Short answer: Sometimes, for one reason. The 2019 global consensus statement, endorsed by the Endocrine Society and menopause societies, says the only evidence-based use is low sexual desire with distress (HSDD) in postmenopausal women, at doses that keep testosterone in the normal premenopausal female range. No testosterone product is FDA-approved for this, so prescribers use male products at reduced doses. The statement advises against injections and pellets that push levels above the female range.
The 2019 Global Consensus Position Statement on testosterone therapy for women was written by a task force from international menopause, endocrine and sexual medicine societies, based on a systematic review and meta-analysis of randomized trials. It concluded that the only evidence-based indication is hypoactive sexual desire disorder (HSDD) in naturally or surgically postmenopausal women, diagnosed after a full assessment.
In those trials, testosterone at doses approximating premenopausal levels improved sexual function above placebo, by an average of one more satisfying sexual event per month, with gains in desire, arousal, orgasm and pleasure and less sexual distress.
The 2014 Endocrine Society guideline reached a similar view: evidence supports the short-term efficacy and safety of testosterone for postmenopausal women with HSDD, and blood testosterone levels did not predict who would respond.
Both documents recommend against testosterone for most other reasons women are offered it. The Endocrine Society recommends against diagnosing "androgen deficiency" in healthy women, and against general use for infertility, sexual problems other than HSDD, thinking and memory, heart, metabolic or bone health, or general well-being.
The consensus statement found no effect on general well-being or depressed mood in postmenopausal women, no effect on bone density at 12 months, and no significant effect on lean mass or strength at physiological doses. It found insufficient data to recommend testosterone for premenopausal women for any purpose. No blood level cutoff separates women with and without sexual problems.
The Endocrine Society guideline notes that testosterone products made for women are not available in many countries, including the United States. The AndroGel 1.62% label, for example, says it is not indicated for use in women. The consensus statement says that where no approved female product exists, prescribing an approved male product off-label is reasonable if blood levels stay in the premenopausal female range.
It recommends against compounded "bioidentical" testosterone unless no approved equivalent is available, and against any product that gives above-normal levels, including pellets and injections. It advises a baseline total testosterone level, a repeat at 3 to 6 weeks, checks every 6 months for overuse, and stopping if there is no benefit by 6 months. Oral testosterone is not recommended because of its effect on cholesterol.
At female-range doses, the consensus statement found mild increases in acne and body or facial hair in some women, but not hair loss, clitoral enlargement or voice change. It found no rise in blood pressure, blood sugar or HbA1c, no increase in breast density, and no serious adverse events, with a non-significant trend toward more deep vein clots. Safety data stop at 24 months, and trials excluded women at high heart risk.
Higher doses are another matter. The testosterone enanthate label, which allows use in some women with advanced breast cancer, says to watch for deepening of the voice, excess hair, acne, clitoral enlargement and menstrual changes, and that stopping at the first mild signs is needed to prevent changes that may not reverse. Testosterone is contraindicated in pregnancy.
If you use testosterone, logging doses, levels and any changes in skin, hair or voice gives your prescriber what the guidelines ask them to monitor. Dose Track keeps those on one timeline.
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