The Benefits of Testosterone in Perimenopause
The FDA is finally examining what it will take to approve testosterone for menopausal women. Here's what existing research — and real patient data — show so far.
You probably think of testosterone as a “male” hormone. In actuality, women make testosterone, too, and it performs key functions, including influencing sex drive, mood, and energy, as well as bone health.
In September 2026, the FDA held its first public workshop devoted to exploring what it would take to approve testosterone for women in perimenopause.1 It’s a good first step toward recognizing the importance of a hormone that currently has no FDA-approved formulation for women, despite decades of off-label prescribing and a 2.6-fold increase in use between 2016 and 2025.2
Here’s what scientists, physicians, and Hone’s real-world patient data can tell us about testosterone for women in perimenopause and menopause.
About the Experts
Natasha Spencer, M.D., a general OB-GYN at Orlando Health Physician Associates in Altamonte Springs, FL.
Jim Staheli, D.O. is the medical director of Broad Health, Hone Health’s affiliated practice. His areas of expertise include metabolic and nutritional medicine, anti-aging, and functional medicine.
How Testosterone Works in the Female Body
Women naturally produce testosterone, and it helps regulate sexual desire, bone and muscle health, mood, and other aspects of well-being.3 4 5 Testosterone levels decline gradually with age, dropping 50% by age 40.6 Decline begins to accelerate around the same time women are navigating menopause symptoms, which can make them feel more impactful.
Low testosterone may have many effects on women’s health, ranging from reduced vaginal lubrication and difficulty reaching orgasm to depression, fatigue, and brain fog, but it’s hard to know whether they are due to low testosterone or something else.7 8 9
Why is Research on Testosterone in Women So Limited?
While men have more than a dozen FDA-approved testosterone formulations, women have none. In a 2025 FDA expert panel on menopause and hormone replacement therapy for women, board-certified urologist Kelly Casperson, M.D., called for addressing testosterone inequality. She called on the FDA and the Drug Enforcement Administration (DEA) to fast-track safe, female-specific dosing so women can be appropriately treated and so that more research can be done on the multiple benefits we know testosterone can have on women in midlife.
Because research on these benefits has so far been limited, organizations like The Endocrine Society, the Menopause Society, and the British Menopause Society don’t currently recommend women take testosterone to treat menopausal symptoms. The exception is for hypoactive sexual disorder (HSDD), which the BMS recommended in 2026, and which accounts for only 8.2% of prescriptions.10
What Are the Benefits of Taking Testosterone in Perimenopause?
Taking testosterone in perimenopause does much more than support sex drive. It also interacts with the brain, muscles, bones, cardiovascular system, and metabolism. But research into the wider effects of testosterone as part of hormone replacement therapy for women in perimenopause and menopause is still evolving. Here’s where the evidence is strongest—and where early findings show promise.
Sexual function
Low-dose testosterone therapy can improve sexual desire in postmenopausal women with Hypoactive Sexual Desire Disorder (HSDD)—persistently low sex drive that causes distress.11
A 2026 review of 33 studies found that testosterone patches and a vaginal cream improved sexual desire and other HSDD symptoms, and the effects were strongest in postmenopausal women.12
“It can increase your energy and libido,” says Natasha Spencer, M.D., a general OB-GYN at Orlando Health Physician Associates in Altamonte Springs, Florida.
A clinical review in the British Journal of General Practice also reported potential improvements in arousal, orgasm, pleasure, and responsiveness, while observational research has linked low testosterone with pain during or after intercourse.13 14 Painful sex can have other causes, however—including vaginal dryness and tissue changes related to low estrogen—so testosterone may be only one part of the solution.
Muscle mass and strength
Clinical guidance suggests that testosterone may have beneficial effects on lean mass, strength, and physical function for pre- and post-menopausal women.15 16 Testosterone supports muscle health in the female body by signaling muscle cells to produce more protein and by activating muscle stem cells. As testosterone levels decline with age, those signals fade. This is why testosterone would be especially helpful during perimenopause and later years, when declining estrogen contributes to the gradual loss of muscle known as sarcopenia.
Bladder and pelvic health
Testosterone can also help strengthen some of the muscles in the pelvic girdle and other muscles as well, according to Spencer, reducing the chances of incontinence and pelvic floor dysfunction. The pelvic floor supports bladder and bowel control as well as sexual arousal and orgasm.17
Bone health
Observational research has linked low testosterone in women with osteoporosis, and clinical reviews have found encouraging evidence that normal testosterone levels may support bone health.18 19 20
Taking testosterone may directly contribute to bone health in two ways:
- Testosterone directly stimulates bone formation
- The body converts some testosterone into estradiol, which further slows bone loss
However, it’s still unclear whether prescribing testosterone meaningfully improves bone density or prevents fractures in menopausal women.
