Testosterone and Menopause: Helps Low Desire, Untested for Mood
For low sexual desire, yes: in randomised trials testosterone beat a dummy pill, and the effect was modest. For tiredness, mood and sleep, I could not find a single trial. It all turns on your main symptom. If it is low desire and the distress it brings, you have solid evidence to take to an appointment. If it is exhaustion, low mood or broken sleep, the honest answer today is "untested".
Write down three things, then say one sentence
Before the appointment, write down three things: your main symptom, the month it started, and every hormone you already take, including any pill, patch or cream.
At the appointment, say: "Low desire is weighing on me. Which options are discussed in my case, and what is known about their safety?"
If your main symptom is something else, say the line that fits instead:
- Tiredness: "Tiredness is weighing on me. What have we ruled out, and which options are discussed in my case?"
- Mood: "Low mood is weighing on me. What else could explain it, and has it been checked?"
- Sleep: "Broken sleep is weighing on me. What have we ruled out, and which options are discussed in my case?"
The answer you get will differ, and the table below shows how.
Find your case
| Your number | What it means | What to ask for | First step |
|---|---|---|---|
| Low sexual desire | Desire rose more on testosterone than on a dummy pill, across 36 trials 1. Reviews of postmenopausal women point the same way 234 | No figure for what blood level counts as low testosterone | Which options are discussed for my case, and what is known about safety? |
| Arousal, pleasure and orgasm | All three rose in the same 36 trials; the gain was modest 1. Women in trials reported more satisfying sexual episodes than on the dummy pill 4 | The result is not split by menopause status 1 | Were these outcomes measured in the trials relevant to me? |
| Distress about sex | Distress went down on testosterone compared with the dummy pill 1 | The size of the drop is not given in my sources | Does the distress count as a reason to discuss treatment? |
| Mood and thinking | No separate trial result reported for mood 1 | No comparison group in the one 2025 study of 510 women on hormone therapy, where mood was better in 47% after 4 months 5 | What else could explain my mood, and has it been checked? |
| Energy and sleep | No trial on either one in my sources | Any comparison with a dummy pill for energy or sleep | What have we ruled out for my tiredness and sleep? |
| Long-term safety | A review links it to higher bone density and possibly lower HDL, the "good" cholesterol 2 | Effect on heart disease and breast cancer risk is not known 3 | What would you monitor, and for how long? |
What 36 trials found for low desire
The strongest evidence is a 2019 analysis that pooled 36 randomised trials, 8,480 women in total 1. In each trial one group received testosterone and the other received a dummy pill without knowing which. The trials lasted from 12 weeks to 12 months 1.
Testosterone raised sexual desire, arousal and pleasure, and the number of orgasms. It also lowered the distress women felt about sex 1. The gain was modest.
Three other reviews point the same way. All three look at women after menopause 234. About 40% of women after menopause live with low desire that distresses them 4.
The 36-trial analysis describes its women by their reduced sexual wellbeing and does not split the result by menopause status 1. I found no figure for what blood level counts as low testosterone, so I will not give you a threshold. I also found no data on how testosterone behaves without estrogen alongside.
What the 510-woman study can and cannot tell you about mood
On mood, energy and sleep, the 36-trial analysis reports nothing. It says cognitive measures were assessed, but gives no separate result for mood, energy or sleep 1. I found no trial at all on energy or sleep.
The only mood data comes from a 2025 study of 510 women around and after menopause 5. They all had low libido plus mood and thinking symptoms, they were all already on hormone therapy, and they used testosterone cream or gel for 4 months. Mood improved in 47% of them 5. Thinking symptoms improved in 39% 5.
Trials compare women on testosterone with women on a dummy pill. This study compared nobody. It reports that about half the women felt better after four months. The study looked back at records, the women rated themselves, and nobody received a dummy pill for comparison 5.
Without that comparison, part of any improvement can come from believing you are being treated, from time passing, and from the other hormones they were taking.
Nobody knows the long-term safety, because the trials were short
Every trial in the 36-trial analysis ended by the 12-month mark 1. Whether testosterone changes the risk of heart disease or breast cancer over years is not known 3.
One review links testosterone therapy to higher bone density and a possible fall in HDL, the "good" cholesterol. It gives no numbers and does not say how many trials that rests on 2. Reviews describe the long-term safety picture as unclear 24.
There is no testosterone product approved for women in the US 3, and none designed for women on the European market 4.
What to say to your doctor, depending on your main symptom
Main symptom: low desire, and the distress that comes with it. The trials were run on exactly this. You can ask for options to be discussed. Also ask how testosterone would sit alongside the hormones you take now.
Main symptom: tiredness, low mood or broken sleep. Ask what has been checked for your symptom. If you are in your forties and your periods still arrive, Can You Be in Perimenopause With Regular Periods? explains why regular periods do not rule it out. If low mood is the centre of it, Does Hormone Therapy Help Perimenopause Depression? covers what is known about hormone therapy and mood. The one mood figure so far, 47% better after four months, comes from women with no dummy-pill comparison 5.
If it does not go to plan
- Your main symptom is not low desireUse the matching line from the first step and ask what has been checked for your symptom.
- A forum post promises better energy or sleep from testosteroneAsk for the study behind the claim. I found no trial on either.
Honestly: what is settled and what is not
The trials cover low desire. The one mood study had no dummy-pill group, and I found no trial on energy or sleep.
What to do with this
- Write down your main symptom, the month it started and every hormone you take before you go
- Say the sentence: "Low desire is weighing on me. Which options are discussed in my case, and what is known about their safety?"
- Name tiredness, mood or sleep as your main symptom if that is it, and ask what has been checked
- Ask what would be monitored, and for how long, if testosterone is ever discussed
- Check any forum claim about energy or sleep by asking for the study behind it
Questions people also ask
Does testosterone help menopause symptoms?
For low sexual desire, randomised trials say yes, and the gain is modest. Thirty-six trials with 8,480 women found higher desire, arousal and pleasure than on a dummy pill 1. For tiredness, mood and sleep I found no trial.
Is there an approved testosterone treatment for women?
Sources
Every number above comes from one of these. Each carries its PMID, the number it is filed under in the US National Library of Medicine, if you want to look it up yourself.
- Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data.
- A systematic review of randomized controlled trials investigating the efficacy and safety of testosterone therapy for female sexual dysfunction in postmenopausal women.
- Androgen Therapy in Women.
- The role of testosterone in menopausal hormone treatment. What is the evidence?
- Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study.
This article is information, not medical advice, diagnosis or treatment. Reference ranges, doses and protocols differ between people and between laboratories. Talk to a qualified clinician before changing anything about your care.