Testosterone Can Help With Libido, Energy, Focus, & More During Menopause. So Why Isn’t It FDA-Approved for Women?

Testosterone has the potential to treat different menopause-related symptoms than estrogen. Here are some of its research-proven benefits.

Higher energy. Fatigue, irritability, and a decreased feeling of well-being can be symptoms of low testosterone levels in pre- and post-menopausal women, according to a 2022 article. Another study that tested testosterone’s ability to treat musculoskeletal aches and pains, medically called arthralgias, actually found that taking testosterone over a period of months did not necessarily help the pain more than placebo, but did decrease fatigue and lessen mood swings.

Libido changes. Androgens, a group of sex hormones that includes testosterone, are partially responsible for sexual desire, and androgen deficiency can lead to low libido during menopause. Research has shown that combining testosterone and estrogen therapy can result in the most improvement in libido.

Changes in muscle mass. Anecdotally, patients I have had who are on testosterone report gains in the gym. A small 2014 study also found that the women in the study given the highest dose of testosterone had higher lean body mass and muscle strength, and had more power with chest presses and on stair climbing challenges.

Improved mental concentration. Believe it or not, menopause can affect your mental clarity, and testosterone might be able to help. Poor memory and focus can be signs of androgen deficiency, and some patients have reported greater mental clarity on testosterone therapy.

Skin tone and texture. Some patients who have excess androgens have reported increases in acne. But a recent study reported that women taking testosterone experience improvements in the smoothness of their skin tone and texture.

Urinary incontinence. Urinary health issues, including incontinence (bladder leakage), can be specific to pre- and post-menopause. These can be signs of a decrease in testosterone. The 2021 study intended to treat arthralgias also showed improvement in urogenital symptoms.

In order to be covered by insurance, there needs to be a specific testosterone product for women to ask insurance to pay for, along with an FDA approval. Right now, testosterone is only able to be sold as a men’s drug, because it’s still culturally considered a “men’s hormone” and the only FDA approved indications and dosing is for men. Without an FDA approval, medications could be more expensive as not covered by insurance and therefore less accessible. The FDA is asking for more safety data, even though the men’s version of testosterone therapy doesn’t require the same level of safety data, has years of proven safety already, and the women’s version would only be one-tenth of that dose. Spoiler alert: Testosterone has been used in women since the 1940’s and we have years of safety data already. There also may not be a rush on the FDA or pharmaceutical companies’ behalf, because testosterone is a generic medication—no one can patent it. And if you can’t patent it, you can’t make as much money selling it, so the drug companies are not going to scramble to do so or pay for a lengthy multi-year safety data research study to get a cheap medication FDA approved.

There are ways you can get testosterone treatment from a doctor. You may have to go to a specialist, like a urologist, because many OB/GYNs don’t regularly prescribe testosterone because they don’t have as much experience with it. The typical dose of testosterone given to men is about 50 milligrams a day in a gel format, and the dose given to women will be very low: 5 milligrams. Hormones are very safe medications, when you think about what types of drugs are given to people, between anxiety and depression drugs, narcotics, and the like. Hormones are one of the safest medications, in terms of risk profile, to improve quality of life. There are four available forms of testosterone: a topical gel, which is an FDA-approved male testosterone product that will cost about 20 dollars a month out of pocket (since it won’t be covered by insurance). A cream is another option, which is slightly more expensive. Another treatment option is an injectable, but this is less common because it is hard to measure out exactly one-tenth of the dose given to men (but you can compound it to make it easier). Testosterone pellets are another option that are implanted under the skin, but they are given at higher doses which often have more side effects, so a doctor may first recommend starting on the lower dose gel first.

Testosterone is contraindicated in pregnancy, as it could increase risk of birth defects. And anyone who already has signs of excess androgens, such as male-patterned balding or hirsutism (if you have PCOS, take note), may not be the right candidate for testosterone therapy. In conclusion, all bodies make testosterone, but as long as it is inappropriately labeled as a “male hormone” it becomes erased from being relevant to all bodies. We need more research on its benefits and better availability on the market if we want true equality for all genders to have safe, inexpensive improvements to their quality of life through hormones.