Best Testosterone Options for Women

The best testosterone option for most women is a low-dose gel or cream rubbed into the skin, dosed to keep your blood levels in the normal range for a premenopausal woman. The 2019 global consensus statement on testosterone for women does not recommend testosterone pills, pellets or injections. Testosterone does its best work on one problem: low sex drive after menopause, when that low drive bothers you. It usually works best once your estrogen is sorted.

Which form of testosterone is best for women?

Testosterone on the skin wins because it leaves your cholesterol alone. In a review of randomized trials in The Lancet Diabetes & Endocrinology, testosterone pills raised LDL ("bad") cholesterol and lowered HDL ("good") cholesterol. Patches and creams did not, so the authors prefer non-oral routes.

The global consensus goes further. It rules out pills because of that cholesterol effect. It also rules out any form that pushes levels above the normal female range, including pellets and injections.

In the US, no testosterone cream is FDA-approved for women. Women's creams are compounded, which means a pharmacy mixes them to order. A clinician can also prescribe an FDA-approved men's gel off-label at a low women's dose. The consensus does not recommend compounded testosterone when an approved equivalent is available. When a compounded product is needed, the pharmacy should meet purity and manufacturing standards, and the dose should keep your levels in the premenopausal range.

Here is what cream costs from online clinics. Based on published prices, the first 90 days run about $489 with Healthspan, $500 before labs with Midi if you self-pay, and $710 with Hone.

Pellets cost $350 to about $600 per insertion, with a median of $375, and insurance usually doesn't cover them. ACOG recommends other forms of testosterone, partly because a pellet can't be removed once it's in. If your skin breaks out or your levels run high, you wait it out.

How much does testosterone help a woman's sex drive?

In the pooled trials, postmenopausal women on testosterone had 0.85 more satisfying sexual events a month than women on placebo. They also had more desire, pleasure, arousal, orgasm and responsiveness, and they felt better about their bodies. Their sexual concerns and distress went down.

In a 24-week trial of 549 naturally menopausal women already taking estrogen pills, a 300 microgram a day testosterone patch raised satisfying sex by 1.9 times per 4 weeks. On placebo, the rise was 0.5.

About one extra good time a month can sound small on paper. If you've stopped wanting sex at all, it can feel like a lot. It's the difference between dreading the topic and looking forward to it. It won't turn you into a different person, and it doesn't need to.

Give it time. The global consensus advises stopping after 6 months if nothing has changed.

Will testosterone give me more energy or help me lose weight?

Don't count on it for your body. At normal female doses, trials have not shown testosterone changing muscle, body fat or strength. The data also don't support an effect on bone density at 12 months. Women on testosterone gained some weight overall in the pooled trials.

Energy is a different story. Two UK menopause doctors write that many women notice better mood, concentration, motivation and energy on testosterone. The British Menopause Society's 2016 recommendations say it could also be used for menopausal women who have low desire together with tiredness. The strongest trial evidence is still for sex drive.

One perimenopausal woman described both the upside and the downside: "I started T and got some zest for life back but now my face breaks out and I am losing hair more than usual."

Is testosterone right for me, or should I fix my estrogen first?

• Wanting your sex drive back is a good enough reason to ask. A top comment on a thread about a doctor brushing off a woman's concern for her libido put it this way: "if you were a man, this would be a crisis."
• The clearest fit is a woman after menopause whose low desire bothers her. The consensus covers women after natural or surgical menopause, whether or not they also take estrogen.
• Estrogen usually comes first. NICE, the UK's health guidance body, says testosterone can be considered when HRT alone hasn't fixed low desire. You should have enough estrogen before testosterone is added. That usually means your hot flashes and vaginal dryness have settled.
• Expect blood tests. The global consensus advises a testosterone test before you start and a recheck 3 to 6 weeks in. After that, you get a total testosterone check every 6 months to make sure your levels aren't too high.
• Start with the whole picture. Our clinical team can prescribe bioidentical estrogen if it fits your goal, and Hot or Nothing's libido plans also include PT-141 and kisspeptin. Tell your clinical team you're interested in testosterone so they can weigh it alongside everything else.

What side effects does testosterone cause in women?

At normal female doses, some women get mild acne or more body or facial hair. Trials didn't link these doses to hair loss, an enlarged clitoris or a deeper voice.

Short-term trials found no serious harms. Safety data stop at 24 months, though, and the trials left out women at high risk of heart disease or diabetes.

Testosterone on the skin has not raised blood pressure or breast cancer risk in the short term. No one knows yet whether it's safe after breast cancer, so a specialist makes that call case by case.

If you want your sex drive back, take the quiz. It starts a plan with our clinical team. They'll look at your hormones and libido goals, including estrogen, PT-141 or kisspeptin, and talk through where testosterone fits.