Women who received individualized, bloodwork-guided testosterone therapy reported improvement across a range of symptoms, according to a retrospective observational study presented at The Menopause Society 2026 Annual Meeting in San Diego. Patients surveyed cited better energy and mood as top benefits, above sexual desire.

The analysis, by Paul R. Reynolds, PhD, professor of cell biology and physiology at Brigham Young University in Provo, Utah, included 332 women aged 27-78 years (mean age, 45.7 years) who received testosterone as routine care through the telehealth platform Joi + Blokes. Reynolds serves as a scientific advisor to the platform.

Doses were adjusted to target a serum total testosterone level of 25-50 ng/dL, the upper physiologic premenopausal range, using topical (1-10 mg/d), oral (0.5-2 mg per dose), or subcutaneous (2-10 mg per injection) routes.

Women completed a structured survey rating change in eight symptom domains (energy and fatigue, memory, concentration, irritability, depression, anhedonia, sexual interest, and relationship satisfaction) and in overall quality of life. Responses were grouped by treatment duration, including 1 month (n = 37), 1-3 months (n = 112), 4-6 months (n = 80), 7-12 months (n = 70), and more than 12 months (n = 33).

Improvement was reported in all eight symptoms. Energy and fatigue showed the strongest response, with 84.3% of women reporting improvement, followed by depression (70.8%), irritability (69.0%), anhedonia (67.5%), and sexual interest (66.9%). Cognitive domains, including memory (54.5%) and concentration (57.8%), had lower rates of improvement, with meaningful gains beginning at 4-6 months and continuing through 7-12 months.

The 2019 paper, “Global Consensus Position Statement on the Use of Testosterone Therapy for Women,” and the 2021 guideline, “International Society for the Study of Women’s Sexual Health,” endorse testosterone therapy in postmenopausal women only for hypoactive sexual desire disorder.

When asked to name their top benefits, women chose energy (64.2%) and mood (49.7%) more often than sexual desire (41.3%).

“The biggest surprise was where women felt the benefit,” Reynolds said. “Almost all of the clinical trials, and current guidelines, frame testosterone therapy in women around low sexual desire. Our patients described something broader.”

Timing also seemed to play a role. Overall, 89.7% of women reported improved quality of life, and the share reporting significant improvement rose from 5.4% among those treated for 1 month to 51.5% among those treated for more than 12 months. No one in the longest-treatment group reported no change or worsening.

“Energy and mood improved early, but memory and concentration improved later, with a clear trend appearing around 4-6 months,” Reynolds said. “If you judge response only at the first follow-up, you may miss the cognitive benefits completely.”

Reynolds was candid about the study’s limits. “This was a retrospective, single-arm study with no placebo group, so it shows association, not cause,” he said. “The survey wasn’t a validated instrument. Women who stayed on therapy were more likely to respond, which may overstate benefit. Adverse events weren’t systematically captured.”

“I’m grateful to the authors for studying some of the main reasons people come to our clinics asking about testosterone,” said Erin Duralde, MD, MPH, MSCP, One Medical's national director of women’s health and menopause program leader, who was not involved in the study. Libido has been the strongest signal in trials to date, she said, but patients are also interested in energy, cognition, relief from brain fog, and general vitality.

Some of those outcomes have been tested in randomized controlled trials that did not show an advantage over placebo, Duralde said. In those trials, energy improved substantially in both the testosterone and placebo groups, but the difference between groups was not significant. “There’s reason to be curious about whether what was studied perhaps could have been just too low of a dose to capture a meaningful effect,” she said.

Duralde noted the wide range of doses and routes of administration, including 1-10 mg of cream and injections, noting it would be underpowered to examine the efficacy or safety of any one dose or route.

Duralde said the studied clinic’s approach of titrating doses to a target blood range challenges the prevailing guidance that there are no specific levels associated with benefit, though the clinic utilizes the range recommended for safety. Currently, serum levels are used more as a safety backstop. While past data suggest too much variation from person to person, further research into personalized treatment targets, and possibly incorporating pharmacogenomics, could be in the future.

“I think it’s very hypothesis generating and a good foundation to continue research on these questions that matter a lot to patients,” Duralde said.

The next step, Reynolds said, is prospective research with validated symptom scales and structured safety monitoring, and ultimately, randomized trials with longer follow-up that examine cardiovascular and breast outcomes.

“We’re designing prospective studies now to address exactly these gaps.”

The study was funded by mentoring awards from Brigham Young University. Reynolds reported serving as a scientific advisor (not an employee) to Joi + Blokes, the telehealth platform whose patient data were analyzed. Duralde reported being employed by One Medical and having no other relevant financial relationships.

Sony Salzman is an Emmy Award-winning journalist covering science and medicine with bylines in The Atlantic, STAT, NBC, MedPage Today, and The Boston Globe. Previously, she worked as the coordinating producer of ABC’s Medical Unit.