--- title: "Testosterone Therapy in Women: Separating Facts from Myths" entity: "blog" canonical_url: "https://www.drsmithnd.com/blog/testosteronetherapyinwomenseparatingfactsfrommyths" markdown_url: "https://www.drsmithnd.com/llms/blog/testosteronetherapyinwomenseparatingfactsfrommyths" lastmod: "2025-09-23T13:33:00.000Z" --- To cut to the chase: yes I can now provide this therapy through my practice and yes, I have lots of experience with it (scroll to the bottom).* MYTHS VS FACTS per the peer reviewed scientific literature to date - Testosterone is a hormone that drops in perimenopause contributing to our symptoms. ❌ Nope. Our testosterone levels gradually decline starting around age 18, then do another drop in the early /mid 30s and then actually rise again as we approach our 60s (there’s a reason some elderly women have that chin hair!). Testosterone is not the key hormone changing in menopause; that role belongs to estrogen and progesterone [1]. - Testosterone is an important female hormone that converts into estrogen that deserves more high quality studies examining more aspects of female aging. ✅ Hell YES, of course it does. While there are many studies on this, there are not nearly enough and they need to expand the end markers they are looking for to look to be focused on the claims we are seeing emerge such as muscle gain, bone health, mood, etc. - Testosterone therapy has been proven with quality studies to help with symptoms of menopause and aging in general. ❌ Not true…yet. The only proven benefit of testosterone therapy in women (so far) is for Hypo Sexual Desire (HSDD), or low libido. Extensive research, including a landmark meta-analysis of over 8,400 women led by Dr. Susan Davis, has shown testosterone can improve sexual desire, pleasure, arousal, and satisfaction in postmenopausal women diagnosed with hypoactive sexual desire disorder (HSDD) [3] However, it is important to understand a few facts subsequent to that result: Only about 50-60% of women experience a meaningful improvement in sexual function after testosterone treatment [7]. The improvements generally appear after a slow burn of 4–6 weeks or more [8]. Testosterone therapy should only be considered after estrogen deficiency symptoms due to the genitourinary syndrome of menopause such as vaginal dryness, have been addressed with a local estrogen prescription and other potential causes (medical, psychological, relationship) have been explored [1]. - HSDD / low libido / low sexual desire in women is biopsychosocial problem that requires integrating biological, psychological, interpersonal, and sociocultural factors as a complex biopsychosocial issue, ensuring a comprehensive understanding and effective, multidimensional treatment approach rather than attributing it simply to low testosterone. ✅ Absolutely. This means that there are MANY inputs that do impact female sexual desire. Biological impacts could be hormones, medication side effects, chronic diseases, untreated GSM, as a few examples. Psychological impacts could be depression, anxiety, high stress, low self esteem, poor body images, etc. Interpersonal impacts are relational -so issues with your partner, communication, sexual satisfaction, boredom, etc. Sociocultural impacts can be derived from religious beliefs or cultural norms driving negative ideas around sex and desire. - Testosterone improves mood, self esteem, energy, muscle mass, brain fog & cognitive function. ❌ Refer back to #3. Despite social media claims, high-quality clinical trials have not found consistent benefits of testosterone therapy for mood, fatigue, muscle strength, bone density, or cognitive health in menopausal women [1]. We need and deserve quality studies!! - The placebo effect in testosterone trials for women has been shown to be profound. ✅ Fascinatingly…yes, a fact. Research on low sexual desire in women reveals a staggering placebo effect in testosterone trials. Dr. Susan Davis, PhD world renowned testosterone expert and someone who has run over 20 high quality studies on it, emphasized that in a key double-blind study, a substantial percentage of women receiving placebo reported improvements in sexual function comparable to those on actual testosterone—highlighting the strong influence of belief and expectancy factors. Her commentary about this topic in various publications and platforms is subsequent to numerous studies: a 2008 trial of transdermal testosterone which showed significant placebo improvements alongside modest benefits from testosterone [2], and a 2019 meta-analysis of 36 trials with over 8,000 women found similar results, confirming that while testosterone can help with libido, placebo effects play a major role [5]. These findings show us that while about 50-60% of women may respond to testosterone therapy for low sexual desire, it is a complex biopsychosocial issue that involves many different inputs that have to be considered in clinical practice. - Testosterone therapy for women is done at a low dose and doesn’t cause side effects. ✅ ❌ Yes it’s done at a much lower dose than in men, but some women have side effects such as acne, facial hair, hair loss, and at higher doses (that nobody should be prescribing) some experience voice deepening and clitoral enlargement [1]. In my practice, women who got side effects had experienced side effects prior from their own endogenous testosterone - this was quite a consistent observation. - The long-term safety profile, especially regarding cardiovascular and breast health, remains unclear [9]. ✅ True. We don’t have enough studies yet to understand long-term use and safety. - Testosterone is approved by the Menopause Society, Heath Canada and the FDA for use in perimenopausal or menopausal women. ❌ It is not recommended for use in perimenopause or menopause due to lack of evidence of benefit and proven safety. There is no Health Canada or FDA (American) approved product for women at this time, even for HSDD/ low libido. What is prescribed and who can prescribe testosterone therapy in Canada? #### Hi, I'm Dr. Kirsten Smith #### Women’s health warrior and advocate with 15+ years of experience in hormonal health My goal is to support women at all stages of their hormonal journey, through pre-perimenopause, perimenopause and post-menopause.