08/29/2026
Let’s talk about testosterone in perimenopause—because women need testosterone too. 💜
Testosterone is often treated like a “male hormone,” but women naturally produce it throughout life. Levels generally decline with age, and hormonal changes during the menopause transition can affect sexual function, energy, mood, body composition, and overall wellbeing. That said, the research is much stronger for some uses than others.
The best-supported use of testosterone therapy in women is for hypoactive sexual desire disorder (HSDD)—persistent low sexual desire that causes personal distress after other contributing factors have been evaluated. Multiple randomized trials and systematic reviews have found that appropriately dosed transdermal testosterone can improve sexual desire, arousal, or**sm, and satisfying sexual activity in postmenopausal women with HSDD. (PubMed)
What about perimenopause specifically? This is where the conversation needs more nuance. Evidence in premenopausal and perimenopausal women is still limited compared with the postmenopausal data. Some studies suggest potential benefit for women with low desire, but major guidelines do not currently support testosterone as a general treatment for fatigue, weight gain, brain fog, low mood, or “low testosterone” alone. (PubMed)
And testosterone isn’t something that should simply be prescribed because a lab number looks low. Guidelines emphasize evaluating symptoms, medications, relationship factors, mental health, other hormonal changes, and medical conditions first. When testosterone is appropriate, dosing should aim to stay within the normal physiologic range for women, with monitoring for response and side effects such as acne or increased hair growth. (ISSWSH)
There is also no FDA-approved testosterone product specifically formulated for women in the United States, so treatment is generally off-label and requires thoughtful prescribing and monitoring. Long-term cardiovascular and breast safety data remain less complete than we would like. (ACOG)
The takeaway? Testosterone can absolutely have a place in women’s healthcare—but it isn’t a cure-all and it shouldn’t be one-size-fits-all.
If your libido has disappeared, your body feels different, or you simply don’t feel like yourself during perimenopause, you deserve a provider who will look at the whole picture instead of dismissing your symptoms.
💜 Ask questions. Understand the evidence. Make decisions based on your symptoms, risks, and goals.
RN-led wellness services, provided in clinical partnership with Wellness on Demand for medical oversight and prescribing.
