Were you told testosterone is only good for libido?
In 2019, a global consensus statement wrote that the only evidence based reason to give a woman testosterone is low desire that bothers her after menopause. One door.
Her most abundant hormone
Testosterone is the most abundant biologically active hormone in a woman's body, and a 2015 review called it an essential hormone for women. A 2021 review puts her testosterone at ten to more than fifteen times her estradiol by weight. Lab sheets hide that: testosterone is printed in ng/dL and estradiol in pg/mL, a ruler ten times smaller.
Her ovaries make some, but most of it starts in her adrenal glands as DHEA, and her tissues turn it into testosterone where they need it. She has testosterone receptors from her brain and breast to her bones, muscle, heart, vagina, bladder and skin, and in the labia and clitoris it becomes DHT, which women need too. Sex is one light on a very big board.
It doesn't crash. It slides.
In a 2005 study of about 1,400 Australian women, researchers saw no effect of natural menopause on androgen levels. By age, women 18 to 24 had more than twice the total testosterone of women 55 to 64, a drop of almost 60%. About half of it is gone before menopause arrives, so a woman in her thirties hears that her level is normal for a woman, meaning normal for a group of women all sliding together.
When both ovaries come out, even after menopause, testosterone falls about 42% (2007). On the pill, pooled across 42 studies (2014), total testosterone fell about a third and free testosterone about 60%, because the pill switches off the monthly signal to her ovaries and raises SHBG, sex hormone binding globulin, the protein that locks testosterone up.
Deficiency is real, and the floor is 250
A 2014 endocrine guideline recommends against diagnosing androgen deficiency in healthy women, then lists the causes of it. The real weakness is the instrument: a 2018 review says standard immunoassays can't accurately measure women's low levels, and one free testosterone reference range was built from 187 convenience samples (1998).
We dose symptoms, but a floor helps. In a 2021 study of 667 women on pellets, symptoms came back at an average of about 237 ng/dL. Most women need to get past 250 to feel like themselves. It's a goal, not a rule: some feel fantastic at 200, some need over 1,000, and there's no upper limit.
Much more than libido
The libido evidence is solid: 36 randomized trials and 8,480 women pooled in 2019, with serious side effects no more common than on placebo. Testosterone improved well being in women still having periods (2003), well being and mood in women without ovaries (2000), and mood, energy, fatigue, sleep, fat free mass and bone in women whose pituitary had failed (2006). In older women with heart failure, it added about 97 meters to a six minute walk, against 36 on placebo (2010). In a 2014 trial, verbal learning and memory beat placebo at six months.
Now line those trials up by the level women reached: about 74, about 102, about 49 in the memory trial. In a 2014 dose trial, only the top weekly dose, around 210 to 230 before the next shot, built muscle: almost four pounds of lean mass, with fat, deep belly fat, blood sugar, insulin and blood pressure unchanged. Every positive controlled trial that printed a level ran below 250. Much of the evidence called weak is underdosed evidence.
The fears, one at a time
The beard. In a 2013 study of 285 women on pellets, at about four times the usual female top for over two years on average, not one reported clitoral enlargement. The voice. A deeper voice is extremely rare and comes from ramping the dose too fast. Start low, go up gradually. In a year long trial, voice changes came in 19 of 267 women on the higher dose and 20 of 277 on placebo. Her hair. Scalp hair loss is an insulin resistance problem; in a separate survey of 285 women on pellets, 48 of the 76 already losing hair reported it growing back. The real side effects are some extra hair and acne, usually mild and dose related, and spironolactone helps.
"It turns into estrogen." What people mean is estradiol. Testosterone given to a woman quiets her ovaries. If it were also converting, her estradiol would hold or rise. It falls: in transgender men with intact ovaries, from about 50 to 29 (2014). Take the ovaries out entirely, in women on a fixed dose of Premarin, and testosterone rose from about 22 to 102 while estradiol sat between 36 and 45 (2000). She doesn't need an aromatase blocker.
The heart and clots. In a 2024 study of about 10,300 matched pairs, major heart events ran about 1.2% against 1.8% over three years, and clots were lower too. There was never a blood clot boxed warning on testosterone. For a woman with factor V Leiden: screen, consent, treat.
