Does Testosterone Help Perimenopause Symptoms?
Published on March 18, 2026
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Estrogen and progesterone hormone therapy are standard for easing menopausal symptoms, but a very different type of hormone treatment may ease certain issues too: testosterone therapy. Classified as an androgen, testosterone famously triggers male physical sexual development, but it also plays a significant role in women’s bodies.
“Most of the testosterone in a woman’s body is used for our sexual function, but it also helps with our strength, cognition, and mood, says Tangela Anderson Tull, MD, a menopause specialist with Hoffman and Associates, an all-female obstetrics and gynecology practice affiliated with Mercy Medical Center in Baltimore.
Testosterone therapy is not currently approved by the U.S. Food and Drug Administration (FDA) for women, but some doctors do prescribe it off-label. Here’s what to know about this method of menopause treatment, and if it will help you address your symptoms.
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Read MoreThe Role of Testosterone in the Female Body
While often considered a male hormone, testosterone has important physiological effects in women throughout their lives. It plays a role in:
- Libido
- Bone and muscle health
- Mood and energy
- Menstrual cycle and fertility
“Testosterone is a critical hormone in women,” says Mary Rosser, MD, PhD, an obstetrician-gynecologist, menopause expert, and the director of Integrated Women's Health at Columbia University’s Irving Medical Center in New York City. It’s also a precursor for estradiol production, the most powerful type of estrogen in the female body.
As we age, testosterone levels start dropping in the body, but in a different way than estrogen does. “Testosterone levels do not decline significantly at menopause itself,” says Dr. Rosser. “They decline gradually with age starting in the early reproductive years. “This is an important distinction that challenges common assumptions about menopause and testosterone.”
When testosterone levels are lower, it may result in these symptoms, many of which directly overlap with the ones commonly associated with the menopausal transition:
- Low sex drive
- Fatigue
- Loss of strength and muscle tone
- Infertility or trouble conceiving
- Irregular menstrual cycles
- Vaginal dryness
- Depression or anxiety
- Thinning hair
- Dry, brittle skin
- Trouble sleeping
What Is Testosterone Therapy for Women?
Testosterone therapy is an off-label treatment, typically for postmenopausal women with low libido. But current research suggests that it may also have benefits for perimenopausal women experiencing sexual problems, anxiety, vaginal dryness, irritability, and physical and mental exhaustion.
This type of therapy has gained mainstream attention recently, despite being used for more than 80 years to treat perimenopause and menopause symptoms. Testosterone therapy has been licensed for use in women in England and Australia for six decades.
“When I [first] trained there was no mention of testosterone therapy for women beyond sexual function,” says Dr. Anderson Tull. “It wasn’t until I did training years later and started to do my own research that I found that patients were reporting they felt significant improvements in brain fog, hot flashes, and other menopausal symptoms, too.”
How It’s Administered
Since it’s not FDA approved, there are no recommended dosages. You’ll work with your doctor to determine what amount may be effective for you. Testosterone comes in different formulations, including:
- Creams and Gels This is the safest and most common form. They’re typically applied daily to the lower abdomen or buttocks.
- Pellet Therapy Testosterone pellets are intended to deliver the hormone for three to four months, and sometimes up to six. A doctor will place it under the skin in a 15-minute in-office procedure.
- Injections These shots are administered into a muscle every week or two, although some formulations can be given every 10 weeks.
Dr. Rosser says the most extensively studied formulation is a transdermal patch, but it’s not currently available in the United States. She also urges caution with certain types of testosterone therapy, as it can be difficult to control the amount of testosterone that is absorbed by the body.
Testosterone is also available in OTC supplements and compounded products, but these are mostly unregulated in the United States, so it’s best to avoid using over-the-counter testosterone products.
What Testosterone Can and Can’t Do for Perimenopause Symptoms
Emerging science suggests testosterone may be an effective treatment for certain perimenopausal symptoms, although more research is needed.
