Testosterone Therapy for Women: Restoring Vitality, Confidence, and Longevity An evidence-based guide from Bio Precision Aging

Guest Contributor: Travis Smith, D.O.  FAAEM | Emergency Medicine Board Certified | Concierge Medicine - Preventive Medicine - Aging and Longevity Consultant | Former Founding Dean of LECOM at Jacksonville University  | Senior Advisor - HHS/HRSA OA

When most people think about testosterone, they think of men. But testosterone is just as essential for women’s health — influencing mood, energy, muscle tone, libido, and overall vitality. Beginning in a woman’s 30s, natural testosterone levels gradually decline, often dropping sharply after menopause or surgical removal of the ovaries. This decline can leave women feeling tired, foggy, unmotivated, and disconnected from the vibrant energy they once had.

Testosterone is not just a “male hormone,” it is as a core longevity molecule that supports strength, cognitive clarity, sexual health, and emotional well-being — in both men and women.

What Does Testosterone Do in the Female Body? Though produced in smaller amounts than in men, testosterone plays vital roles throughout a woman’s body: Sexual Function and Desire. Clinical evidence consistently demonstrates that testosterone therapy significantly improves multiple domains of sexual function in postmenopausal women. A comprehensive 2019 meta-analysis of 36 randomized controlled trials involving 8,480 participants found that testosterone therapy significantly increased satisfactory sexual events, sexual desire, pleasure, arousal, orgasm, responsiveness, and self-image while reducing sexual concerns and distress.

Mood and Cognitive Function: Recent research reveals testosterone’s profound impact beyond the bedroom. A 2024 pilot study of 510 women receiving transdermal testosterone therapy demonstrated significant improvements in both cognitive and mood symptoms. Forty-seven percent of participants reported mood improvements, while 39% experienced enhanced cognition. These effects appear particularly relevant for women experiencing persistent symptoms despite adequate estrogen replacement. Testosterone influences cognitive function, mood regulation, and overall energy levels throughout life.

Musculoskeletal Health: Research indicates that testosterone can be important for bone density and muscle mass, cognitive function, mood, sexual function, and energy in women. The importance of testosterone for bone and muscle health in women is increasingly recognized. Studies demonstrate a positive relationship between serum testosterone levels and bone mineral density, particularly in the hip region of postmenopausal women. Higher serum free testosterone concentrations in older women are associated with greater bone mineral density, increased lean body mass, and interestingly, higher total fat mass as well.Testosterone possesses strong androgenic and anabolic effects important for both women and men. Research shows that testosterone administration can increase bone width and help prevent bone loss, with these effects being independent of growth hormone and insulin-like growth factor-1. In women with low serum testosterone levels (below 30 ng/dL), there may be particular benefit for bone health from appropriately increasing testosterone levels. 

Body Composition and Metabolic Health: Testosterone plays a crucial role in maintaining healthy body composition and metabolic function. The hormone influences muscle mass maintenance, fat distribution, and insulin sensitivity. Some studies have found that low-dose testosterone therapy can improve insulin sensitivity in postmenopausal women, which may represent a mechanism for reducing cardiovascular risk. Overall Vitality and Well-Being. Beyond these specific physiological effects, testosterone contributes to overall sense of well-being, motivation, and energy levels.

The symptoms of androgen insufficiency in women commonly include dysphoric mood, unexplained fatigue, changes in sexual function including reduced libido, alterations in cognition, vasomotor symptoms, bone loss, and decreased muscle strength. 

Addressing Common Misconceptions: “Testosterone will make me masculine.” False. Physiologic replacement keeps hormone levels in the female range, restoring what time and stress have depleted — not pushing you into male territory. The doses used for women are carefully calibrated to achieve concentrations within the normal female physiological range, typically 30-100 ng/dL total testosterone. 

“It’s not FDA approved, so it must be unsafe.” Off-label use doesn’t mean unsafe; it simply means the FDA hasn’t yet approved a female-specific formulation. Multiple international medical societies recognize the safety and efficacy of female testosterone therapy when prescribed responsibly. A 2019 Global Consensus Position Statement on the Use of Testosterone Therapy for Women, endorsed by major international menopause and endocrine societies, supports the use of testosterone for postmenopausal women with hypoactive sexual desire disorder. The safety profile of testosterone therapy for women has been evaluated for over 80 years. Controlled clinical trials of up to 2 years duration have demonstrated that women receiving testosterone therapy tolerated treatment well with no serious side effects when appropriately dosed. 