Mood and cognition
Some women say taking testosterone in perimenopause helps them feel more energetic, mentally sharper, or more like themselves.
“Testosterone has neuroprotective effects and may improve cognition,” says Staheli. “It also improves blood flow to the brain and plays a role in raising dopamine and potentially serotonin, all leading to a happier mental state.”
A 2025 pilot study followed 510 perimenopausal and postmenopausal women who were already taking hormone therapy but continued to experience low libido, low mood, or cognitive symptoms. After using testosterone cream or gel for four months:
- 47% of women reported improved mood
- 39% of women reported improved cognition
Comparing baseline scores to the end of four months on testosterone, average low mood-symptom scores fell 34%, while brain fog scores fell 22%.21
Earlier research has associated low testosterone with depression and examined testosterone’s potential role in mood, cognition, and overall well-being.22 23 24 25
More definitive data should come from the ESTEEM trial, which is studying whether adding testosterone improves menopause-related quality of life in 400 women.26 27
Heart health
Testosterone may support cardiovascular health in women who face higher risk due to declining estrogen. Here’s how it helps throughout perimenopause and menopause:
Observational studies have linked very low testosterone levels with worse cholesterol profiles, impaired blood vessel function, and greater cardiovascular risk.30 31
It’s equally important to note that testosterone doesn’t seem to harm the female heart. A 2026 review of studies on women using low-dose transdermal testosterone reported no major cardiovascular events or cardiovascular deaths during up to one year of treatment.32 Longer studies are still needed to determine its effects on heart attack, stroke, atherosclerosis, and cardiovascular mortality.
Immune function and inflammation
Testosterone helps regulate immune function and can lower certain types of inflammation in women.33 It works by modulating keeping chronic low-grade inflammation in check and reducing specific inflammatory signaling molecules (cytokines) that cause tissue damage.34 35
Testosterone also lowers inflammation indirectly: By helping reduce excess body fat — itself a major source of inflammatory signals — it decreases overall systemic inflammation.36 This matters for postmenopausal women, as inflammatory autoimmune conditions increase after menopause due to hormonal changes.
Body composition
Testosterone is not prescribed for weight loss, but it can help menopausal women reduce excess belly and visceral fat by promoting fat as an energy source and improving fat distribution. Research in Maturitas links low testosterone levels directly to increased body fat in postmenopausal women.37 Testosterone also plays a role in maintaining muscle, which supports metabolic health.38 39
Hone’s Patient Data Shows Testosterone Benefits
In a September 2026 analysis, Hone looked at 1,220 women who took testosterone without estrogen or progesterone. All the menopause symptoms Hone tracks improved. Most notably:
- Sexual desire improved by 38%
- Stamina and sense of accomplishment increased by 33%
- Energy improved by 30%
Hot flashes improved only slightly, showing that testosterone can help with certain symptoms but can’t replace estrogen-based hormone therapy. This was an observational analysis rather than a randomized trial, so it can’t prove that testosterone alone caused the improvements.
Types of Testosterone Therapy for Women
Several types of testosterone are available for women in perimenopause:
- Cream
- Pellets
- Injections
- Gels
- Oral pills
Hone Health offers testosterone injections for $28/mo with membership ($155/mo) or testosterone cream for $60/mo with membership ($155/mo).
Side Effects of TRT in Women
When it comes to testosterone therapy for women in perimenopause and menopause, more isn’t better. Common side effects include acne or oily skin, facial hair, and thinning hair.
The most serious side effects of testosterone come from taking too-large doses. At Hone Health, physicians start treatment by prescribing lower doses of testosterone in women, requiring ongoing tests every three months to ensure levels remain in balance. Excessively high doses can raise cardiovascular risk, especially in people with preexisting conditions, though it can be reversed if caught early, Staheli says.
The Bottom Line
Testosterone replacement therapy for women is FDA-approved to treat low sex drive in menopause and prescribed off-label for benefits including bone density, muscle building, mood, and fat loss. The FDA is encouraging further research on testosterone to expand its evidence-based use in menopausal women.
U.S. Food and Drug Administration (2026) FDA Public Meeting: Testosterone Use in Menopausal Women
↑Avivi I, et al. (2026) Accelerating Testosterone Prescribing for U.S. Women: Implications for Cardiovascular Safety.
↑Zumoff B, et al. (1995) Twenty-four-hour mean plasma testosterone concentration declines with age in normal premenopausal women.
↑Adams M. (2019) Prescribing Testosterone for Women [conference handout]. Oregon Health & Science University
↑Wylie K, et al. (2020) Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care.”
↑Zumoff B, et al. (1995) Twenty-four-hour mean plasma testosterone concentration declines with age in normal premenopausal women.
↑Wang Y, et al. (2026) Associations between testosterone and pre-androgens and sexual function; findings from the Australian Women’s Midlife Years Study.
