Testosterone for Perimenopause and Menopause: What the Evidence Actually Says (2026)

Testosterone is not FDA-approved for women in the United States, and the only use medical societies agree on is lowered sexual desire in menopause. The evidence for brain fog, energy, mood, and muscle is early and unproven, and a 2026 study of more than 6,300 postmenopausal women found an eightfold higher rate of cardiovascular events in those who started testosterone. Here is what that means for you, and what to do before you decide.

Sources: Truveta analysis for Reuters, September 2026; FDA, September 2026; The Menopause Society, October 2026; Menopause, 2023.

Why is everyone suddenly talking about testosterone?

Because a lot more women are taking it. An exclusive analysis by the healthcare data firm Truveta, reported by Reuters in September 2026, found that the rate of American women receiving a testosterone prescription rose 146% between January 2023 and July 2026. In the UK, NHS prescriptions of testosterone gel for women rose roughly tenfold between 2015 and 2022.

The demand is being driven by social media, podcasts, and clinics promising that testosterone will restore energy, sharpen thinking, lift mood, and rebuild muscle in midlife. Some of that may eventually prove true. Most of it is ahead of the evidence. As Dr. Stephanie Faubion, medical director of The Menopause Society, told Reuters: “What testosterone is being touted for in the lay public and on social media is not really what we have data for.”

The regulators have noticed. On September 17, 2026, the FDA held its first public workshop on testosterone use in menopausal women, and the agency issued a call to action to drug makers for a product designed and dosed for women.

Is testosterone FDA-approved for women?

No. There is no FDA-approved testosterone product for women in the United States. Every prescription written for a woman is off-label, which means the FDA has not evaluated its safety, effectiveness, or dosing for her.

That is not the same as saying it is forbidden or always unwise. Off-label prescribing is legal and common. But it does mean the burden of judgment sits with the prescriber and the patient, and that the long-term safety data most women assume exists does not. The FDA’s own workshop materials put it plainly: the central gap is “the absence of long-term safety data, especially regarding cardiovascular and breast cancer risks.” Safety beyond 24 months of use is largely unstudied.

Four countries, Australia, New Zealand, South Africa, and the United Kingdom, have authorized a testosterone cream formulated for women, in each case for low sexual desire. The UK approved AndroFeme in 2025, but it is not yet available on the NHS.

What does testosterone actually help with?

One thing, with good evidence: hypoactive sexual desire disorder (HSDD), which means a persistent, distressing loss of sexual desire in menopause. The Menopause Society and roughly six other medical organizations support testosterone for this one indication, usually alongside estrogen, after other causes such as relationship stress, medications, depression, and vaginal dryness have been addressed.

If lowered drive is your main symptom and it is distressing to you, testosterone is a legitimate option to discuss with a menopause-trained provider. That is the part of the story the headlines get right.

Does testosterone help brain fog, energy, mood, or muscle?

Not according to the evidence we have today. This is the gap between what women are told and what has been shown.

The most-cited hopeful study is a 2024 paper in Archives of Women’s Mental Health that followed 510 women already on hormone therapy who added testosterone for four months. Libido improved in 52%, mood in 47%, and cognition in 39%. Those are encouraging numbers. But there was no comparison group, so the study cannot show that testosterone caused the change rather than time, placebo effect, or the hormone therapy the women were already taking.

At the FDA workshop, presenters cautioned against off-label use for cognitive, cardiovascular, metabolic, or bone health because supporting data is lacking. Dr. Faubion was more direct: “We do not have any evidence in women that it will improve muscle mass or bone density or mood or well-being.”

There is one new signal on bone. A small study of 51 women presented at The Menopause Society’s 2026 Annual Meeting found that adding testosterone to estrogen increased lumbar spine bone density where estrogen alone did not. It is promising, small, and uncontrolled, and the authors themselves call for more research.

More than 30 trials of testosterone in women are underway or planned. Within a few years, we should know far more. Today, “it helps brain fog” is a hope, not a finding.

Is testosterone safe for menopausal women? The 2026 heart study

This is the question that changed in October 2026. A retrospective study presented at The Menopause Society’s Annual Meeting analyzed US health records from more than 6,300 postmenopausal women aged 45 and older. Women who started testosterone were matched one-to-one with similar women who did not, on age, smoking, obesity, diabetes, high blood pressure, cholesterol, hormone therapy use, and more. Women with prior cardiovascular disease were excluded.