The breast: testosterone is the brake
Estradiol is the accelerator for breast cells, and testosterone, through the androgen receptor, is the brake. Block that receptor in living human breast tissue and the cells divide more (2012). Testosterone was treating advanced breast cancer in the 1940s. In a 2007 randomized trial in postmenopausal women on estradiol plus a synthetic progestin, dividing breast cells climbed from about 1% to 6% on placebo and went from 1.6% to 2% on testosterone. Women on pellets followed up to ten years had 165 invasive breast cancers per 100,000 a year, against 271 expected (2019). A family history of breast cancer may well be a good reason to start testosterone early.
How I start
There's no FDA approved testosterone for women in this country, and that isn't the barrier. Training is. Often she gets a dab of a men's gel, feels nothing and is told it didn't work. She was underdosed.
I start most women on compounded testosterone cream in Ellage base at 20 mg/g, one chocolate chip's worth, vaginally at bedtime, and the concentration is gradually increased and dosed to effect. The tissue there has androgen receptors, absorbs it well and stays healthier for it. Or testosterone cypionate 200 mg/mL, 0.1 mL injection twice a week, or that can be divided into a smaller daily dose for even steadier levels, which can be particularly helpful if acne is problematic. Same start, cycling or past menopause, then up by symptoms. I don't prescribe pellets, because they don't give a steady level. Never by mouth, which lowered HDL and raised LDL in the 2019 review. And DHEA won't stand in for it.
Questions for your next appointment
My total testosterone, aiming above 250? Free testosterone with the lab named (I look for above 6 on Quest, above 4 on LabCorp)? SHBG? DHEA-S (I like it at 200 to 300)? If I'm menopausal and on estradiol, a level of 75 or higher? A timed draw: noon after a bedtime cream, or right before the next shot? And do you prescribe compounded testosterone, or only a men's gel?
Nobody should stop a prescribed medication on their own because of an article, but you have every right to a provider who was trained to answer these questions.
The whole argument:
Listen to podcast Part One on Spotify
Listen to podcast Part Two on Spotify
⚠️ Educational content, not individual medical advice or a treatment recommendation. Nobody should start, stop or change a prescription because of an article. Your labs and history belong in a one on one.
🩺 DNP led telehealth hormone optimization. Book a consultation and find everything: withinyou.health/links
Sources
Agrawal, P., Singh, S. M., Hsueh, J., Grutman, A., An, C., Able, C., Choi, U., Kohn, J., Clifton, M., & Kohn, T. P. (2024). Testosterone therapy in females is not associated with increased cardiovascular or breast cancer risk: a claims database analysis. J Sex Med, 21(5), 414-419. https://doi.org/10.1093/jsxmed/qdae032
Banaszewska, B., Pawelczyk, L., Spaczynski, R. Z., Dziura, J., & Duleba, A. J. (2007). Effects of simvastatin and oral contraceptive agent on polycystic ovary syndrome: prospective, randomized, crossover trial. J Clin Endocrinol Metab, 92(2), 456-61. https://doi.org/10.1210/jc.2006-1988
Banaszewska, B., Pawelczyk, L., Spaczynski, R. Z., & Duleba, A. J. (2011). Effects of simvastatin and metformin on polycystic ovary syndrome after six months of treatment. J Clin Endocrinol Metab, 96(11), 3493-501. https://doi.org/10.1210/jc.2011-0501
