Low testosterone in women

Women make testosterone too, and when they feel tired, flat or uninterested in sex, low testosterone often gets the blame. The evidence is narrower than that. A 2019 Global Consensus Position Statement, endorsed by 11 medical societies including The Endocrine Society and The North American Menopause Society, concluded that the only evidence-based reason to give a woman testosterone is hypoactive sexual desire disorder (HSDD) after menopause: low desire that causes distress, diagnosed after a full assessment. For other symptoms, trials haven’t shown a benefit.

There is also no FDA-approved testosterone product for women in the US. Any prescription is off-label, usually a product made for men at a fraction of the dose, or a compounded cream that isn’t FDA-approved, and testosterone is a Schedule III controlled substance. Here is what the guidelines say about symptoms, testing, treatment and risks.

Why “low testosterone” is hard to define in women

In men, low testosterone is diagnosed with symptoms plus a blood level below a cut-off (see low testosterone symptoms in men). Women don’t have an equivalent:

• The 2019 consensus says no cut-off blood level of any androgen can be used to tell women with sexual problems from women without them, and that a blood testosterone level should not be used to diagnose HSDD.
• The Endocrine Society’s 2014 guideline recommends against diagnosing an “androgen deficiency syndrome” in healthy women, because no well-defined syndrome exists and data linking androgen levels with specific symptoms are lacking. It also found that a woman’s own testosterone level didn’t predict whether treatment helped.
• Measuring is hard. The consensus says direct assays for total and free testosterone are “highly unreliable in the female range,” while mass spectrometry assays are accurate.

Testosterone does change with age. The consensus notes that it declines during the reproductive years and appears to hold steady after 65. Some conditions are linked with low androgen levels: the Endocrine Society names pituitary failure, adrenal insufficiency, surgical removal of the ovaries and glucocorticoid medicines. Even then, it recommends against routinely prescribing testosterone for them, because there is little evidence that it improves symptoms and no long-term risk data.

Symptoms, and what the evidence shows

The consensus based its findings on blinded, placebo- or comparator-controlled trials of at least 12 weeks, pooled in a meta-analysis of 36 trials and 8,480 women (Islam et al., 2019):

So low desire is the one symptom where testosterone has trial evidence, and only after menopause. Even there, the effect is moderate: the meta-analysis found 0.85 more satisfying sexual events a month than placebo or a comparator. The consensus also stresses that low desire has many causes, including physical illness, relationship difficulties, psychological distress and cultural or religious values, and that these should be identified and addressed before testosterone is tried.

If testosterone is tried

The consensus sets out how a trial of treatment should work when a postmenopausal woman has been diagnosed with HSDD:

• Dose. Aim for blood levels in the normal range for premenopausal women, not higher.
• Form. Use the skin (transdermal), such as a gel or cream. Oral testosterone isn’t recommended because it worsened cholesterol in trials, and pellets, injections or anything that pushes levels above the female range aren’t recommended either.
• Product. Where no approved female product exists, an approved male product at a female dose is reasonable. The panel recommended against compounded “bioidentical” testosterone, because there is no evidence for its effectiveness or safety.
• Monitoring. Check total testosterone before starting and again 3 to 6 weeks in, then every 6 months to watch for overuse, along with signs of too much androgen.
• Stopping. If there’s no benefit by 6 months, stop.

Blood tests have a role here: not to diagnose, but to rule out a high starting level and to keep treatment within the female range.

Side effects and risks

At doses that keep levels in the premenopausal range, the consensus found:

• mild increases in acne and body or facial hair in some women
• no hair loss, clitoral enlargement or voice change
• no serious adverse events in trials, which excluded women at high risk of heart and metabolic disease
• no short-term change in breast cancer risk with transdermal testosterone, but not enough data on long-term risk; caution with hormone-sensitive breast cancer
• no harmful effect on cholesterol from non-oral forms in the short term

Long-term safety hasn’t been established. Testosterone must not be used in pregnancy: the AndroGel label says it can cause virilization of a female fetus. Gels approved for men also carry a boxed warning: children exposed to the skin where gel was applied have shown virilization, so avoid skin contact with children at the application site.

The consensus advises against injections and pellets because they can push levels above the female range, where signs of androgen excess appear.

Legal status and how it’s prescribed

No testosterone product is FDA-approved for women in the US. Labels for men’s products, such as AndroGel 1.62%, say they are not indicated for use in women, so prescribing them to a woman is off-label. Compounded testosterone creams are not FDA-approved.

Testosterone is a Schedule III controlled substance. Prescribing it by telemedicine without an in-person exam relies on a temporary DEA and HHS rule, 90 FR 61301, which runs through December 31, 2026 and requires a live audio-video visit with the prescriber.

What it costs online

Few online menopause clinics we compare prescribe testosterone for women. As of October 2026:

Joi + Blokes says some of its products may be compounded without naming which. Keep in mind that the consensus advises against injections for women and against compounded testosterone. Ask which product you would get, whether it is compounded, and how the clinic will check your levels. See testosterone for women, HRT online and the menopause provider rankings.

Other options for low desire

Testosterone isn’t the only route. Two drugs are FDA-approved for acquired, generalized HSDD: Addyi (flibanserin), a nightly pill whose current label covers women under 65, and Vyleesi (bremelanotide), an injection for premenopausal women. Both have important warnings; see Viagra for women for how they compare. If menopause symptoms such as hot flashes, poor sleep or vaginal dryness are part of the picture, hormone therapy for those may help too; see menopause symptoms.

The bottom line

There is no agreed blood test or cut-off for low testosterone in women, and a level alone shouldn’t be used to diagnose anything. The one use with trial evidence is low sexual desire with distress after menopause, where testosterone at female doses added about one satisfying sexual event a month. It didn’t help mood, general wellbeing, bone or muscle in trials, and the evidence on memory is too thin to support it. In the US it is off-label and a Schedule III controlled substance, best given through the skin at doses that keep levels in the female range, checked at 3 to 6 weeks and stopped if it hasn’t helped by 6 months. Compare menopause clinics on our menopause hub.