Do women need testosterone supplements?

Although commonly thought of as a “male" hormone, testosterone is essential for women too—it contributes to libido, sexual arousal and orgasm by increasing dopamine levels in the central nervous system. Since the 1940s doctors had been prescribing the hormone to their female patients to address problems such as low libido. But this ended when the scare around hormone-replacement therapy (HRT) emerged at the turn of the millennium. Although the concern centred on oestrogen and progesterone, testosterone got caught up in the mix. Doctors worried about a shortage of evidence-based research to support its use.

As concerns about the use of HRT have fallen away, however, women have started reconsidering testosterone, says Caroline Messer, a doctor at Fifth Avenue Endocrinology, a clinic in New York. Since 2019 the hormone has been offered for low libido, now called hypoactive sexual desire disorder (HSDD). In America, between 2013 and 2023, prescriptions increased by almost 50%; in Britain they rose ten-fold between 2015 and 2022.

Testosterone peaks in a woman’s 20s; by menopause, blood levels are about a quarter of the peak. The goal of therapy for HSDD is to get women roughly to their pre-menopausal levels, using products applied to the skin. Dr Messer avoids injectable pellets—she says that women can get too much testosterone this way. Too much hormone comes with side-effects including acne, excess body hair, mood swings or a permanent deepening of a woman’s voice.

Testosterone may also be useful during menopause for reasons other than sexual dysfunction. Women in menopause frequently complain of “brain fog"—with symptoms including fatigue, difficulty concentrating, poor memory, reduced verbal fluency and reduced ability to multitask. Enone McKenzie, a consultant psychiatrist specialising in women’s hormonal mental health at The Soke, a clinic in London, says peri-menopausal women who have been prescribed testosterone for low libido report improvements in mood and say they remember things better and have less decision fatigue. A few studies also suggest improvements in mood and cognition in post-menopausal women treated with testosterone.

However, well-designed trials are still needed to establish long-term efficacy and safety for these sort of uses. That leaves them in a medical grey area. For younger women who have no medical need for testosterone, its use to improve mood or performance is therefore terra incognita. The use of high doses for muscle-building or performance, equivalent to the way male bodybuilders might use the hormone, is deemed unsafe by experts.

For women with medical needs, testosterone supplements, at sensible doses, can be invaluable. But for everyone else, says Dr Messer, this is another “hormone du jour" needlessly offered up by influencers on social media.