Dozens of TikTok creators tout the benefits of testosterone therapy, such as Tamsen Fadal, who says the therapy improves muscle tone; Grayson Smith, who claims it provides more energy and mental clarity; and Marcella Hill, who has been on the therapy for a year, and said it has improved her sex life.
- Mary Jane Minkin, MD, board-certified OB/GYN and clinical professor at the Yale University School of Medicine
But is it safe? Ahead, we explain testosterone therapy and whether those influencers are steering you in the right direction.
What is testosterone therapy?
For females, the production of testosterone (a sex hormone) peaks in their 20s and gradually declines with age. By menopause, testosterone levels have decreased by about 75 percent. Testosterone affects libido (sex drive), mood, energy, and bone and muscle health in females, according to Harvard Health..
Currently, testosterone therapy is only approved to treat hypoactive sexual desire disorder (HSDD), which causes symptoms like having little to no interest in sex, avoiding sex, and no or few sexual fantasies. If you’re experiencing these symptoms, it’s a good idea to contact your primary care provider for a referral to a mental health clinician, such as a psychiatrist or psychologist, for proper testing and treatment.
Healthcare providers can prescribe testosterone therapy “off-label” for HSDD because the available medications are formulated for men, and there is no FDA-approved testosterone therapy for women. (Note: “Off-label” is a very common practice among doctors.) The FDA’s resistance to approving it for women is disputed but is generally attributed to a lack of research on long-term safety.
Is it safe?
In 2019, a large group of international physicians, endorsed by groups like the International Society for the Study of Women's Sexual Health, North American Menopause Society, and many others, defended the use of testosterone therapy for women and provided guidance to physicians on how to use the therapy. The group said the only evidence-based use for testosterone therapy is HSDD. That’s because some concerning side effects, such as brain fog and fatigue, can occur. What all this means is that there’s still more research that needs to be done to understand how safe testosterone therapy truly is in the long term. The group of physicians, however, only recommended testosterone therapy for a relatively narrow group of individuals—naturally or surgically postmenopausal women diagnosed with HSDD.
“We’ve always suspected testosterone was good for libido; however, before it was not officially endorsed by all the major organizations like the Menopause Society, which it is now,” says Mary Jane Minkin, MD and OB-GYN at the Yale School of Medicine, who adds the sea change in the national menopause conversation has caused more postmenopausal patients to ask her for testosterone therapy.
Recent health data reported by NBC News indicates prescriptions for testosterone therapy increased by almost 50% between 2013 and 2023. Per the report, the increase in interest is being driven by men and women in their 40s and 50s.
Dr. Minkin recommends a bioidentical testosterone gel that is applied to the skin, usually once a day. It may take as long as three to six months to increase libido, but many women notice a difference sooner than that, she says. In addition to increased libido, her patients have reported better energy and mental clarity, although there is not yet a medical consensus on those effects.
Not all forms are equal
Dr. Minkin recommends the gel form of testosterone, since natural testosterone is not absorbed well when taken orally, and you can’t measure someone’s testosterone levels, which is required. The 2019 guidance does not recommend injections or testosterone pellets, which are about the size of a grain of rice and implanted by a doctor under the skin.
“Don’t do pellets,” Dr. Minkin says. “It’s a huge concentration of testosterone, and once they stick these things in your tush, which is where they usually put them, they can’t get them out! It’s going to stay there until it gets broken down. I have seen levels ten times what’s normal, and people get horrible side effects.”
These side effects that Dr. Minkin is referring to can include hair loss, facial hair growth, acne, unintended weight gain, and, in some cases, lowering of the voice.
The bottom line
Women on testosterone therapy should have their blood drawn every six months to check their hormone levels or they could develop these potential side effects. Simply testing low for testosterone on a blood test does not indicate you should be prescribed testosterone therapy, according to the 2019 guidance.
But, if you are a postmenopausal woman working with a credentialed medical provider, Dr. Minkin says testosterone therapy is safe. “I think the increased use of testosterone is about women speaking up more about everything in menopause, which is great,” she says.
Dr. Minkin and other doctors hope more research is done on women and testosterone therapy now that women are demanding more options for their hormonal health.
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