Testosterone Cream for Women - Does It Help in Menopause?

When you think of hormone replacement therapy (HRT), you probably think of estrogen and progesterone. While those are the primary hormones used to treat common menopause symptoms (think: hot flashes, night sweats, and mood swings), testosterone may also come up in conversations about menopause care, especially if your libido (sex drive) is lower than usual.

In fact, current clinical guidelines support testosterone therapy for treating hypoactive sexual desire disorder (HSDD), a condition characterized by persistently low sexual desire that causes distress. Testosterone can be prescribed in several forms, including creams, gels, pellets, troches, and injections. Experts prefer the topical option, such as a cream or gel, because it's easy to apply and adjust and is less likely to cause spikes in levels and the potential for supraphysiologic levels, like the injections or pellets.

Read further if you want to learn more about testosterone cream, what it may help with, and what current research says it isn't designed to treat.

Women Produce Testosterone Too

Testosterone is often thought of as a “male hormone,” but women naturally produce it too. Specifically, the ovaries and adrenal glands make testosterone throughout your reproductive years, just in much smaller amounts than men.

Testosterone gradually declines with age, and menopause can contribute to that decline. While estrogen levels drop dramatically during the menopausal transition, testosterone levels tend to decrease more gradually. That means changes in sexual desire, arousal, and satisfaction during menopause usually aren't due to lower testosterone alone.

Other factors that occur during this transition, including sleep disruption, stress, vaginal dryness, painful sex, medications, mood disorders, and your overall health, can all affect your sex drive. For more on  understanding the causes low libido - we suggest reading our article - “Why Is My Libido Low? Understanding Sexual Desire and The Connections to Menopause and Stress”.

The One Evidence-Based Use for Testosterone Therapy

Right now, the strongest evidence supports testosterone therapy for treating HSDD, which is defined as persistent and distressing low sexual desire. In other words, that shift in libido bothers or even worries you. You may miss feeling interested in sex, feel disconnected from your partner, or find that your lack of desire is affecting your quality of life. 

Before recommending testosterone therapy for HSDD, a menopause-trained clinician will usually assess for other factors that may be contributing to low libido.

For example, if sex has become painful because of vaginal dryness or the genitourinary syndrome of menopause (GSM), treating those symptoms may naturally improve desire. Likewise, poor sleep, depression, anxiety, chronic stress, certain medications, and relationship concerns can all reduce sexual interest, regardless of your hormone levels.

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What Testosterone Cream Is and How It Works

Transdermal testosterone therapy that is absorbed through the skin surface into the bloodstream, is generally the preferred way to prescribe testosterone for women. It can come in the form of a cream or gel.

Much like menopausal hormone therapy (MHT), transdermal testosterone is designed to restore testosterone levels to the normal physiologic range for women. Because there are no FDA-approved testosterone products specifically designed for women in the U.S., some clinicians prescribe carefully compounded formulations.

Where you get your testosterone prescription from matters, as does the dose. Too little testosterone may not improve symptoms, while too much increases the risk of unwanted side effects, such as acne and increased facial or body hair, called hirsutism. That's why it’s so important for your treatment to be individualized and monitored using testosterone levels by a healthcare professional.

What Testosterone Isn't Proven to Treat

Despite what you may see on social media, there isn’t any strong evidence to suggest that it helps ease other classic menopause symptoms, such as mood changes, fatigue, or muscle loss. It also shouldn’t be used as an anti-aging therapy. 

Sure, some women report feeling more energetic or motivated after starting testosterone, but studies have yet to show these benefits consistently or without additional androgenic side effects from the high doses being utilized to obtain these benefits. 

“The patients on testosterone who report feeling super energized or who have awareness of significant changes in stamina or exercise, are on doses that are giving supraphysiologic levels (levels outside typical female range) for which we just have zero long term safety data. In addition, they are the same patients that are often surprised when they find out their insomnia, receding hairline and cystic acne breakouts are related to these high levels. So the concern is: Yes, you may be feeling an energy “high”, but at what cost immediately and later to your body. For women who are boosted to healthy standard female levels which can absolutely help sexual response and desire, they are less likely to report changes in energy, focus or strength.” - Dr Traci Kurtzer

As of now, menopausal hormone therapy (estradiol +/- progesterone) remains the treatment with the strongest evidence for managing menopausal symptoms, such as hot flashes, night sweats, sleep disruptions, body composition and weight management. 