“It will cause hair loss or acne.” Only at excessive doses. With modern compounding and expert supervision, side effects are minimal and reversible. The comprehensive 2019 meta-analysis found that testosterone therapy was generally well-tolerated, with transdermal administration showing a neutral lipid profile — an important advantage over oral formulations. 

“It’s just for sex drive.” Libido benefits are real, but testosterone’s impact reaches far beyond the bedroom — affecting mood, metabolism, cognition, and body composition. While sexual function improvements are the most well-studied benefits, emerging evidence demonstrates effects on cognitive performance, mood regulation, energy levels, and musculoskeletal health. 

The Evidence: What Does the Research Show? 

Sexual Function: The evidence for testosterone’s benefit on sexual function is robust. The landmark 2019 systematic review demonstrated that testosterone therapy significantly improved all measured aspects of sexual function compared to placebo, including desire, arousal, orgasm, satisfaction, and overall sexual self-image. 

Mood and Cognitive Benefits: A 2024 study examining transdermal testosterone therapy over 4 months found significant improvements across all nine measured cognitive and mood symptoms. Mood improved more dramatically than cognition, with 47% of women reporting mood improvements and mean symptom scores decreasing by 34% for mood symptoms versus 22% for cognitive symptoms. Notably, 52% of women reported improvements in libido with a 33% decrease in symptom severity. 

One of the most important recent findings concerns cardiovascular safety. A large 2024 claims database analysis found a decreased risk of major adverse cardiac events (MACE) among women receiving testosterone therapy compared to matched controls. The study demonstrated similar risk in postmenopausal women and similar or significantly lower risk of breast cancer on age-based analysis.

Additionally, a 2007 randomized controlled trial of physiological testosterone replacement in women with hypopituitarism found that 12 months of treatment did not increase — and may actually improve — insulin resistance. Chronic low-dose testosterone administration did not increase markers of cardiovascular disease across multiple mechanistic pathways.

The comprehensive 2019 meta-analysis confirmed that transdermal testosterone administration produces a neutral lipid profile, an important cardiovascular safety marker. Recent observational data mostly show an inverse relationship between testosterone levels and cardiovascular disease risk in women, contrary to long-held assumptions. 

Long-Term Safety Data: Recent publications on complications of subcutaneous testosterone implant therapy, examining large cohorts over seven years, have demonstrated long-term safety of this delivery method. While testosterone therapy remains an off-label treatment in the United States, it has been approved and widely prescribed in several countries including Australia and the United Kingdom for over a decade. 

Who May Benefit from Testosterone Therapy? Testosterone therapy should be considered for women experiencing:

- Persistent low libido despite adequate estrogen replacement

- Unexplained fatigue not attributable to other causes

- Mood changes including dysphoria or lack of motivation

- Cognitive symptoms such as brain fog or decreased concentration

- Loss of muscle mass and strength beyond what’s expected with aging

- Decreased sense of well-being despite otherwise good health.

Women who have undergone bilateral oophorectomy (surgical menopause) may be particularly likely to benefit, as they experience more dramatic and sudden declines in testosterone production. However, natural menopause and aging also contribute to testosterone deficiency that can affect quality of life. 

Delivery Methods and Dosing: 

Transdermal Application: (Preferred) Transdermal testosterone (creams, gels, or patches) is the preferred delivery method for women because it:- Maintains stable, physiologic hormone levels- Avoids first-pass hepatic metabolism- Shows a neutral effect on lipid profiles- Allows for dose adjustments and discontinuation if needed. Typical dosing ranges from 3-10 mg daily of compounded testosterone cream, adjusted to achieve total testosterone levels in the range of 30-100 ng/dL. 

Subcutaneous Pellets: Testosterone pellets provide 3-6 months of hormone delivery and can be convenient for some women. Recent data support their long-term safety when administered at appropriate doses. However, they cannot be removed once implanted and may result in more variable hormone levels. Intramuscular Injection: While less commonly used in women, intramuscular testosterone can be effective but may result in more fluctuation in hormone levels compared to transdermal options. 

Oral Preparations (Not Recommended)Oral testosterone formulations are generally not recommended for women due to unfavorable effects on lipid profiles and the need for higher doses to compensate for first-pass metabolism.

Integrating Testosterone Therapy Into a Longevity Program. Testosterone therapy is one component of a comprehensive longevity blueprint.

1. Advanced Biomarker Testing: Including comprehensive hormone panels (total testosterone, free testosterone, SHBG, estradiol, DHEA-S), metabolic markers, inflammatory markers, and lipid profiles. 