↑Maseroli E and Vignozzi L (2020) Testosterone and Vaginal Function.
↑Huang G, et al. (2014) Testosterone dose-response relationships in hysterectomized women with or without oophorectomy: effects on sexual function, body composition, muscle performance and physical function in a randomized trial.
↑Avivi I, et al. (2026) Accelerating Testosterone Prescribing for U.S. Women: Implications for Cardiovascular Safety.
↑Adams M. (2019) Prescribing Testosterone for Women [conference handout]. Oregon Health & Science University.
↑Furlan VA, et al. (2026) Testosterone therapy for female sexual dysfunction: a systematic review of the literature.
↑Wylie K, et al. (2020) Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care.
↑Cathcart-Rake E, et al. (2020) A randomized, double-blind, placebo-controlled trial of testosterone for treatment of postmenopausal women with aromatase inhibitor-induced arthralgias: Alliance study A221102.
↑Wylie K, et al. (2020) Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care.
↑Donovitz G. (2022) A Personal Prospective on Testosterone Therapy in Women—What We Know in 2022.
↑Rohr UD. (2002) The impact of testosterone imbalance on depression and women’s health.
↑Rohr UD. (2002) The impact of testosterone imbalance on depression and women’s health.
↑Cathcart-Rake E, et al. (2020) A randomized, double-blind, placebo-controlled trial of testosterone for treatment of postmenopausal women with aromatase inhibitor-induced arthralgias: Alliance study A221102.
↑Donovitz G. (2022) A Personal Prospective on Testosterone Therapy in Women—What We Know in 2022.
↑Glynne S, et al. (2025) Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study.
↑Wylie K, et al. (2020) Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care.
↑Cathcart-Rake E, et al. (2020) A randomized, double-blind, placebo-controlled trial of testosterone for treatment of postmenopausal women with aromatase inhibitor-induced arthralgias: Alliance study A221102.
↑Donovitz G. (2022) A Personal Prospective on Testosterone Therapy in Women—What We Know in 2022.
↑Huang G, et al. (2015) Effects of testosterone administration on cognitive function in hysterectomized women with low testosterone levels: a dose-response randomized trial.
↑Panay N, on behalf of the BMS Medical Advisory Council (2026) British Menopause Society Tool for Clinicians: Testosterone replacement in menopause.
↑AJMC (2026) Jury Still Out on Testosterone Benefit to Menopause.
↑Davis SR. (2024) Testosterone and the heart: friend or foe?
↑Nwizu C. (2020) The Effects of Testosterone Therapy in Females on Lipid Parameters and Cardiovascular Disease Risk.
↑Davis SR. (2024) Testosterone and the heart: friend or foe?
↑Nwizu C. (2020) The Effects of Testosterone Therapy in Females on Lipid Parameters and Cardiovascular Disease Risk.
↑Viana DPC, et al. (2026) Cardiovascular mortality associated with testosterone therapy in cisgender women and transgender men: a systematic review.
↑Lorenz TK, et al. (2017) Testosterone and immune-reproductive tradeoffs in healthy women.
↑Gubbels-Bupp M. (2018) Androgen-Induced Immunosuppression.
↑Traish A, et al. (2018) Do Androgens Modulate the Pathophysiological Pathways of Inflammation? Appraising the Contemporary Evidence.
↑Bianchi VE. (2018) The Anti-Inflammatory Effects of Testosterone.
↑Cathcart-Rake E, et al. (2020) A randomized, double-blind, placebo-controlled trial of testosterone for treatment of postmenopausal women with aromatase inhibitor-induced arthralgias: Alliance study A221102.
↑Wylie K, et al. (2020) Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care.
↑Donovitz G. (2022) A Personal Prospective on Testosterone Therapy in Women—What We Know in 2022.
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Mentioned in This Article:
Testosterone (Injections)
In women, testosterone injections are intended to help with symptoms of menopause such as decreased libido, bone loss, and irregular periods.
Testosterone (Cream)
Topical testosterone cream is a treatment option for symptoms related to menopause and testosterone deficiency, and can help to overcome decreased libido, fatigue and mood changes.
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The Edge upholds the highest standards of health journalism. We source research from peer-reviewed medical journals, top government agencies, leading academic institutions, and respected advocacy groups. We also go beyond the research, interviewing top experts in their fields to bring you the most informed insights. Every article is rigorously reviewed by medical experts to ensure accuracy. Contact us at support@honehealth.com if you see an error.
About the author
Deborah Skolnik is a journalist whose career has included staff positions at magazines and newspapers, including Woman’s Day, Parenting, and the New York Daily News. Her work has also appeared in the New York Times.
About the reviewer
Natalie Kunsman, M.D., is a board certified physician specializing in functional, anti-aging, and regenerative medicine. She is a fellow of the American Academy of Anti-Aging medicine and the American Academy of Family Physicians.