Basson, R., & Schultz, W. W. (2007). Sexual sequelae of general medical disorders. Lancet, 369(9559), 409-24. https://doi.org/10.1016/S0140-6736(07)60197-4
Berrino, F., Pasanisi, P., Bellati, C., Venturelli, E., Krogh, V., Mastroianni, A., Berselli, E., Muti, P., & Secreto, G. (2005). Serum testosterone levels and breast cancer recurrence. Int J Cancer, 113(3), 499-502. https://doi.org/10.1002/ijc.20582
Cassar, S., Misso, M. L., Hopkins, W. G., Shaw, C. S., Teede, H. J., & Stepto, N. K. (2016). Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies. Hum Reprod, 31(11), 2619-2631. https://doi.org/10.1093/humrep/dew243
Davis, S. R., McCloud, P., Strauss, B. J., & Burger, H. (1995). Testosterone enhances estradiol's effects on postmenopausal bone density and sexuality. Maturitas, 21(3), 227-36. https://doi.org/10.1016/0378-5122(94)00898-h
Davis, S. R., Goldstat, R., Papalia, M. A., Shah, S., Kulkarni, J., Donath, S., & Bell, R. J. (2006). Effects of aromatase inhibition on sexual function and well-being in postmenopausal women treated with testosterone: a randomized, placebo-controlled trial. Menopause, 13(1), 37-45. https://doi.org/10.1097/01.gme.0000168061.32917.83
Davis, S. R., Moreau, M., Kroll, R., Bouchard, C., Panay, N., Gass, M., Braunstein, G. D., Hirschberg, A. L., Rodenberg, C., Pack, S., Koch, H., Moufarege, A., & Studd, J. (2008). Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med, 359(19), 2005-17. https://doi.org/10.1056/NEJMoa0707302
Davis, S. R., Jane, F., Robinson, P. J., Davison, S. L., Worsley, R., Maruff, P., & Bell, R. J. (2014). Transdermal testosterone improves verbal learning and memory in postmenopausal women not on oestrogen therapy. Clin Endocrinol (Oxf), 81(4), 621-8. https://doi.org/10.1111/cen.12459
Davis, S. R., & Wahlin-Jacobsen, S. (2015). Testosterone in women--the clinical significance. Lancet Diabetes Endocrinol, 3(12), 980-92. https://doi.org/10.1016/S2213-8587(15)00284-3
Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Islam, R. M., Kaunitz, A. M., Kingsberg, S. A., Lambrinoudaki, I., Liu, J., Parish, S. J., Pinkerton, J., Rymer, J., Simon, J. A., Vignozzi, L., & Wierman, M. E. (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab, 104(10), 4660-4666. https://doi.org/10.1210/jc.2019-01603
Davison, S. L., Bell, R., Donath, S., Montalto, J. G., & Davis, S. R. (2005). Androgen levels in adult females: changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab, 90(7), 3847-53. https://doi.org/10.1210/jc.2005-0212
Dichtel, L. E., Carpenter, L. L., Nyer, M., Mischoulon, D., Kimball, A., Deckersbach, T., Dougherty, D. D., Schoenfeld, D. A., Fisher, L., Cusin, C., Dording, C., Trinh, N. H., Pedrelli, P., Yeung, A., Farabaugh, A., Papakostas, G. I., Chang, T., Shapero, B. G., Chen, J., . . . Miller, K. K. (2020). Low-Dose Testosterone Augmentation for Antidepressant-Resistant Major Depressive Disorder in Women: An 8-Week Randomized Placebo-Controlled Study. Am J Psychiatry, 177(10), 965-973. https://doi.org/10.1176/appi.ajp.2020.19080844
Dimitrakakis, C., Zhou, J., Wang, J., Belanger, A., LaBrie, F., Cheng, C., Powell, D., & Bondy, C. (2003). A physiologic role for testosterone in limiting estrogenic stimulation of the breast. Menopause, 10(4), 292-8. https://doi.org/10.1097/01.GME.0000055522.67459.89
Dolan Looby, S. E., Collins, M., Lee, H., & Grinspoon, S. (2009). Effects of long-term testosterone administration in HIV-infected women: a randomized, placebo-controlled trial. AIDS, 23(8), 951-9. https://doi.org/10.1097/QAD.0b013e3283299145
