Is testosterone important for women?
Testosterone is also an important hormone for women. The strongest evidence concerns sexual desire after the menopause: applied to the skin it works, but always consult a doctor, as long-term safety has not yet been established.
Testosterone is the most biologically active hormone in women's blood, present in higher concentrations than oestradiol. It acts partly directly in tissues and is partly converted into oestradiol. Even so, the science on its precise mechanisms remains limited.
The strongest evidence concerns sexual desire. In postmenopausal women with low sexual desire, a meta-analysis of 36 randomised trials involving more than 8,400 participants shows that testosterone applied to the skin increases the number of satisfying sexual experiences, improves desire and reduces sexual distress1. The effect is real but modest: on average just under one additional satisfying experience per month compared with a placebo.
The safety picture is nuanced. Testosterone applied to the skin produces no serious adverse effects in the available studies, but acne and increased body hair occurred more frequently2,3. Testosterone in pill form is a different matter: that form raises bad cholesterol and lowers good cholesterol, which is harmful to the heart. Pills are therefore not recommended. Compounded preparations from unregistered providers are also not recommended: evidence for both efficacy and safety is lacking.
What testosterone does NOT do in women is at least as important to know. Current data do not support a role in bone health, energy or cognition. There are early indications that testosterone applied to the skin may ease mood and cognitive complaints during the menopause, but this is based on a single retrospective study without a control group (n=510,4. Randomised trials for this indication are still lacking.
An important caveat: long-term safety has not yet been established. In most countries worldwide there are no approved testosterone preparations for women, precisely because long-term data on cardiovascular disease and cancer are absent. Use it therefore only in consultation with a doctor and preferably via the skin. At the other end of the spectrum, excess testosterone as seen in PCOS causes clear symptoms such as excessive hair growth. Testing is then useful, although commercially available tests are not always accurate5,6,7.
Based on a meta-analysis of 36 randomised trials (n=8,480) for sexual outcomes (PMID 31353194), additional systematic reviews and consensus statements (PMID 33814355, 40706034), one retrospective cohort study for mood and cognition (n=510, PMID 39283522), and narrative reviews for physiology and testosterone excess (PMID 26358173, 23380529, 34688417).