2. Genetic and Epigenetic Assessments: Identifying individual variations in hormone metabolism, including polymorphisms in androgen receptor genes and enzymes involved in testosterone metabolism. 

3. Personalized Supplement Protocols: Supporting optimal testosterone activity with nutrients such as:- Zinc (cofactor for testosterone synthesis)- Vitamin D (associated with testosterone levels)- Magnesium (supports hormone production)- CoQ10 (mitochondrial support)- Adaptogenic botanicals (stress management) 

4. Lifestyle Design- Resistance training: Essential for maximizing testosterone’s anabolic effects on muscle- Sleep optimization: Hormone production and regulation occur primarily during sleep- Stress management: Chronic stress elevates cortisol, which can suppress testosterone- Nutrition: Adequate protein and healthy fats support hormone production 

5. Ongoing Monitoring: Ensuring long-term safety and sustained benefits through:- Regular hormone level testing (every 3-6 months initially, then annually)- Metabolic and cardiovascular marker surveillance- Bone density assessment (baseline and periodic)- Clinical response evaluation. This whole-person approach ensures hormones amplify — not replace — your body’s natural vitality. 

Realistic Expectations: What Testosterone Therapy Can and Can’t Do What it can do:- Restore energy, motivation, and libido to more youthful levels- Improve body composition (increased lean mass, optimized fat distribution)- Enhance bone health and reduce fracture risk- Support cognitive function and mental clarity- Improve mood and sense of well-being- Support cardiovascular and metabolic balance when appropriately dosed- Reinforce overall confidence and quality of life 

What it can’t do:- Stop all aspects of aging (it’s one tool among many)- Compensate for poor sleep, nutrition, or physical inactivity- Function optimally without medical guidance and regular monitoring- Reverse established osteoporosis or other chronic conditions (though it may help prevent progression)- Replace the need for estrogen therapy in women with menopausal symptoms. Think of testosterone therapy as a foundation, not a magic bullet — a tool that helps you feel like your best self again when combined with healthy lifestyle practices. 

Safety Considerations and Contraindications Regular Monitoring Includes:- Testosterone levels (total and free)- Hematocrit (testosterone can increase red blood cell production)- Lipid panel- Liver function tests- Fasting glucose and insulin (for metabolic assessment)- Blood pressure- Clinical assessment of symptoms and side effects Potential Side Effects: When doses are kept in the physiologic range, side effects are minimal and typically reversible.

Possible effects include:- Mild acne (responds to dose adjustment)- Increased facial or body hair (rare at appropriate doses)- Mild voice deepening (uncommon, usually dose-related)- Scalp hair thinning (rare, typically in those genetically predisposed)- Increase in hematocrit (monitored regularly) 

Contraindications: Testosterone therapy should be avoided or used with extreme caution in women with:- Current or recent breast cancer (relative contraindication; data are evolving)- Polycythemia or significantly elevated hematocrit- Active liver disease- Pregnancy or breastfeeding (absolute contraindication)- Uncontrolled cardiovascular disease 

Ethical and Regulatory Perspective: Testosterone therapy for women remains an off-label treatment in the United States, though it’s approved and widely prescribed in several other countries, including Australia and the U.K. To ensure safety:- Only pharmacies registered under 503B compounding standards are used- Each batch undergoes quality and purity testing- Patients receive full informed consent explaining benefits, risks, and alternatives- Treatment is individualized based on symptoms, laboratory values, and response- Regular monitoring ensures early detection of any adverse effects. An approach should follows the Global Consensus Position Statement on the Use of Testosterone Therapy for Women and recommendations from leading menopause and endocrine societies worldwide. 

The Future of Female Testosterone Therapy: Scientific interest is rapidly expanding. Ongoing research is exploring neuroprotection investigations into testosterone’s role in memory, cognitive function, and potentially reducing risk of neurodegenerative diseases. The hormone’s effects on brain plasticity and remodeling throughout life suggest promising applications. Cardiometabolic OutcomesStudies examining effects on insulin sensitivity, metabolic syndrome, and cardiovascular outcomes in diabetic and postmenopausal women. Early evidence suggests potential benefits for insulin resistance and metabolic health. 

Optimal Delivery Systems: Research into sustained-release formulations, optimized transdermal preparations, and novel delivery methods that maintain steady, physiologic hormone levels with minimal side effects. 

