Testosterone for women: useful, specific, and oversold.
There is a legitimate, evidence-supported role for testosterone in postmenopausal women. It is narrower than the marketing suggests — and safer when it is prescribed like medicine, not merchandise.
What the evidence actually supports
Testosterone has one well-supported indication in postmenopausal women: hypoactive sexual desire disorder — distressing low desire not explained by relationship factors, medications, or other conditions. For that indication, transdermal testosterone at physiologic doses has reasonable evidence of benefit.
What it is not
It is not an energy cure, a cognition enhancer, a muscle-restoration program, or an anti-aging therapy — the evidence does not support those uses, whatever the marketing says. And because no FDA-approved female testosterone product exists in the U.S., all use is off-label, which makes careful prescribing and monitoring more important, not less.
How we prescribe it safely
Transdermal preparations at low doses, with blood levels monitored to stay within the normal premenopausal range. Keeping levels physiologic is what separates evidence-based therapy from the supraphysiologic dosing common with pellets — which we do not recommend. We review response and side effects (acne, hair changes, voice changes at excessive doses) at defined intervals, and we stop if it isn't helping.