Testosterone is produced by the ovaries and adrenal glands throughout a woman’s life and declines gradually with age and more sharply with oophorectomy. Treatment for women is a legitimate but narrow indication, and the guidelines specifically target dosing.
What the global consensus supports
The 2019 Global Consensus Position Statement, endorsed by 10+ international menopause societies including The Menopause Society and the Endocrine Society:
- Supports transdermal testosterone for postmenopausal women with diagnosed hypoactive sexual desire disorder (HSDD) after other factors are addressed.
- Dosing target: Serum testosterone levels in the premenopausal physiologic range — not supraphysiologic.
- Does not support testosterone for general wellbeing, energy, cognitive symptoms, or fatigue in the absence of HSDD, due to insufficient evidence.
What providers typically prescribe
Since no FDA-approved female product exists in the US:
- Transdermal cream compounded at roughly 1/10 the male dose.
- Transdermal gel (male-labeled product like AndroGel) applied at a reduced female dose.
- Pellets — the global consensus specifically cautions against this route because of supraphysiologic dosing.
What to monitor
- Baseline and follow-up serum testosterone (total and free) to confirm physiologic target.
- Lipid panel.
- Symptoms of androgen excess (acne, hair changes).