Synergy with Other Therapies: Investigation of combined approaches with:- Estrogen and progesterone optimization- Peptide therapies (growth hormone secretagogues, BPC-157)- Mitochondrial support compounds (NAD+ precursors, urolithin A)- Senolytic and senostatic interventions with precision medicine applications. Using genetic, epigenetic, and metabolomic data to:- Predict who will respond best to testosterone therapy- Optimize individual dosing based on metabolism- Identify women at higher risk for side effects- Personalize complementary interventions, As the data grows, so will access. The next generation of hormone medicine will be more precise, data-driven, and individualized than ever. 

Clinical Perspective: Overcoming Barriers to Treatment: Despite strong evidence for benefits and acceptable safety profile, millions of women who could benefit from testosterone therapy remain untreated. This results from several factors: 

Lack of FDA-Approved Formulations: The absence of FDA-approved testosterone products specifically for women has created challenges for both physicians and patients. However, this regulatory gap doesn’t reflect the safety or efficacy of appropriately prescribed testosterone therapy — it reflects market and regulatory complexities. 

Outdated Safety Concerns: Negative narratives about testosterone safety in women, often not scientifically established in peer-reviewed literature, have caused hesitation among both physicians and patients. Current evidence demonstrates that when prescribed in physiologic doses with appropriate monitoring, testosterone therapy has a favorable safety profile. 

Limited Physician Education: Many healthcare providers receive minimal training on female androgen physiology and testosterone therapy during medical education. This knowledge gap has slowly improved as evidence has accumulated and professional societies have released position statements. Insurance Coverage Limitations. Off-label use often results in limited or no insurance coverage, creating financial barriers to access. However, compounded testosterone preparations are generally affordable, particularly when weighed against the quality-of-life benefits. 

Conclusion: Reclaiming Your Vitality: Testosterone is a foundational hormone for women’s health throughout life — not a male hormone that women happen to produce in smaller amounts. As our understanding of female androgen physiology has evolved, so has our appreciation for testosterone’s wide-ranging effects on vitality, strength, cognition, and overall well-being.

For women experiencing symptoms of testosterone deficiency — whether from natural menopause, surgical menopause, or other causes — physiologic testosterone replacement offers a safe and effective approach to restoring quality of life. The extensive body of evidence now available supports its use for sexual function, with emerging data suggesting benefits for mood, cognition, metabolic health, and musculoskeletal integrity.

Optimal health requires a comprehensive, personalized approach. Testosterone therapy is one tool — albeit an important one — in a broader longevity strategy that includes nutrition, exercise, stress management, sleep optimization, and targeted supplementation. If you’re experiencing persistent fatigue, decreased motivation, cognitive changes, or diminished libido despite otherwise good health, testosterone deficiency may be contributing to your symptoms.

A comprehensive evaluation including detailed symptom assessment, physical examination, and laboratory testing can determine whether testosterone therapy might benefit you.The future of women’s healthcare includes reclaiming testosterone as an essential component of hormonal health and longevity.

Women deserve access to evidence-based treatments that can restore vitality, confidence, and quality of life at any age. 

References: This article is based on extensive review of peer-reviewed literature from PubMed, including systematic reviews, meta-analyses, randomized controlled trials, and observational studies published through 2025. Key sources include the following articles and numerous additional peer-reviewed publications examining testosterone physiology, therapy outcomes, and safety:

1. Islam RM, et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomized controlled trial data.

2. Lancet Diabetes Endocrinol. 2019;7(10):754-766.- Glynne S, et al. Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study.

3. Arch Womens Ment Health. 2024 Sep 16.- Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660-4666.- Miller KK, et al.

4. Effects of testosterone therapy on cardiovascular risk markers in androgen-deficient women with hypopituitarism. J Clin Endocrinol Metab. 2007;92(7):2474-9.- Simon JA, et al.

5. Testosterone for Treating Female Sexual Dysfunction. Clin Obstet Gynecol. 2025;68(1):60-67.- Renke G, et al.

6. Cardiovascular Safety and Benefits of Testosterone Implant Therapy in Postmenopausal Women: Where Are We? Pharmaceuticals (Basel). 2023;16(4):619.- Rariy CM, et al.

7. Higher Serum Free Testosterone Concentration in Older Women Is Associated with Greater Bone Mineral Density, Lean Body Mass, and Total Fat Mass. J Clin Endocrinol Metab. 2011;96(4):989-996.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Testosterone therapy should only be initiated under the supervision of a qualified healthcare provider after comprehensive evaluation. Individual results may vary. All treatment decisions should be made in consultation with your healthcare team.

The information provided in this post is for educational purposes only and is not intended as medical advice, diagnosis, or treatment. Please consult with your healthcare provider before starting any new supplement regimen, exercise program, or making significant changes to your health routine, especially if you have existing medical conditions or take medications.