What Is Known, What Is Unclear, and What You Should Ask Before Starting
When people hear the word testosterone, they often think of men. But testosterone is also a naturally occurring hormone in women, produced by the ovaries and adrenal glands in small amounts. It plays a role in sexual desire, energy, bone health, and overall well-being.
In recent years, testosterone therapy for women—especially in the form of hormone pellets—has become more widely marketed. This has raised important questions for patients: Who actually benefits? What does the science support? And what are the real risks?
Testosterone therapy is being marketed and sold in many places, promising to solve a wide range of problems. Women are searching for answers, so it’s important to understand what you can realistically expect from testosterone therapy.
What Does Testosterone Do in Women?
In women, testosterone contributes to:
- Sexual desire and arousal
- Energy and motivation
- Muscle mass and strength
- Bone density
- Mood and sense of well-being
Testosterone levels naturally decline with age, particularly after menopause, alongside estrogen.
When Is Testosterone Therapy Supported by Evidence?
The Strongest Evidence Supports One Use Only
Medical societies agree that the only evidence-based indication for testosterone therapy in women is:
Hypoactive Sexual Desire Disorder (HSDD)—in other words, low libido. This is defined as a persistent lack of sexual desire that causes personal distress and is not explained by relationship issues, depression, medications, or other medical conditions.
In postmenopausal women with low libido, testosterone therapy has been shown to:
- Increase sexual desire
- Improve sexual satisfaction
- Reduce sexual distress
Importantly, this benefit is seen when testosterone levels are kept within the normal female physiologic range, not at higher doses.
There is no high-quality evidence supporting testosterone therapy for:
- Weight loss
- Fatigue alone
- Brain fog
- Anti-aging
- General “hormone optimization”
What About Mood, Energy, or Bone Health?
Some women report feeling better on testosterone, with improvements in mood or energy. However:
- Studies are small and inconsistent
- Results are subjective
- Benefits are not reliably reproduced in large trials
At this time, these effects are not considered proven or predictable. That said, many women do report feeling that they have more energy after starting testosterone therapy—which is not surprising, as testosterone is a sex steroid.
Potential Side Effects of Testosterone Therapy
Side effects are dose-dependent and more likely when testosterone levels rise above the normal female range.
Possible side effects include:
- Acne or oily skin
- Increased facial or body hair
- Hair thinning on the scalp
- Mood changes or irritability
- Deepening of the voice (which may be irreversible)
- Enlargement of the clitoris (rare, but possible at higher doses)
Important: Voice deepening and clitoral enlargement are particularly concerning because these changes cannot be reversed. When clitoral enlargement occurs, it is very distressing for patients.
Is Testosterone FDA-Approved for Women?
No testosterone formulation is currently FDA-approved for use in women in the United States. When prescribed, testosterone is used off-label, often by adjusting doses of products originally approved for men or by using compounded formulations.
Off-label prescribing is legal and common in medicine, and physicians use medications off-label fairly commonly.
What Are Testosterone Pellets?
It’s not possible to discuss testosterone treatment without addressing the use of testosterone pellets, as they are widely available.
Testosterone pellets are small implants placed under the skin, usually in the hip or buttock area. They release hormone continuously over several months.
Pellets are often marketed as:
- “More natural”
- “More stable”
- “Low maintenance”
However, marketing claims should not be confused with scientific evidence.
Is There Good Evidence Supporting Testosterone Pellets in Women?
Short answer: No high-quality evidence exists.
What we know:
- Most pellet studies are observational, not randomized
- Many studies combine estrogen and testosterone, making effects hard to separate
- There is no ability to adjust the dose once pellets are placed
- Blood testosterone levels can become supraphysiologic (higher than the normal female range)
Major medical organizations do not recommend pellet therapy as a preferred method of testosterone delivery in women due to:
- Lack of robust safety data
- Difficulty reversing side effects
- Risk of prolonged over-exposure if adverse effects occur
Once a pellet is inserted, it cannot be easily removed, which is an important consideration if side effects develop.
Key Questions to Ask Before Starting Testosterone
Before starting testosterone therapy—especially pellets—patients should ask:
- What is the specific diagnosis we are treating?
- What evidence supports testosterone for my symptoms?
- What form of testosterone is being used, and why?
- How will levels be monitored, and how often?
- What happens if I develop side effects?
- Are there safer or better-studied alternatives?
A thoughtful, individualized discussion is essential.
Bottom Line
- Testosterone plays a real role in women’s health
- The only clearly supported use is for postmenopausal women with low libido (hypoactive sexual desire disorder)
- Claims of broad anti-aging or wellness benefits are not supported by strong evidence
- Testosterone pellets lack high-quality safety and efficacy data in women
- Long-term risks remain uncertain
Hormone therapy should be evidence-informed, cautiously dosed, and closely monitored—not driven by trends or marketing.
If you are considering testosterone therapy, partner with a physician who prioritizes safety, transparency, and individualized care.
Dr. Corinne Rao is a board-certified internal medicine physician and founder of Legacy Physicians, specializing in functional medicine approaches to weight loss, hormonal health, stress and chronic disease management. Schedule a consultation with Dr. Corinne at Legacy Physicians.