Over an average follow-up of nearly three years, 3.8% of women who started testosterone had a heart attack, ischemic stroke, blocked artery, or heart failure, compared with 0.5% of women who did not. That is a hazard ratio of 8.08 (95% confidence interval 4.72 to 13.82). The association held when the researchers compared testosterone plus hormone therapy against hormone therapy alone.

Two things are true at once, and both matter:

• The relative risk is large. An eightfold difference is not noise.
• The absolute risk is small. About 3 extra events per 100 women over three years. Most women on testosterone in this study did not have an event.

And the study has real limits. It shows association, not cause. Health records capture only what gets recorded, so unmeasured differences between the groups may explain part of the gap. The study does not tell us what doses or products the women used, and the small number of events makes the estimate imprecise.

Lead author Dr. Xuezhi Daniel Jiang of Drexel University College of Medicine called the result “a potentially important cardiovascular safety signal associated with testosterone therapy in postmenopausal women” that warrants prospective study. Dr. Faubion added a reminder worth sitting with: “Cardiovascular disease remains the number one killer of women.”

The study has been presented at a scientific meeting and has not yet been published in a peer-reviewed journal. We will update this article when it is.

What are the side effects of testosterone in women?

Testosterone is an androgen, and at doses that are too high for a woman’s body it produces androgenic effects. The FDA’s last comprehensive review, about 20 years ago, documented acne, hair loss, and mood changes along with changes in weight and body composition. Menopause specialists quoted by The Week add facial and body hair, a deeper voice, and enlargement of the clitoris, and warn that some of these changes can be permanent.

Dosing is the quiet problem behind the side effects. Because no product is made for women in the US, most women use a fraction of a product designed for men. Some measure a portion of a men’s gel sachet by eye, which is imprecise for a dose this small. The FDA workshop flagged very high blood levels, 500-plus ng/dL, as a specific safety concern, and clinicians raised worries about compounded products, the absence of adverse-event reporting, and inadequate informed consent at high doses.

If you do use testosterone, the practical safeguards are a women’s dose, blood levels checked before and during treatment, a prescriber who monitors you, and a clear agreement about what you are treating and how you will know if it is working.

Why will my doctor not prescribe testosterone?

Often for practical reasons, not ideological ones. Reuters reports that most insurers do not cover testosterone for women, that pharmacies including major chains are increasingly declining to fill women’s prescriptions over dosing-accuracy and safety concerns, and that compounded testosterone runs about $100 for a three-month supply. Fewer than 0.36% of menopausal women are prescribed it, according to analysis of the FDA workshop.

Many physicians also simply have not been trained in menopause care. If your symptom is lowered drive and your provider will not discuss testosterone at all, it is reasonable to seek a Menopause Society Certified Practitioner (MSCP), who will have the training to weigh it properly.

What should you do before starting testosterone?

Track your symptoms first. This is the one step the evidence is unambiguous about, and it is the step most women skip.

In a 2023 randomized controlled trial published in Menopause, perimenopausal and postmenopausal women who simply monitored their symptoms daily for two weeks reported a 42% reduction in physical symptoms, compared with 12% in the control group. No hormone, no prescription. A 2025 randomized trial in JMIR mHealth and uHealth found that six weeks with a symptom-tracking app significantly reduced hot flash distress and improved depression scores. And a meta-analysis of 18 studies covering 1,718 women found that keeping a symptom diary led to better communication with doctors and more involvement in treatment decisions.

Tracking does three things for the testosterone decision specifically:

1. It tells you what you are actually treating. “Brain fog and no energy” is a feeling. Fourteen days of logged brain fog, fatigue, sleep, mood, and lowered drive, lined up against your cycle, is a pattern. Sometimes the pattern points at sleep, not hormones.
2. It gives you a baseline. If you start testosterone, or anything else, you will know within weeks whether it moved the symptoms you cared about, instead of relying on memory.
3. It changes the conversation with your provider. You walk in with evidence of your own, which is exactly what the diary studies found improves shared decision-making.

