Perimenopausal symptoms often begin to manifest in women as they enter their 40s, driven by hormonal fluctuations. These symptoms can include irregular periods, brain fog, insomnia, and hair loss. As testosterone levels naturally decrease with age around this time, many women are turning to testosterone therapy in search of relief. Despite the fact that testosterone is primarily known as a male sex hormone, it plays crucial roles in both men and women's health. However, the U.S. Food and Drug Administration (FDA) has not approved testosterone therapy for women, leading to a surge of off-label prescriptions.
Topical testosterone products became available in the early 2000s, and since then, testosterone prescriptions in the United States have increased nearly 50% between 2013 and 2023. Dr. Amy Voedisch, an OB-GYN at Stanford Medicine, has observed a significant rise in middle-aged women requesting testosterone therapy. She explains that many patients seek this treatment after learning about its potential benefits from various sources, including social media influencers.
Dr. Traci Kurtzer, a menopause specialist at Northwestern Medicine, echoes this sentiment, noting that the push for testosterone therapy among women has gained momentum in recent years. Testosterone levels in men are typically about 15 times higher than in women, and while men often require higher doses, women are recommended to take just 5 mg a day—10% of the dose prescribed for men.
Despite its popularity, testosterone therapy for women remains controversial. Dr. Jan Shifren, director of Massachusetts General Hospital’s Midlife Women’s Health Center, states that the benefits for women with low libido are not particularly impressive. Moreover, Dr. Akshay Syal from UCLA Health emphasizes that few claims about testosterone therapy are backed by substantial evidence.
“We have ignored women’s health for a very long time in this country,” – Dr. Amy Voedisch
Dr. Voedisch warns about the potential side effects of improper dosing. She recalls a patient who discontinued testosterone therapy after experiencing a change in her voice, stating that such effects "may not get better even once you stop, which is really unfortunate."
“What really did it for me was once I was on the phone and somebody called me ‘sir’” – Dr. Amy Voedisch
The allure of testosterone therapy extends beyond just libido improvement. Dr. Rebecca Dunsmoor-Su notes that many women are promised a range of benefits from this "miracle-drug pill," including increased energy, weight loss, and enhanced sexual desire. However, she cautions that these claims can sometimes feel exaggerated.
“It feels almost like an epidemic,” – Dr. Rebecca Dunsmoor-Su
“They’re being told this is the miracle-drug pill that they’ve been looking for.” – Dr. Rebecca Dunsmoor-Su
“It’ll give them energy, it’ll make them thin, it will make them horny, like they’ve been promised,” – Dr. Rebecca Dunsmoor-Su
Marcella Hill, one of the women who sought relief through testosterone therapy, shares her personal journey with the treatment.
“I thought that’s insane. I can’t live like this,” – Marcella Hill
She recounts her experience after starting the therapy.
“A couple months into it, all of a sudden my libido turns back on,” – Marcella Hill
Hill describes the rekindled passion she felt as transformative.
“I want to be with my husband and I have this passion, this desire that I hadn’t had since college.” – Marcella Hill
Despite individual success stories like Hill's, medical professionals remain cautious about endorsing testosterone therapy as a comprehensive solution for perimenopausal symptoms. The lack of FDA approval and limited scientific backing urge caution and further research.
Because patients often receive testosterone through med-spas and telemedicine services, there might be more women using these treatments than official statistics suggest. This raises concerns about oversight and regulation in the administration of testosterone therapies.
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