Testosterone for Women After 40? A Gynecologist Shares the Benefits of the Prescription Treatment
Discover the best time to start hormone therapy to get the most relief
You already know that as we age, key sex hormones like estrogen and progesterone start to decline, affecting everything from heart health and bone density to mood and energy levels. But you may be surprised to learn that men don’t have a monopoly on testosterone—it’s a vital player in women’s hormonal health as well. We asked a leading gynecologist to weigh in on when women might benefit from testosterone, the potential risks and rewards and what to consider before starting hormone therapy.
What is hormone replacement therapy (HRT), a.k.a. menopause hormone therapy?
Before we explore the merits of testosterone for women, let’s zoom out a bit to get a bigger picture of hormone replacement therapy (HRT), also known as menopause hormone therapy. “In general, if you’re a good fit for it and don’t have any of the conditions we screen for beforehand, most people can use hormone replacement therapy,” reveals Maral Malekzadeh, DO, a board-certified gynecologist.
“When the route and dosage are kept within safe ranges, it can be a very effective treatment [for menopause symptoms]. There are, of course, specific cases—such as individuals with clotting disorders or certain hormone-positive breast cancers—where HRT isn’t recommended.”
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Another group that needs individualized assessment is women with polycystic ovary syndrome (PCOS), who naturally have higher testosterone levels, she adds. “It’s important to check their levels first to make sure you’re not treating someone who already has elevated testosterone, since that could do more harm than good. But for the majority of people, HRT can be an effective option.”
When is the best time to start hormone therapy?
For the biggest benefits, women should typically start HRT during perimenopause, before their cycles have completely stopped. “Many symptoms during those years are caused by significant hormonal fluctuations, which can lead to issues like brain fog, hot flashes and night sweats,” confirms Dr. Malekzadeh. “HRT helps maintain more stable hormone levels so those swings are less noticeable.
“I do think there’s a strong role for HRT, and I tend to advocate for it more now because newer data suggest it is safe when the method is chosen carefully and patients are closely monitored.”
The top benefits of testosterone for women
When we think about women’s hormones, estrogen and progesterone usually come to mind first, but testosterone plays an important role alongside them, says Dr. Malekzadeh. “As we get older, typically from our mid- to late-30s into our early 40s, testosterone levels can start to dip. That’s partly because ovarian aging affects hormone production.
What we see most clearly is that testosterone can really help with libido. When someone is experiencing reduced sexual responsiveness, it can sometimes help fill that gap—that’s where it tends to shine.”
Testosterone therapy—which can come in the form of creams, gels, pellets or injections (more on that below)—can also help boost the flagging energy levels that often accompany hormonal upheaval in perimenopause and menopause, though Dr. Malekzadeh says she doesn’t typically see the same benefit when it comes to depressed mood or brain fog.
Should you test your testosterone levels during perimenopause?
While it’s not considered a first-line hormone therapy, if you have symptoms that could be related to a lack of testosterone, it’s definitely worth checking your levels and having a discussion with your doctor about whether treatment could help, encourages Dr. Malekzadeh.
That said, getting your testosterone levels checked isn’t always straightforward. “During perimenopause, your hormones are constantly fluctuating, and I know many providers avoid testing for testosterone, thinking that results will vary too much from day to day,” notes Dr. Malekzadeh.
It’s important to note, however, that not all doctors feel this way. “I take a different approach: I like to get a baseline to understand where you are,” she continues. “The testosterone level can be really important—if it’s low or mid-to-low and you’re experiencing symptoms, I might suggest it as a potential therapy. But if your testosterone is high, your libido issues likely aren’t related to testosterone and other factors should be explored.”
Types of testosterone therapy
Since testosterone therapy in women isn’t currently FDA-approved and there are no official dosing guidelines, Dr. Malekzadeh says doctors rely on international studies; for example, many recommendations come from large systematic reviews in Australia.
“That’s why it’s important to proceed with caution—who you speak to about prescribing it and the method they choose really matters,” she says.
Here are the three main types of testosterone therapy for women:
- Creams and gels: usually applied daily
- Pellets: can be inserted under the skin and dissolve slowly over a few months
- Injections: typically given once or twice a week
The method you choose often depends on dosing and your preferences. For example, if you’re not comfortable applying a cream or gel daily, you might consider pellets or injections. “It’s not one-size-fits-all, and careful monitoring is key,” emphasizes Dr. Malekzadeh.
Side effects of testosterone therapy in women
Though testosterone can be a game-changer when it comes to sex drive and energy, as with any therapy, there can be side effects, cautions Dr. Malekzadeh. “It’s important to review those carefully and decide whether it feels like the right choice.” Here, she shares a few rare side effects often caused by improper or too-high dosing:
- Increased acne on the face and body
- Thinning hair on the scalp
- Deepening of the voice
- Clitoral enlargement
The empowering bottom line about testosterone
Perhaps the biggest takeaway is just how important it can be to monitor testosterone levels. “For most people, that means at least once a year, but I usually check every three months, depending on how we administer it,” notes Dr. Malekzadeh.
It’s also key to understand how different methods affect dosing and to have a thorough consultation with your doctor, she adds. “A lower dose might not feel like much at first, but over time it can build. By checking your testosterone levels and seeing how much you’re absorbing, you can adjust the dose based on your numbers and symptoms and get the relief you deserve.”
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