Off-label use of testosterone for conditions like breast cancer and hypogonadism isn’t new. But now, an increasing number of women in perimenopause and menopause are turning to testosterone therapy for symptom relief.

In the US, the number of testosterone prescriptions per 1000 women increased from 0.4 to 1.8 from January 2018 to July 2026, according to a data analysis by healthcare analytics firm Truveta. This represents a 389.6% increase. There are no Health Canada-approved testosterone formulations or indications for female use.

Randomized controlled trials, meta-analyses, and global guidelines, including those of the Society of Obstetricians and Gynaecologists of Canada, support off-label transdermal testosterone as a treatment option for hypoactive sexual desire disorder (HSDD).

“The only symptom for which doctors should consider testosterone in perimenopausal and menopausal women is HSDD,” Nisha Nigil Haroon, MD, an endocrinologist and clinical associate professor at Toronto Metropolitan University, told Medscape News Canada. “It’s important for female patients to take vaginal estrogen to correct local symptoms of HSDD. Patients should avoid testosterone pellets or oral formulations because of concerns about dosing inconsistency and excessive testosterone exposure,” she added.

Setting Realistic Expectations

Experts in hormone therapy agree that women must have realistic expectations about off-label testosterone use. “Not every woman will see a benefit from testosterone, and if they do, the benefit may be modest,” explained Russell Frank, MD, an ob/gyn with a subspeciality in menopause at the Jewish General Hospital University Health Centre in Montréal. “There are definite reasons to use testosterone for women in menopause and in menopause medicine, but there is a lot of misinformation as well regarding its role. Testosterone is sometimes promoted for benefits for which evidence is lacking. Assessing the patient’s hopes and goals is the first thing a clinician should do,” he added.

Doctors should begin the discussion with a patient by understanding what symptoms he or she is hoping to improve. “There is considerable interest in testosterone, but we need to distinguish between what is being promoted and what the science actually supports,” Marie Christakis, MD, FRCSC, MPH, assistant professor of ob/gyn at the University of Toronto and clinical lead of the Weston and O’Born Centre for Mature Women’s Health at Mount Sinai Hospital in Toronto, told Medscape News Canada.

Women’s testosterone levels naturally decline with age, but that doesn’t necessarily mean that they need to be increased. Treatment should be guided by symptoms, evidence, and a discussion of the potential risks and benefits, according to Christakis.

“When doctors are asked for testosterone therapy, they should engage in an honest discussion about safer options and about the fact that its use is limited to certain conditions,” said Haroon. “This kind of treatment isn’t going to improve mood, energy, brain fog, sleep, hot flashes, or pain. It’s important to rule out depression or other possible causes of HSDD, including stress, excessive social media use, disrupted sleep, anemia, and vaginal dryness,” she added.

Gap in Therapy

The increasing use of testosterone in perimenopausal and menopausal women results from the lack of products formulated specifically for this demographic, according to Haroon. “It’s embarrassing that we’re still using a male health product in women. The situation is that bad. We don’t have anything to offer these women. Gynecologists are prescribing the male testosterone gel, but it’s messy and difficult to use. We counsel patients not to use injectable testosterone. The healthcare system needs to hasten approval of testosterone products for women,” she said.

Clinical diagnosis determines the need for testosterone as hormone therapy during menopause, based on a conversation with the patient to assess his or her symptoms, Frank explained. He usually tells patients that low libido is often multifactorial. It could be menopause itself, but medications can also cause low libido. Vaginal dryness or pain with intercourse can cause lack of sexual desire, he added.

Low-dose testosterone applied to the skin is generally the preferred method of administration. Where a female-specific product is unavailable, approximately one-tenth of a standard male transdermal dose may be considered, depending on the formulation, noted Christakis.

“At the doses we prescribe for perimenopausal and menopausal women, the side effect risk is quite low. The two possible side effects that women should be cautioned about are an increase in acne or oily skin, and a possible increase in or a mild increase in unwanted facial and body hair," said Frank.

Blood levels should be checked roughly 6 weeks after initial treatment and periodically thereafter. Clinicians should also monitor symptoms and side effects. Follow-up testing should include total testosterone and sex hormone-binding globulin so that free testosterone can be recalculated and used to confirm that exposure remains within the intended physiologic range. If there is no meaningful benefit after 6 months, then treatment should be stopped, Christakis concluded.

Haroon, Frank, and Christakis reported no relevant financial relationships.

Evra Taylor is a widely published freelance medical writer and reporter with 20 years of experience covering a broad range of therapeutic sectors, including family health, cardiology, psychiatry, ophthalmology, and dermatology.