Low Libido
Testosterone has shown the most promise in treating an unwanted decrease in sexual desire, a symptom that may impact as many as a third of women in perimenopause.
“Testosterone therapy has demonstrated moderate effectiveness in postmenopausal women with distressingly low sexual desire,” says Rosser.
She points to a comprehensive meta-analysis involving 8,480 participants that found testosterone significantly increased satisfactory sexual events, sexual desire, pleasure, arousal, orgasm, and responsiveness, while reducing sexual concerns and distress.
“[Low libido] is the only evidence-based indication for testosterone use in women,” says Rosser.
Hot Flashes
Conventional hormone therapy remains the go-to treatment for hot flashes. Testosterone plays a minor role in managing vasomotor symptoms, but is not currently considered a first-line treatment.
But some research suggests testosterone shows promise in that area. An observational study of 78 perimenopausal and menopausal women treated with testosterone pellet therapy over the course of 10 years reported that their hot flashes were significantly reduced.
Mood and Brain Fog
Rosser says that the current evidence doesn’t support testosterone use for mood and brain fog.
“Available data show no effect of testosterone therapy on depressed mood, and there is insufficient evidence to support its use to enhance cognitive performance or delay cognitive decline in postmenopausal women,” she says.
She pointed to one small pilot study which suggested improvements in mood and cognition with testosterone therapy, but it was a retrospective study without a control group and requires confirmation in randomized trials.
Fatigue
Testosterone therapy is commonly used to address fatigue in men; however, there is less evidence to support its use in perimenopausal and menopausal women.
Results from the previously mentioned pellet therapy study found that fatigue improved considerably after treatment. More studies are needed to confirm their findings.
Risks and Side Effects of Testosterone Therapy
When used at dosages that approximate pre-menopausal levels, testosterone therapy has only mild side effects, though long-term safety has not been established.
Common side effects, which are typically reversible when you stop taking testosterone, may include:
- Acne
- Excessive hair growth
- Weight gain
More serious side effects, such as alopecia (hair loss), voice deepening, and clitoral enlargement are rare with testosterone replacement.
The Takeaway
- Testosterone plays a key role in women’s health, supporting libido, mood, strength, cognition, bone health, and fertility. Levels decline gradually with age (not abruptly at menopause), and low levels can overlap with common perimenopausal symptoms like fatigue, low sex drive, and mood changes.
- Testosterone therapy is not FDA-approved for women, but it is sometimes prescribed off-label. It’s mainly used to address low libido, but some observational and pilot studies have shown that it may also help improve hot flashes, mood, brain fog, and fatigue.
- Side effects are usually mild and may include acne, excess hair growth, and weight gain. Over-the-counter and compounded products are largely unregulated, so use testosterone under medical supervision.
FAQ
What is the role of testosterone in women’s bodies?
Testosterone is best known as a male sex hormone, but it plays a supporting role in women’s bodies, helping regulate sex drive, improve muscle strength and bone density, and boost energy and mood.
What happens to natural testosterone levels during perimenopause?
Is testosterone therapy a replacement for traditional hormone therapy for menopausal symptoms?
No. Estrogen, taken with or without progesterone, remains the gold standard for treating common symptoms like hot flashes, night sweats, and vaginal dryness. Testosterone therapy is not FDA-approved for women and is currently only used off-label.
What are the side effects of testosterone therapy?
Side effects include acne, increased facial or body hair, and weight gain. They are typically mild and reversible, and they’re more likely to happen if blood levels rise above the normal range of testosterone you’d find in the female body.
Resources We Trust
- Cleveland Clinic: Should Women Get Treatment for Low Testosterone?
- Mayo Clinic: Can Low Libido Be Treated?
- The Menopause Society: Find a Menopause Practitioner
- American College of Obstetricians & Gynecologists: Menopause: What Your Ob-Gyn Wants You to Know
- Office on Women’s Health: Menopause Basics
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