Eigeliene, N., Elo, T., Linhala, M., Hurme, S., Erkkola, R., & Härkönen, P. (2012). Androgens inhibit the stimulatory action of 17β-estradiol on normal human breast tissue in explant cultures. J Clin Endocrinol Metab, 97(7), E1116-27. https://doi.org/10.1210/jc.2011-3228
Eisenegger, C., Naef, M., Snozzi, R., Heinrichs, M., & Fehr, E. (2010). Prejudice and truth about the effect of testosterone on human bargaining behaviour. Nature, 463(7279), 356-9. https://doi.org/10.1038/nature08711
Elbers, J. M., Asscheman, H., Seidell, J. C., Megens, J. A., & Gooren, L. J. (1997). Long-term testosterone administration increases visceral fat in female to male transsexuals. J Clin Endocrinol Metab, 82(7), 2044-7. https://doi.org/10.1210/jcem.82.7.4078
Elraiyah, T., Sonbol, M. B., Wang, Z., Khairalseed, T., Asi, N., Undavalli, C., Nabhan, M., Firwana, B., Altayar, O., Prokop, L., Montori, V. M., & Murad, M. H. (2014). Clinical review: The benefits and harms of systemic testosterone therapy in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab, 99(10), 3543-50. https://doi.org/10.1210/jc.2014-2262
Escobar-Morreale, H. F. (2018). Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol, 14(5), 270-284. https://doi.org/10.1038/nrendo.2018.24
Finkelstein, J. S., Lee, H., Burnett-Bowie, S. A., Pallais, J. C., Yu, E. W., Borges, L. F., Jones, B. F., Barry, C. V., Wulczyn, K. E., Thomas, B. J., & Leder, B. Z. (2013). Gonadal steroids and body composition, strength, and sexual function in men. N Engl J Med, 369(11), 1011-22. https://doi.org/10.1056/NEJMoa1206168
Fogle, R. H., Stanczyk, F. Z., Zhang, X., & Paulson, R. J. (2007). Ovarian androgen production in postmenopausal women. J Clin Endocrinol Metab, 92(8), 3040-3. https://doi.org/10.1210/jc.2007-0581
Fooladi, E., Reuter, S. E., Bell, R. J., Robinson, P. J., & Davis, S. R. (2015). Pharmacokinetics of a transdermal testosterone cream in healthy postmenopausal women. Menopause, 22(1), 44-9. https://doi.org/10.1097/GME.0000000000000259
Geniole, S. N., Bird, B. M., McVittie, J. S., Purcell, R. B., Archer, J., & Carré, J. M. (2020). Is testosterone linked to human aggression? A meta-analytic examination of the relationship between baseline, dynamic, and manipulated testosterone on human aggression. Horm Behav, 123, 104644. https://doi.org/10.1016/j.yhbeh.2019.104644
Glaser, R., York, A. E., & Dimitrakakis, C. (2011). Beneficial effects of testosterone therapy in women measured by the validated Menopause Rating Scale (MRS). Maturitas, 68(4), 355-61. https://doi.org/10.1016/j.maturitas.2010.12.001
Glaser, R. L., & Dimitrakakis, C. (2013). Reduced breast cancer incidence in women treated with subcutaneous testosterone, or testosterone with anastrozole: a prospective, observational study. Maturitas, 76(4), 342-9. https://doi.org/10.1016/j.maturitas.2013.08.002
Glaser, R., & Dimitrakakis, C. (2013). Testosterone therapy in women: myths and misconceptions. Maturitas, 74(3), 230-4. https://doi.org/10.1016/j.maturitas.2013.01.003
Glaser, R., Kalantaridou, S., & Dimitrakakis, C. (2013). Testosterone implants in women: pharmacological dosing for a physiologic effect. Maturitas, 74(2), 179-84. https://doi.org/10.1016/j.maturitas.2012.11.004
Glaser, R. L., & Dimitrakakis, C. (2014). Rapid response of breast cancer to neoadjuvant intramammary testosterone-anastrozole therapy: neoadjuvant hormone therapy in breast cancer. Menopause, 21(6), 673-8. https://doi.org/10.1097/GME.0000000000000096
