TRT for women means testosterone replacement therapy. It uses prescription testosterone, usually as a low-dose transdermal gel or cream, to treat specific symptoms linked to low sexual desire. The strongest evidence supports testosterone therapy for postmenopausal women with hypoactive sexual desire disorder, or HSDD, after medical, psychological and relationship-related factors have been assessed.
TRT is not a general treatment for menopause, fatigue, weight loss, brain fog, muscle gain or "hormone balance." Current evidence does not support routine testosterone therapy for those purposes. ACOG's 2023 clinical consensus also advises against testosterone pellet therapy because the pellets are difficult to remove and their safety and effectiveness are not well established.
TRT for Women at a Glance
| Question | Answer |
|---|---|
| What does TRT mean? | Testosterone replacement therapy |
| Main evidence-supported use | Postmenopausal HSDD |
| What is HSDD? | Persistent, generalized low sexual desire that causes personal distress |
| Usual form | Low-dose transdermal testosterone gel or cream |
| United States approval | No testosterone product is FDA-approved specifically for cisgender women |
| Expected benefit | A moderate improvement in sexual desire and related sexual function for some women |
| Main risks | Acne, increased facial hair, scalp hair thinning and virilization |
| Long-term safety | Cardiovascular and breast cancer risks remain uncertain |
What Condition Does Testosterone Therapy Treat?
Hypoactive sexual desire disorder is persistent, generalized low sexual desire that causes personal distress. A low testosterone blood test does not diagnose HSDD, and no single testosterone level proves that a woman needs treatment.
Before prescribing testosterone, a clinician should look for other possible causes of low desire, including:
- Pain during sex or vaginal dryness
- Depression, anxiety or chronic stress
- Relationship problems
- Poor sleep
- Medication side effects, including some antidepressants
- Thyroid disease or other medical conditions
- Menopause symptoms that have not been adequately treated
Most international guidance places testosterone therapy after these factors have been assessed. The Global Consensus Position Statement identifies postmenopausal HSDD as the only clearly evidence-based indication. The International Society for the Study of Women's Sexual Health also allows treatment to be considered for carefully selected women in the later reproductive years.
What Benefits Can Women Expect From TRT?
Testosterone therapy may produce a modest improvement in sexual desire, arousal, satisfaction and sexually related distress for some women with HSDD. It does not reliably improve every symptom associated with menopause, and it is not a guaranteed treatment for low energy or poor mood.
Treatment is not intended to raise testosterone to male levels. The usual goal is to keep testosterone within the normal physiological range for premenopausal women. Higher doses do not necessarily improve results and can raise the risk of androgen-related side effects.
How Is TRT Given to Women?
Guidelines generally favor systemic transdermal testosterone, which is absorbed through the skin from a gel or cream. In the United States, clinicians may prescribe a male-approved product at a substantially reduced dose because no testosterone product is FDA-approved specifically for cisgender women. This is off-label use.
Guidance generally discourages:
- Testosterone pellets
- Testosterone injections for routine female HSDD treatment
- Oral testosterone
- Self-adjusted doses
- Compounded products when a suitable regulated alternative is available
ACOG advises against testosterone pellets because they cannot be removed easily, and their safety and effectiveness are not well established.
What Are the Risks and Side Effects?
Possible androgen-related side effects include:
- Acne or oily skin
- Increased facial or body hair
- Scalp hair thinning
- Voice deepening
- Enlargement of the clitoris
- Other signs of virilization
Some effects, especially voice deepening and clitoral enlargement, may be irreversible. The long-term effects of testosterone therapy on breast cancer and cardiovascular disease risk remain uncertain.
Contact the prescribing clinician if you develop rapidly worsening acne, new facial hair, scalp hair loss, voice changes or other signs of excessive testosterone.
What Monitoring Is Needed?
Before treatment, clinicians commonly check total testosterone and sex hormone-binding globulin, or SHBG. These tests establish a baseline and can help identify an already-high testosterone level. Treatment should not aim for a high target number. Monitoring is used to limit excessive exposure and keep testosterone within the female physiological range.
The ISSWSH guideline recommends checking testosterone about 3 to 6 weeks after treatment begins, repeating the test after dose changes and continuing periodic monitoring once the dose is stable. Clinicians also assess symptoms, acne, hair growth, scalp hair loss and other signs of androgen excess.
Is TRT the Same as Menopause Hormone Therapy?
No. Menopause hormone therapy usually means estrogen, with progestin added for people who have a uterus. Estrogen is the primary hormone treatment for hot flashes, night sweats and many symptoms of vaginal dryness. Testosterone has a narrower role, mainly for distressing low sexual desire.
Testosterone should not replace appropriate treatment for:
- Hot flashes
- Night sweats
- Vaginal dryness or painful sex
- Osteoporosis prevention
- Depression or anxiety
- General fatigue
- Weight management
Vaginal dryness and painful sex may need vaginal estrogen, moisturizers, lubricants or other treatments instead of testosterone.
Is TRT Right for You?
TRT may be worth discussing with a gynecologist, menopause specialist or sexual-medicine clinician if you are postmenopausal and have persistent low sexual desire that causes distress, particularly after other contributing factors have been assessed.
Before prescribing testosterone, a clinician should review your symptoms, medical history, medications and treatment goals. People who are pregnant, trying to become pregnant or could become pregnant should not use testosterone because it can masculinize a developing fetus.
Testosterone therapy for a transgender woman is a different situation. Gender-affirming treatment for transgender women generally focuses on estrogen and, when appropriate, testosterone suppression rather than testosterone replacement therapy.