Five years ago, when Dr. Risa Kagan offered testosterone to postmenopausal women whose sex drive had vanished, the Berkeley-based OB-GYN had few takers. Women were wary of using what they thought was a male sex hormone, she said, and concerned about developing “masculine” traits, like body hair or a deeper voice.
Now, she said, “every patient is coming in asking.”
Across the country, women’s health providers have reported a similar surge in recent months, sparked by menopause influencers on Instagram and TikTok who promote testosterone’s wellness benefits. Even Kate Winslet praised its power to make her “feel sexy again.”
But amid the cultural enthusiasm for testosterone — and a newly energized conversation about helping women feel good through the menopause transition and beyond — nuances about the drug are getting lost, experts told The Times. While decades of evidence suggests that low doses of testosterone can increase some women’s sexual desire with few side effects, some proponents are overstating the drug’s ability to boost mood, cognition, muscle strength and heart health, they said, and underplaying its potential risks.
“People are trying to take testosterone for everything — it’s become the new feel-good drug,” said Dr. Kagan, who is a clinical professor at the University of California, San Francisco, and has prescribed and studied testosterone in women for more than 20 years. But for anything beyond libido, “if you really delve into the data, it’s just not ready for prime time.”
So what do we actually know about testosterone and women? Here’s what the scientific evidence has revealed about its very real benefits, and its risks.
Why do women need testosterone?
There’s a lot we know about testosterone’s role in women’s bodies, and more we don’t know.
While men have about 10 times as much testosterone as women, the hormone plays an important role in reproductive health for both sexes, said Dr. Susan Davis, an endocrinologist at Monash University in Australia, and one of the world’s leading researchers on women and sex hormones. In women, it is primarily produced by the ovaries and adrenal glands, and helps produce an egg each menstrual cycle, among other things.
Beyond reproduction, though, researchers are still trying to figure out how testosterone affects women’s health. They are intrigued by the fact that women have testosterone receptors all over the body — including the heart, brain, muscles and bones — which suggests that it is linked to the health of these organs, Dr. Davis said, but we aren’t sure yet why or how.
Generally, women’s testosterone levels peak in their 20s, then gradually decline over time. They appear to rise again in their 70s, according to Dr. Davis’s research, so “there may be some survival benefit for older women,” she said.
For some women, as their testosterone declines, their libido declines, too. But this is far from true for everyone, Dr. Davis said. Women can have testosterone levels close to zero and have a raging sex drive, while others can have normal-to-high levels and struggle with a complete lack of desire.
For this reason, testing a woman’s testosterone levels without knowing how they might have changed over time doesn’t reveal much about her sexual or overall health, experts said, unless her numbers are atypically high, which could signal a condition like polycystic ovary syndrome.
How can taking testosterone improve your health?
For some postmenopausal women diagnosed with low sexual desire, taking a low dose of testosterone can improve libido, including arousal, orgasm and the frequency of what researchers call “satisfying sexual events.”
It improves sexual health in about 50 percent of women who try it, but it’s not like “whammo bammo,” Dr. Kagan said — the effects are usually subtle.
This is partly because women’s sexual function is complex, and libido can be affected by many factors: aches and pains, depression and your relationship with your sexual partner, among other things, said Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University, who specializes in women’s sexual health.
For this reason, many women benefit most from taking testosterone along with seeing a sex therapist. For some of Dr. Streicher’s patients, “testosterone kind of gave them a little kick start — you know, it kind of woke up that part of the brain,” she said. But therapy led to more lasting improvements in their sex lives.
Many women say testosterone has improved their energy, mood, mental sharpness and muscle strength — along with intangible benefits like making them say they “feel like themselves again” or “see the world in technicolor” — Dr. Streicher said. But research into the connection between safe doses of testosterone and these benefits is still inconclusive. In several studies, women who unknowingly received a placebo reported the same mood and health benefits as women taking testosterone.
“I can’t argue with how people feel,” Dr. Streicher said. But, for now, “the data does not support that it is going to increase your general sense of well-being.”
Even in studies that have demonstrated testosterone’s positive impact on libido, the effect in the placebo group is also very high, experts said, which could reflect women’s response to finally feeling heard and validated after years of suffering.
How do you take testosterone?
The safest way to take testosterone for sexual desire is as a gel that you rub on the back of your calf, or on your thigh, according to major medical societies.
But women face obstacles accessing the drug, since the Food and Drug Administration has never approved testosterone for women — despite approving 31 different testosterone products for men. (The F.D.A. has yet to approve any drug to treat sexual dysfunction in postmenopausal women; it has, however, approved two drugs, Addyi and Vyleesi, to treat it in premenopausal women.)
As a result, women’s options are limited. You can use a gel that’s formulated for men, giving yourself a tenth of the male daily dose by using your best judgment to ration a single tube over 10 days. You can get a dose formulated for women from a compounding pharmacy — but the concentration of compounded products is often less consistent. Or you can try to import a women’s testosterone gel from Australia, the only country that has approved the drug for women.
None of these options, which cost $10 or more per month, are covered by insurance.
What are the risks?
When taken at doses that raise your testosterone levels no higher than what’s typically seen in premenopausal women, side effects are rare, said Dr. James Simon, a menopause and sexual medicine specialist in Washington D.C. and clinical professor at The George Washington University School of Medicine. Your health care provider will likely want to test your levels a few weeks after starting the drug to make sure they’re not getting too high.
If your testosterone levels are too high for too long, however, you may experience side effects — some reversible, some not. These can include thinning of hair on your head, growth of hair on your face and chest, a deepening of your voice, acne, an enlarged clitoris, irritability and aggression.
High testosterone levels can also lead to a thickening of the uterine lining and vaginal bleeding, and increase your risk for endometrial cancer, since the body converts excess testosterone into estrogen.
Steer clear of pellets
For all of these reasons, experts discourage patients from receiving testosterone through “pellets,” or compounded hormone capsules inserted under the skin at medical spas, anti-aging clinics and medical offices. They typically contain much higher doses than gels.
While the treatment can make women feel great in the short term, it can also cause testosterone levels to skyrocket — and once pellets are inserted, they can’t be removed. Patients have to wait out their side effects, or in some cases, live with them permanently.
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