is no FDA-approved testosterone product specifically indicated for women in the United States.

Does testosterone increase libido in women?

Evidence supports benefit for sexual function in appropriately selected postmenopausal women with HSDD when physiological female dosing is used.

Can testosterone help brain fog?

There is currently insufficient evidence to recommend testosterone as a general treatment for cognitive symptoms or “brain fog” in women.

Does testosterone give women more energy?

Evidence isn't strong enough to treat testosterone as a general therapy for fatigue or low energy in otherwise healthy women.

What are signs of low testosterone in women?

There is no single symptom profile or universally accepted testosterone cutoff that diagnoses a generalized “low testosterone syndrome” in women. Symptoms such as low libido, fatigue and mood changes have many potential causes.

Is testosterone safe for women?

Appropriate physiological dosing can be used clinically in selected women, but androgenic side effects can occur and important questions remain about long-term safety.

Giana's Take

I actually think the testosterone conversation represents something bigger happening in women's health.

For years women were told:

“It's just menopause.”

Now we're finally acknowledging that hormones matter.

Good.

But let's not overcorrect into:

“Every symptom is a hormone deficiency.”

Women deserve access to testosterone when evidence supports it.

We deserve estrogen when evidence supports it.

We deserve pelvic-floor therapy when that's the problem.

We deserve mental-health care when that's the problem.

We deserve sleep medicine, nutrition support, cardiovascular care, sexual-health care and actual diagnostic workups when those are the problem.

The goal isn't to get every woman on more hormones.

The goal is to understand her physiology well enough to figure out what she actually needs.

That's the difference between personalized medicine and personalized marketing.

And women's health desperately needs more of the first.