Glaser, R. L., York, A. E., & Dimitrakakis, C. (2019). Incidence of invasive breast cancer in women treated with testosterone implants: a prospective 10-year cohort study. BMC Cancer, 19(1), 1271. https://doi.org/10.1186/s12885-019-6457-8
Glaser, R., & Dimitrakakis, C. (2021). Testosterone Implant Therapy in Women With and Without Breast Cancer: Rationale, Experience, Evidence. Androgens: Clinical Research and Therapeutics, 2(1), 94-110. https://doi.org/10.1089/andro.2021.0003
Goldstat, R., Briganti, E., Tran, J., Wolfe, R., & Davis, S. R. (2003). Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women. Menopause, 10(5), 390-8. https://doi.org/10.1097/01.GME.0000060256.03945.20
Gurrala, R. R., Kumar, T., Yoo, A., Mundinger, G. S., Womac, D. J., & Lau, F. H. (2023). The Impact of Exogenous Testosterone on Breast Cancer Risk in Transmasculine Individuals. Ann Plast Surg, 90(1), 96-105. https://doi.org/10.1097/SAP.0000000000003321
Hak, A. E., Westendorp, I. C., Pols, H. A., Hofman, A., & Witteman, J. C. (2007). High-dose testosterone is associated with atherosclerosis in postmenopausal women. Maturitas, 56(2), 153-60. https://doi.org/10.1016/j.maturitas.2006.07.004
Hofling, M., Hirschberg, A. L., Skoog, L., Tani, E., Hägerström, T., & von Schoultz, B. (2007). Testosterone inhibits estrogen/progestogen-induced breast cell proliferation in postmenopausal women. Menopause, 14(2), 183-90. https://doi.org/10.1097/01.gme.0000232033.92411.51
Huang, G., Basaria, S., Travison, T. G., Ho, M. H., Davda, M., Mazer, N. A., Miciek, R., Knapp, P. E., Zhang, A., Collins, L., Ursino, M., Appleman, E., Dzekov, C., Stroh, H., Ouellette, M., Rundell, T., Baby, M., Bhatia, N. N., Khorram, O., . . . Bhasin, S. (2014). Testosterone dose-response relationships in hysterectomized women with or without oophorectomy: effects on sexual function, body composition, muscle performance and physical function in a randomized trial. Menopause, 21(6), 612-23. https://doi.org/10.1097/GME.0000000000000093
Huang, G., Tang, E., Aakil, A., Anderson, S., Jara, H., Davda, M., Stroh, H., Travison, T. G., Bhasin, S., & Basaria, S. (2014). Testosterone dose-response relationships with cardiovascular risk markers in androgen-deficient women: a randomized, placebo-controlled trial. J Clin Endocrinol Metab, 99(7), E1287-93. https://doi.org/10.1210/jc.2013-4160
Huang, G., Wharton, W., Travison, T. G., Ho, M. H., Gleason, C., Asthana, S., Bhasin, S., & Basaria, S. (2015). Effects of testosterone administration on cognitive function in hysterectomized women with low testosterone levels: a dose-response randomized trial. J Endocrinol Invest, 38(4), 455-61. https://doi.org/10.1007/s40618-014-0213-3
Iellamo, F., Volterrani, M., Caminiti, G., Karam, R., Massaro, R., Fini, M., Collins, P., & Rosano, G. M. (2010). Testosterone therapy in women with chronic heart failure: a pilot double-blind, randomized, placebo-controlled study. J Am Coll Cardiol, 56(16), 1310-6. https://doi.org/10.1016/j.jacc.2010.03.090
Islam, R. M., Bell, R. J., Green, S., Page, M. J., & Davis, S. R. (2019). Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol, 7(10), 754-766. https://doi.org/10.1016/S2213-8587(19)30189-5
Islam, R. M., Bell, R. J., Handelsman, D. J., McNeil, J. J., Nelson, M. R., Reid, C. M., Tonkin, A. M., Wolfe, R. S., Woods, R. L., & Davis, S. R. (2022). Associations between blood sex steroid concentrations and risk of major adverse cardiovascular events in healthy older women in Australia: a prospective cohort substudy of the ASPREE trial. Lancet Healthy Longev, 3(2), e109-e118. https://doi.org/10.1016/S2666-7568(22)00001-0
