In women, testosterone can cause a deeper voice, more body and facial hair, increased muscle, and acne, and some effects are permanent. It should be used only under medical supervision.
Effects
- Deeper voice (often permanent).
- More body and facial hair.
- Increased muscle mass.
- Clitoral enlargement.
- Acne and oily skin.
- Stopped periods.
- Possible hair loss.
Risks
High red blood cell count, liver problems and mood changes.
Medical use
For gender-affirming care or low libido under a doctor.
Sports
Banned without exemption.
Advice
Take only under medical supervision.
Physical effects
Women have testosterone naturally at levels roughly 15 to 70 ng/dL, about 10 to 20 times lower than men. Taking additional testosterone can cause voice deepening, increased facial and body hair, acne, enlarged clitoris, menstrual changes, increased muscle mass, oily skin and mood changes. Some effects, such as voice deepening and clitoral enlargement, may be permanent.
- Testosterone is not FDA-approved for women in the US. Low-dose testosterone has been used off-label for hypoactive sexual desire disorder in postmenopausal women, and the 2019 Global Consensus Position Statement supports it for that use with a physician.
- Testosterone suppresses ovulation and can reduce fertility, and it can harm a fetus in pregnancy.
- Transgender men use testosterone as gender-affirming therapy under medical supervision.
Risks and sports
Possible risks include high red blood cell count, liver effects with oral forms, cholesterol changes and cardiovascular concerns. Testosterone is banned in sport by WADA. Women should not use it for bodybuilding. Hormone use should be supervised by an endocrinologist with blood level monitoring.
Physical effects
Testosterone therapy in women (used off label or for menopausal hypoactive sexual desire) can increase libido, muscle mass and bone density in studies, and cause acne, hair growth, voice deepening and clitoral enlargement at higher doses. Some changes may be irreversible.
Risks and sports
Risks include lipid changes and liver effects. Testosterone is banned in sports by WADA. Treatment requires a doctor. The FDA has not approved a testosterone product for women.
Why and how women use it
Women are prescribed testosterone mainly for hypoactive sexual desire disorder (HSDD) in postmenopausal women, and, off label, for fatigue or low libido after oophorectomy. In the United States no testosterone product is FDA approved for women, so clinicians use low doses of products made for men, usually about one tenth of a male dose, or compounded creams. Some countries such as Australia have approved female specific formulations.
Risks and monitoring
Side effects include acne, excess hair growth, voice deepening that may be permanent, scalp hair thinning and changes in cholesterol. Blood levels are monitored, and the Global Consensus Position Statement recommends keeping levels within the normal premenopausal female range. Evidence of benefit is best for sexual desire. Long term cardiovascular and breast safety data are limited. Gender affirming therapy for transgender men uses different, higher doses under specialist care.
Based on data from the Endocrine Society and the International Menopause Society