Who Might Be a Candidate for Testosterone Therapy?

Not every woman in the menopausal transition will need testosterone therapy. 

Much like HRT, testosterone therapy isn’t appropriate for everyone experiencing menopause. Women dealing with HSDD are the top candidates, but again, because libido is complex, your clinician will first consider other factors like vaginal dryness, painful sex, poor sleep, stress, medications, and relationship changes before prescribing testosterone. Treating those underlying issues using an estrogen-based hormone therapy can often help improve sexual function indirectly.

What Are the Benefits and Side Effects of Testosterone Cream?

For women with HSDD, testosterone therapy may improve sexual desire, arousal, orgasm, and overall sexual satisfaction. While the improvements seen in studies are generally modest, that’s not to say it can’t be meaningful for women whose symptoms are affecting their quality of life.

When testosterone is prescribed at doses that keep levels within the normal female range, side effects are generally uncommon. Taking too much, however, can increase the risk of acne, oily skin, unwanted facial hair growth, and/or hair thinning on your scalp. In severe cases, deepening of the voice, enlargement of the “Adam’s apple” and clitoromegaly can occur, though rare. 

Remember this: Keeping your doctor in the loop about any unusual side effects is essential while taking any type of hormone therapy.

Testosterone Cream vs. Pellets

If you and your care team decide that testosterone therapy may be appropriate for you, you should consider starting with a transdermal cream or gel, as these products are often prescribed at a lower, more precise dose that can be easily adjusted if needed.

Injections and pellet implants, on the other hand, slowly release testosterone over a week to several months and can't be easily adjusted or removed once they’re in. They could also produce testosterone levels that are higher than the normal female range, which may increase your risk of side effects. Last, there are additional financial costs for injection and pellet visits to take into consideration, that are not needed for prescription creams that you administer daily.

No matter which route you go, ask your doctor how they intend to monitor your testosterone while using this therapy. Here is some further counseling on the safe use of testosterone.

Final Thoughts About Testosterone Therapy

Testosterone therapy can help some women reconnect with their libido, which may improve their quality of life. Before starting treatment, consider asking your clinician whether your symptoms fit the criteria for HSDD and whether other menopause symptoms, such as vaginal dryness or painful sex, could also be contributing to your lower-than-usual sexual desire.

You might also ask what results you can realistically expect, how your treatment will be monitored, and what potential side effects you may want to watch out for. The more informed you are before starting therapy, the better equipped you'll be to decide whether it’s the right fit for your symptoms and health goals. 

When it comes to your health, you are your number one advocate! And while Alloy physicians do not prescribe testosterone due to it being a controlled substance and the need for close level monitoring, we support our patients who choose to use testosterone as part of their approach to their mid-life wellbeing ! 

Frequently Asked Questions

What is the primary evidence-based reason for prescribing testosterone therapy to menopausal women?

The primary evidence-based use of testosterone therapy in women is for treating hypoactive sexual desire disorder (HSDD), which involves persistently low sexual desire that causes distress. When prescribed at physiologic doses, testosterone can improve sexual desire, arousal, orgasm, and overall sexual satisfaction, though it is not recommended as a treatment for low libido caused primarily by other factors like vaginal dryness or stress.

Is testosterone effective for boosting energy, improving mood, or anti-aging?

No, testosterone is not proven or recommended to treat general menopause symptoms such as mood changes, fatigue, muscle loss, or aging. While high doses might cause temporary energy boosts, these supraphysiologic levels lack long-term safety data and significantly increase the risk of side effects like insomnia, hair thinning, and cystic acne breakouts. Standard menopausal hormone therapy using estradiol with or without progesterone remains the primary treatment with the strongest evidence for common symptoms like hot flashes and energy disruptions.

Why do experts prefer testosterone creams and gels over pellets or injections?

Topical creams and gels are preferred because they allow for precise, daily dosing within the normal female range and can easily be adjusted if needed. Conversely, pellets and injections slowly release testosterone over weeks or months, cannot be easily removed or adjusted once administered, and carry a higher risk of producing excessively high hormone levels that cause unwanted side effects. Additionally, pellets and injections require extra clinical visits that add financial costs not required for daily prescription creams.