Jankowski, C. M., Wolfe, P., Schmiege, S. J., Nair, K. S., Khosla, S., Jensen, M., von Muhlen, D., Laughlin, G. A., Kritz-Silverstein, D., Bergstrom, J., Bettencourt, R., Weiss, E. P., Villareal, D. T., & Kohrt, W. M. (2019). Sex-specific effects of dehydroepiandrosterone (DHEA) on bone mineral density and body composition: A pooled analysis of four clinical trials. Clin Endocrinol (Oxf), 90(2), 293-300. https://doi.org/10.1111/cen.13901
Kaunitz, A. M., Kapoor, E., & Faubion, S. (2021). Treatment of Women After Bilateral Salpingo-oophorectomy Performed Prior to Natural Menopause. JAMA, 326(14), 1429-1430. https://doi.org/10.1001/jama.2021.3305
Kocoska-Maras, L., Zethraeus, N., Rådestad, A. F., Ellingsen, T., von Schoultz, B., Johannesson, M., & Hirschberg, A. L. (2011). A randomized trial of the effect of testosterone and estrogen on verbal fluency, verbal memory, and spatial ability in healthy postmenopausal women. Fertil Steril, 95(1), 152-7. https://doi.org/10.1016/j.fertnstert.2010.05.062
Labrie, F., Luu-The, V., Labrie, C., Bélanger, A., Simard, J., Lin, S. X., & Pelletier, G. (2003). Endocrine and intracrine sources of androgens in women: inhibition of breast cancer and other roles of androgens and their precursor dehydroepiandrosterone. Endocr Rev, 24(2), 152-82. https://doi.org/10.1210/er.2001-0031
Laughlin, G. A., Barrett-Connor, E., Kritz-Silverstein, D., & von Mühlen, D. (2000). Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: the Rancho Bernardo Study. J Clin Endocrinol Metab, 85(2), 645-51. https://doi.org/10.1210/jcem.85.2.6405
Lincoff, A. M., Bhasin, S., Flevaris, P., Mitchell, L. M., Basaria, S., Boden, W. E., Cunningham, G. R., Granger, C. B., Khera, M., Thompson, I. M., Jr., Wang, Q., Wolski, K., Davey, D., Kalahasti, V., Khan, N., Miller, M. G., Snabes, M. C., Chan, A., Dubcenco, E., . . . Nissen, S. E. (2023). Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med, 389(2), 107-117. https://doi.org/10.1056/NEJMoa2215025
Mehta, J., Kling, J. M., & Manson, J. E. (2021). Risks, Benefits, and Treatment Modalities of Menopausal Hormone Therapy: Current Concepts. Front Endocrinol (Lausanne), 12, 564781. https://doi.org/10.3389/fendo.2021.564781
Miller, K. K., Biller, B. M., Beauregard, C., Lipman, J. G., Jones, J., Schoenfeld, D., Sherman, J. C., Swearingen, B., Loeffler, J., & Klibanski, A. (2006). Effects of testosterone replacement in androgen-deficient women with hypopituitarism: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab, 91(5), 1683-90. https://doi.org/10.1210/jc.2005-2596
Montero Bernaldez, J., Burgess, E. R., Martinez, R., & Peñalver, M. (2026). Testosterone Therapy in Women: A Literature Review of Clinical Indications, Dosing, Routes of Administration, and Safety. Cureus, 18(4), e106713. https://doi.org/10.7759/cureus.106713
Nestler, J. E., Powers, L. P., Matt, D. W., Steingold, K. A., Plymate, S. R., Rittmaster, R. S., Clore, J. N., & Blackard, W. G. (1991). A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with the polycystic ovary syndrome. J Clin Endocrinol Metab, 72(1), 83-9. https://doi.org/10.1210/jcem-72-1-83
Olsen, E. A. (2025). Hair Loss in Women. N Engl J Med, 393(15), 1509-1520. https://doi.org/10.1056/NEJMcp2412146
Ooi, D. S., Innanen, V. T., Wang, D., Chong, G. L., Donnelly, J. G., Arseneault, J. J., Pronovost, C., & Wells, G. (1998). Establishing reference intervals for DPC's free testosterone radioimmunoassay. Clin Biochem, 31(1), 15-21. https://doi.org/10.1016/s0009-9120(97)00143-4
