By Akshay Syal, MD

Do women have a testosterone problem?

Social media influencers believe they do. And with the rise of telemedicine and testosterone replacement clinics opening up across the country, access to the drug has never been easier.

In the U.S., prescriptions for testosterone increased nearly 50% between 2013 and 2023, according to recent data from the health technology company IQVIA. Doctors say interest in the hormone isn’t being driven only by men, but also by women in their 40s and 50s.

“It feels almost like an epidemic,” Dr. Rebecca Dunsmoor-Su, chief medical officer for Gennev, a national telemedicine company for menopause patients, said about middle-age women seeking testosterone. “They’re being told this is the miracle-drug pill that they’ve been looking for.”

Because patients are often prescribed testosterone gels, pellets or pills through med-spas and telemedicine, there could be even more women taking the hormone than realized, Dunsmoor-Su said.

Testosterone is the primary male sex hormone and plays a variety of roles in the human body. In men, testosterone boosts muscle mass, sex drive and deepening of the voice. In women, who also have testosterone generally in much lower levels, it also plays a role in libido, muscular health and energy.

Typically, testosterone levels in men are around 15 times higher than in women.

In both women and men, it’s normal for testosterone levels to drop with age — starting at about age 30 in men and around 40 in women. The decline doesn’t mean that it necessarily needs to be replaced, either for health or longevity.

Levels for what is considered normal can vary depending on the lab, and just because levels are low, that does not necessarily mean testosterone should be started. Doctors use a combination of symptoms and blood work in deciding whom to treat.

If a patient does have symptoms of “low T” — including depression, lethargy and low sex drive — doctors typically gauge levels with a blood test before deciding treatment.

Testosterone treatment includes a gel rubbed on the shoulder, pills or an implantable pellet in the buttocks.

Why do women use testosterone?

Dr. Amy Voedisch, an OB-GYN at Stanford Medicine in Palo Alto, California, has noticed a dramatic rise in recent years in middle-age women asking for testosterone therapy.

Perimenopausal symptoms begin when women reach their 40s, triggered by hormonal fluctuations and accompanied by irregular periods, brain fog, insomnia and hair loss. The changes typically begin a few years before menopause, when periods permanently end.

Some women may notice a decrease in sex drive as levels of estrogen and testosterone, both of which play a role in libido, start to decline as they get older.

“I’ll talk about menopausal hormone therapy and then they’ll say — but what about testosterone?”

Topical testosterone products first hit the market in the early 2000s.

Voedisch, who has been in practice for decades, says the phenomenon among women really started to take off just in the last couple of years. Previously, interest in testosterone therapy rarely came up in appointments, she said.

Now, virtually every new menopause patient she sees will ask about it.

A patient will say, “I was listening to this podcast, and they said that I needed this,” she said. “Or I have this Instagram person that I follow and she said that I absolutely have to be on it.”

On the Reddit community r/menopause, scores of posts tout the drug’s benefits of improved energy and sex drive for women.

Few of the claims are supported by evidence, Dunsmoor-Su said.

“It’ll give them energy, it’ll make them thin, it will make them horny, like they’ve been promised,” she said, describing common claims about the drug. “It does everything — and all of their problems are just because they’re a little low in testosterone.”

Dr. Traci Kurtzer, a menopause specialist at the Northwestern Medicine Center for Sexual Medicine and Menopause in Chicago, agreed the push for testosterone started happening in recent years. Her patients inquire about testosterone therapy for multiple problems — to improve mood, energy, sex drive, brain fog and muscle mass.

She tells patients that testosterone therapy is currently only recommended for a low sex drive, although future research may find other benefits.

“If that’s the case, that’ll be wonderful, but at this point in time we don’t have the data to support that,” Kurtzer said.

Does testosterone help women?

The Food and Drug Administration hasn’t approved testosterone therapy for women. However, doctors can prescribe it for low sex drive after other causes, including medical and psychological ones, are ruled out, said Dr. Jan Shifren, director of Massachusetts General Hospital’s Midlife Women’s Health Center in Boston.

Shifren, who has been involved in clinical trials looking at testosterone therapy in women, said that the benefits for women with low libido aren’t terribly impressive.

“Women who are randomized to testosterone, compared with placebo, have one additional satisfying sexual event in four weeks, compared with placebo,” she said.

In addition to declining hormonal levels, causes of low libido in women can include relationship problems, anxiety or depression, and metabolic conditions such as high blood pressure or diabetes. Discomfort from vaginal dryness from menopause is another reason. Exhaustion from caregiving and other family responsibilities also take their toll, doctors say.

Shifren urges women to address all other possible causes of low libido before starting testosterone.

“It’s not that I don’t sometimes prescribe it, but it’s after addressing a lot of other concerns,” she said.

For Marcella Hill, 44, the symptoms of depression, body aches and low sex drive were affecting her relationship with her husband.

“I was really suffering,” said Hill who lives in Vineyard, Utah. Her doctor told her that it was just normal.

“I thought that’s insane. I can’t live like this,” Hill said.

At first, she was given a testosterone gel prescription but didn’t notice an improvement and found it hard to use.

Frustrated that her doctor didn’t offer more help, she went to a local medical clinic at a friend’s urging and started testosterone pellet therapy, a more potent version of the hormone.

After two years of treatment, she says the results have been life-changing.

“A couple months into it, all of a sudden my libido turns back on,” she said. “I want to be with my husband and I have this passion, this desire that I hadn’t had since college.”

She posts about her testosterone therapy on Instagram and other social media.

“​​I opened TikTok to just tell that story, and the next day my phone blew up with 9 million views,” she said. “Women all over the whole world were like, ‘Wait, I have all these symptoms.’”

Hill isn’t paid for promoting testosterone, although she has worked with a telehealth company in ads urging women to get regular medical checkups.

She gets her levels checked regularly and says that her testosterone is closer to the low end for a male. While she is not worried about her high levels, she does have an unwanted side effect — excess hair growth on her face.

Is testosterone therapy safe?

When prescribed by a doctor and carefully monitored, testosterone is relatively safe for women and side effects are rare, experts said.

When men start testosterone therapy, it is typically given in a gel with a dose of 50-100 mg a day.

Women, on the other hand, are recommended to take just 5 mg a day — 10% of the dose of a man.

Higher doses for women can cause side effects including acne, excessive body hair and even body odor. Some are permanent.

Voedisch recalls one patient who finally stopped testosterone therapy after her voice was altered.

“She said, ‘What really did it for me was once I was on the phone and somebody called me ‘sir,’” said Voedisch.

Voedisch warned about side effects from improper dosing. “It may not get better even once you stop, which is really unfortunate.”

She’s sympathetic to patients who feel ignored by doctors and are frustrated with the lack of treatment options available for perimenopausal and menopausal symptoms.

“We have ignored women’s health for a very long time in this country,” said Voedisch. “This comes from a place of frustration and it comes from a place of wanting to feel better.”