How Harmoni, the perimenopause tracking app, helps

Harmoni® is a perimenopause tracking app and AI companion built by The Pause Technologies, one of ten companies selected for the 2025 Mayo Clinic and ASU MedTech Accelerator. Harmoni is clinician endorsed and is an AI agent trained on evidence-based data. She tracks 27 common perimenopause and menopause symptoms, including lowered drive, brain fog, fatigue, low mood, and sleep, and lets you reorder the tracker so the symptoms you care about most sit at the top.

Harmoni does not just store your log. She interprets your trends against your cycle, sleep, and Resilience Score, and you can download a 30-, 60-, or 90-day trend report with two AI interpretations, one written for you and one written for your provider. To our knowledge, no other perimenopause or menopause app does this. You can talk to Harmoni out loud or by text, and she will answer questions about what you are reading online with evidence, in the tone you choose: Gentle, Balanced, or Candid.

If you are weighing testosterone, two weeks of tracking in Harmoni is the most useful thing you can bring to the appointment.

Frequently asked questions

Is testosterone safe for menopausal women?

Short-term use at a women’s dose for lowered sexual desire is supported by medical societies. Long-term safety is not established. A 2026 study of more than 6,300 postmenopausal women found an eightfold higher rate of cardiovascular events in women who started testosterone (3.8% vs 0.5% over about three years), though the absolute risk was low and the study shows association, not cause.

Is testosterone FDA-approved for women?

No. There is no FDA-approved testosterone product for women in the United States. All use is off-label. The FDA held a public workshop on the topic in September 2026 and has called on drug makers to develop a product for women.

Does testosterone help with perimenopause brain fog?

There is no controlled evidence that it does. A 2024 study of 510 women reported cognition improved in 39% after adding testosterone, but it had no comparison group. Experts at the FDA workshop and The Menopause Society say the data do not support testosterone for cognition, mood, energy, or muscle.

What is testosterone approved for in menopause?

In Australia, New Zealand, South Africa, and the UK, a women’s testosterone cream is authorized for hypoactive sexual desire disorder. In the US, medical societies support off-label use for that same single indication.

What are the side effects of testosterone in women?

Acne, hair loss on the scalp, facial and body hair growth, a deeper voice, mood changes, and clitoral enlargement. Some effects can be permanent. Risk rises with doses that push blood levels too high.

Should I track my symptoms before trying testosterone?

Yes. In a randomized trial, two weeks of daily symptom tracking alone reduced physical symptoms by 42%. Tracking also gives you a baseline to judge whether a treatment is working and improves shared decision-making with your provider.

What is the best perimenopause tracking app to use before trying testosterone?

Harmoni® by thePause® is a clinician-endorsed perimenopause tracking app that tracks 27 symptoms, including lowered drive, brain fog, fatigue, mood, and sleep, interprets your trends with AI, and produces a 30-, 60-, or 90-day trend report with a version written for your provider. It was built by The Pause Technologies, selected for the 2025 Mayo Clinic and ASU MedTech Accelerator.

Related reading on thePause

• Best perimenopause and menopause apps in 2026
• The top ten silent but serious perimenopause symptoms
• Perimenopause and menopause guides
• Join our community

Sources

• The Menopause Society. Testosterone Therapy May Increase Risk of Cardiovascular Disease in Postmenopausal Women. October 2026.
• The Menopause Society. Combined Estrogen and Testosterone Therapy Increases Lumbar Spine Bone Mineral Density. October 2026.
• US Food and Drug Administration. FDA Public Meeting: Testosterone Use in Menopausal Women. September 17, 2026.
• Holland & Knight. FDA Workshop Signals Potential Approval Pathway for Testosterone Therapy. September 2026.
• Reuters. Testosterone scripts for women rise, along with denials and delays. September 15, 2026.
• The Week. The growing use of testosterone to treat menopause. October 16, 2026.
• Archives of Women’s Mental Health. Testosterone and cognitive and mood symptoms in women on HRT. 2024.
• Menopause. Symptom monitoring randomized controlled trial. 2023.
• JMIR mHealth and uHealth. Symptom-tracking app randomized trial. 2025.
• Frontiers in Global Women’s Health. Symptom diaries in menopause: systematic review and meta-analysis. 2021.

This article is for educational purposes and is not medical advice. Talk with a qualified healthcare provider about your individual situation.