Popat, V. B., Calis, K. A., Kalantaridou, S. N., Vanderhoof, V. H., Koziol, D., Troendle, J. F., Reynolds, J. C., & Nelson, L. M. (2014). Bone mineral density in young women with primary ovarian insufficiency: results of a three-year randomized controlled trial of physiological transdermal estradiol and testosterone replacement. J Clin Endocrinol Metab, 99(9), 3418-26. https://doi.org/10.1210/jc.2013-4145
Puurunen, J., Piltonen, T., Puukka, K., Ruokonen, A., Savolainen, M. J., Bloigu, R., Morin-Papunen, L., & Tapanainen, J. S. (2013). Statin therapy worsens insulin sensitivity in women with polycystic ovary syndrome (PCOS): a prospective, randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab, 98(12), 4798-807. https://doi.org/10.1210/jc.2013-2674
Raval, A. D., Hunter, T., Stuckey, B., & Hart, R. J. (2011). Statins for women with polycystic ovary syndrome not actively trying to conceive. Cochrane Database Syst Rev(10), CD008565. https://doi.org/10.1002/14651858.CD008565.pub2
Rech, C. M., Clapauch, R., de Souza Md, & Bouskela, E. (2016). Low testosterone levels are associated with endothelial dysfunction in oophorectomized early postmenopausal women. Eur J Endocrinol, 174(3), 297-306. https://doi.org/10.1530/EJE-15-0878
Rocca, W. A., Bower, J. H., Maraganore, D. M., Ahlskog, J. E., Grossardt, B. R., de Andrade, M., & Melton, L. J., III (2007). Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology, 69(11), 1074-83. https://doi.org/10.1212/01.wnl.0000276984.19542.e6
Rock, C. L., Flatt, S. W., Laughlin, G. A., Gold, E. B., Thomson, C. A., Natarajan, L., Jones, L. A., Caan, B. J., Stefanick, M. L., Hajek, R. A., Al-Delaimy, W. K., Stanczyk, F. Z., & Pierce, J. P. (2008). Reproductive steroid hormones and recurrence-free survival in women with a history of breast cancer. Cancer Epidemiol Biomarkers Prev, 17(3), 614-20. https://doi.org/10.1158/1055-9965.EPI-07-0761
Saad, F., & Traish, A. M. (2025). Effects of testosterone deficiency and therapy on the cardiometabolic syndrome in men. Am J Med Sci, 370(5), 409-419. https://doi.org/10.1016/j.amjms.2025.08.004
Shah, S., Bell, R. J., Savage, G., Goldstat, R., Papalia, M. A., Kulkarni, J., Donath, S., & Davis, S. R. (2006). Testosterone aromatization and cognition in women: a randomized, placebo-controlled trial. Menopause, 13(4), 600-8. https://doi.org/10.1097/01.gme.0000227333.50867.4e
Sharma, A., Davies, R., Kapoor, A., Islam, H., Webber, L., & Jayasena, C. N. (2023). The effect of hormone replacement therapy on cognition and mood. Clin Endocrinol (Oxf), 98(3), 285-295. https://doi.org/10.1111/cen.14856
Sherwin, B. B., & Gelfand, M. M. (1985). Sex steroids and affect in the surgical menopause: a double-blind, cross-over study. Psychoneuroendocrinology, 10(3), 325-35. https://doi.org/10.1016/0306-4530(85)90009-5
Sherwin, B. B. (1988). Estrogen and/or androgen replacement therapy and cognitive functioning in surgically menopausal women. Psychoneuroendocrinology, 13(4), 345-57. https://doi.org/10.1016/0306-4530(88)90060-1
Shifren, J. L., Braunstein, G. D., Simon, J. A., Casson, P. R., Buster, J. E., Redmond, G. P., Burki, R. E., Ginsburg, E. S., Rosen, R. C., Leiblum, S. R., Caramelli, K. E., & Mazer, N. A. (2000). Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. N Engl J Med, 343(10), 682-8. https://doi.org/10.1056/NEJM200009073431002
