---
title: Testosterone-Should this be part of your MHT regime?
description: What do we know about testosterone? The guidelines support its' use for sexual health disorders like low libido but what about energy, mood, and more?
---

[PAUZ Blog](https://pauz.health/blog)

# [Testosterone-Should this be part of your MHT regime?](https://pauz.health/blog/testosterone-should-this-be-part-of-your-mht-regime)

 Written by [PAUZ Health](https://pauz.health/blog/author/pauz-health) | Nov 24, 2025 12:47:25 PM

 

# **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](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

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