Testosterone prescriptions for women in the United States have almost tripled over the decade leading to September 2026, driven by rising off-label use during perimenopause and menopause. While international guidelines recommend the hormone solely for hypoactive sexual desire disorder, patients and longevity platforms report various benefits, even as medical experts urge caution over long-term safety data.
US Testosterone Prescriptions Triple Over Decade
Off-label use of testosterone for conditions like breast cancer and hypogonadism is not new according to a data analysis by healthcare analytics firm Truveta. In the US, the number of testosterone prescriptions per 1,000 women climbed from 0.4 to 1.8 between January 2018 and July 2026. This growing demand prompted the FDA to hold its first-ever public workshop on testosterone use in menopausal women in September 2026 to examine efficacy, safety, and standardized treatments designed for female bodies.
Women in midlife, specifically ages 45 to 64, account for more than 60% of testosterone prescriptions among women nationwide as reported by UC San Diego Today. The most common reported diagnoses tied to these prescriptions are menopause, decreased libido, and hormone replacement therapy. Medical guidelines support testosterone for only one of those indications: hypoactive sexual desire disorder causing distress.
Clinical Evidence Focuses on Sexual Desire
International clinical guidelines recognize testosterone therapy as an evidence-based treatment exclusively for hypoactive sexual desire disorder, defined as persistent low sexual desire that causes personal distress.
Experts emphasize that sexual desire is shaped by relationships, stress, fatigue, and mental health as much as by any single hormone, making testosterone one input among several rather than a master switch. High-quality clinical trial evidence supporting health claims beyond sexual desire in women remains largely absent.
Hone Health Analysis Examines 1,220 Women
While clinical trials focus narrowly on sexual health, observational data tell a different story. An analysis released in September 2026 by physician-led longevity platform Hone Health evaluated 1,220 patients in perimenopause or menopause who had a testosterone prescription and no recorded estrogen, estradiol, or progesterone prescription through the platform. Symptoms were ranked using the Menopause Quality of Life Questionnaire, or MENQOL.
Women taking testosterone reported meaningful improvements across 18 menopause symptoms, registering their biggest gains in sexual desire, energy, strength, and stamina. Clinicians affiliated with the platform argue that symptom scores capture only part of the picture.
Kunsman added that tracking specific symptoms is like looking through a keyhole when we know testosterone is working the whole room
and noted that without testosterone optimization, we have difficulty holding on to our lean mass
to prevent sarcopenia and frailty.
PAMELA Trial Tests Physical Outcomes
Controlled trial data present a more nuanced picture of physical outcomes. Presented at the International Menopause Society Congress meeting in Brazil, the PAMELA trial in Australia evaluated transdermal testosterone in a randomized, double-blind, placebo-controlled study of 26 weeks detailed by The Vajenda. Led by Dr. Hayley Dillon, the trial aimed to determine the effect of physiologic-dose testosterone versus placebo on lower-limb muscle power in relatively healthy postmenopausal women.
The primary outcome measure showed no treatment effect of testosterone on lower-limb muscle power. Among five secondary outcome measures, grip strength, neuromuscular quickness, and static balance showed no difference between testosterone and placebo. However, two secondary measures favored testosterone: dynamic balance and the amount of lean soft tissue in the hips and thighs.
Researchers caution that the study participants were primarily of European descent, highly active, and already possessed good muscle reserve. Experts like Dr. Avivi point out that administrative databases capturing prescriptions often miss med spas, longevity clinics, and sexual health clinics that dispense higher doses of compound products outside FDA oversight.
Short-term adverse effects reported with female testosterone therapy include acne, oily skin, and mild hirsutism, alongside safety concerns regarding androgen excess, dosing variability, and uncertain cardiometabolic and breast safety data according to Medscape. Clinicians typically monitor total testosterone and sex hormone-binding globulin to keep exposure within a physiologic range while patients face prescription hurdles and pharmacy delays.