Shufelt, C., Bretsky, P., Almeida, C. M., Johnson, B. D., Shaw, L. J., Azziz, R., Braunstein, G. D., Pepine, C. J., Bittner, V., Vido, D. A., Stanczyk, F. Z., & Bairey Merz, C. N. (2010). DHEA-S levels and cardiovascular disease mortality in postmenopausal women: results from the National Institutes of Health--National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women's Ischemia Syndrome Evaluation (WISE). J Clin Endocrinol Metab, 95(11), 4985-92. https://doi.org/10.1210/jc.2010-0143
Sievers, C., Klotsche, J., Pieper, L., Schneider, H. J., März, W., Wittchen, H. U., Stalla, G. K., & Mantzoros, C. (2010). Low testosterone levels predict all-cause mortality and cardiovascular events in women: a prospective cohort study in German primary care patients. Eur J Endocrinol, 163(4), 699-708. https://doi.org/10.1530/EJE-10-0307
Slomski, A. (2020). Which Postmenopausal Women Should Use Testosterone for Low Sexual Desire?. JAMA, 323(6), 493-495. https://doi.org/10.1001/jama.2019.22070
Tienforti, D., Castellini, C., Di Giulio, F., Spagnolo, L., Muselli, M., Fisher, A. D., Vignozzi, L., Baroni, M. G., & Barbonetti, A. (2024). Metabolic Features of Assigned Female at Birth Transgender People on Gender-Affirming Hormone Therapy: A Meta-analysis. Transgend Health, 9(6), 466-483. https://doi.org/10.1089/trgh.2023.0040
Tomaselli, K. P. (2005, January 17). Intrinsa stalled by concerns about safety. American Medical News. https://amednews.com/article/20050117/health/301179964/7/
Traish, A., Guay, A. T., & Spark, R. F. (2007). Are the Endocrine Society's Clinical Practice Guidelines on Androgen Therapy in Women misguided? A commentary. J Sex Med, 4(5), 1223-34; discussion 1234-5. https://doi.org/10.1111/j.1743-6109.2007.00584.x (Read via Traish & Morgentaler, 2022.)
Traish, A. M., & Morgentaler, A. (2022). Androgen Therapy in Women with Testosterone Insufficiency: Looking Back and Looking Ahead. Androgens: Clinical Research and Therapeutics, 3(1), 2-13. https://doi.org/10.1089/andro.2021.0030
U.S. Food and Drug Administration. (2004, October 28). Advisory Committee for Reproductive Health Drugs; notice of meeting [NDA 21-769, testosterone transdermal system]. Federal Register, 69(208), 62902. FR Doc. 04-24068.
Viana, D. P. D. C., Câmara, L. C., & Alto, L. S. M. (2026). Cardiovascular mortality associated with testosterone therapy in cisgender women and transgender men: a systematic review. Front Endocrinol (Lausanne), 17, 1789504. https://doi.org/10.3389/fendo.2026.1789504
Wierckx, K., Van Caenegem, E., Schreiner, T., Haraldsen, I., Fisher, A. D., Toye, K., Kaufman, J. M., & T'Sjoen, G. (2014). Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: results from the European network for the investigation of gender incongruence. J Sex Med, 11(8), 1999-2011. https://doi.org/10.1111/jsm.12571
Wierman, M. E., Basson, R., Davis, S. R., Khosla, S., Miller, K. K., Rosner, W., & Santoro, N. (2006). Androgen therapy in women: an Endocrine Society Clinical Practice guideline. J Clin Endocrinol Metab, 91(10), 3697-710. https://doi.org/10.1210/jc.2006-1121 (Read via Traish & Morgentaler, 2022.)
Wierman, M. E., Arlt, W., Basson, R., Davis, S. R., Miller, K. K., Murad, M. H., Rosner, W., & Santoro, N. (2014). Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 99(10), 3489-510. https://doi.org/10.1210/jc.2014-2260
Writing Group for the Women's Health Initiative Investigators. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA, 288(3), 321-33. https://doi.org/10.1001/jama.288.3.321
Zimmerman, Y., Eijkemans, M. J., Coelingh Bennink, H. J., Blankenstein, M. A., & Fauser, B. C. (2014). The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis. Hum Reprod Update, 20(1), 76-105. https://doi.org/10.1093/humupd/dmt038
