Testosterone Therapy in Menopause: What We Know, What We Don’t Know, and Why Evidence Still Matters

Many women in perimenopause and menopause struggle with fatigue, low mood, and reduced energy. These symptoms are often attributed to shifting hormones — including declining testosterone levels — which has led to growing interest in testosterone therapy as a potential solution.

But here’s the essential truth:

👉 While testosterone therapy may improve energy, mood, and overall well-being for some women, the scientific evidence is still limited — and strong clinical support exists only for one indication: hypoactive sexual desire disorder (HSDD).
Not general energy enhancement.

This distinction matters, because women deserve both honesty and clarity about what treatments can (and cannot yet) do.

Why Women Look to Testosterone for Energy

Menopause brings real neuroendocrine changes that can affect:

• Motivation

• Mood stability

• Cognitive sharpness

• Physical energy

• Overall sense of vitality

Because testosterone influences libido, mood regulation, and motivation pathways, it seems plausible that it might help with energy. Many women report exactly that.

But what does the evidence actually say?

What Studies Show About Testosterone and Well-Being

Some research — though limited — suggests possible benefits:

1. Improvements in mood, vigor, and reduced fatigue

Small randomized and observational studies have shown that testosterone therapy may improve:

• Mood

• Motivation

• Subjective feelings of energy

• Fatigue levels

Especially in women who still experience symptoms despite estrogen therapy.
However, these studies are small, short-term, and often rely on self-reported data.

2. A pilot study showed cognitive and mood benefits

One study found that after 4 months of testosterone therapy:

• 47% of women reported improved mood

• 39% reported improved cognition

But again — this was a pilot study with limitations (small sample size, short duration).

3. Some women report better overall well-being

Clinically, many practitioners hear these improvements. But anecdotal benefit ≠ proven evidence.

Where Evidence Is Clear: Sexual Desire (HSDD)

Across multiple high-quality systematic reviews and international guidelines (including the Global Consensus Position Statement on Testosterone Therapy for Women), the only evidence-supported use of testosterone in women is:

✔️ Hypoactive Sexual Desire Disorder (HSDD)

After other causes (stress, vaginal atrophy, sleep issues, etc.) have been evaluated.

There is no robust evidence supporting testosterone for:

• Fatigue

• Energy improvement

• Cognitive enhancement

• General well-being

This doesn’t mean testosterone can’t help in these areas — just that the research is not strong enough to recommend it.

Why the Evidence Is Limited

There are major research gaps:

• Few large randomized controlled trials

• Short follow-up durations

• Lack of long-term safety data

• Scarcity of studies specifically in perimenopause

• Inconsistent dosing strategies across studies

• Limited standardized measurement of outcomes like “energy”

Women simply haven’t been studied adequately — a theme we see across the entire menopause landscape.

Safety, Monitoring, and What We Know So Far

Short-term safety: Generally reassuring

Low-dose, transdermal testosterone appears safe for the short term.

Long-term safety: Not established

We lack data on:

• Long-term cardiovascular risk

• Breast cancer risk

• Metabolic effects

• Impact on cognition over years

Side effects are usually mild if doses remain physiologic:

• Acne

• Mild hair growth

• Scalp hair thinning

• Voice changes (less common but potentially irreversible)

Monitoring is essential.

The Bottom Line

Testosterone may help some women feel better — and many report improvements in mood, drive, and energy.

But:

✨ These benefits are not yet backed by robust research.
✨ Guidelines support testosterone only for HSDD.
✨ Women need honest, evidence-informed conversations — not overpromises.

You deserve clarity, not confusion.
You deserve choices, not gatekeeping.
You deserve evidence, not assumptions.

And as research evolves, so will the options.

References

1. Global Consensus Position Statement on the Use of Testosterone Therapy for Women (2019) – The Journal of Clinical Endocrinology & Metabolism.
   https://doi.org/10.1210/jc.2019-01603

2. Islam RM, Bell RJ, Green S, Page MJ, Davis SR. “Safety and efficacy of testosterone for women: a systematic review and meta-analysis.” Lancet Diabetes Endocrinol. 2019.
   https://doi.org/10.1016/S2213-8587(19)30189-5

3. Parish SJ et al. “International Society for the Study of Women’s Sexual Health Clinical Practice Guideline for Testosterone Therapy.” J Sex Med. 2021.
   https://doi.org/10.1016/j.jsxm.2021.01.022

4. Miller KK et al. “Beneficial effects of testosterone therapy in women with antidepressant-resistant depression.” Am J Psychiatry.
   https://doi.org/10.1176/appi.ajp.161.7.1249

5. Wierman ME et al. “Androgen therapy in women: an Endocrine Society clinical practice guideline.” J Clin Endocrinol Metab.
   https://doi.org/10.1210/jc.2006-1813

6. Davis SR, Wahlin-Jacobsen S. “Testosterone in women—the clinical significance.” Lancet Diabetes Endocrinol.
   https://doi.org/10.1016/S2213-8587(15)00328-1

7. Nappi RE et al. “Testosterone for hypoactive sexual desire disorder in postmenopausal women.” Climacteric.
   https://doi.org/10.1080/13697137.2016.1199389

8. Huang G et al. “Testosterone and mood/cognition: review.” Expert Rev Clin Pharmacol.
   https://doi.org/10.1080/17512433.2016.1210286