Aesthetic pressure, the promise of vitality, and the influx of content about hormones on social media have led more women to seek testosterone replacement therapy. There is no updated data on the increase in this demand—particularly because there are no formulations approved for female use—but this trend worries medical entities.
In May 2025, the Brazilian Society of Endocrinology and Metabolism (SBEM), the Brazilian Federation of Obstetrics and Gynecology Societies (Febrasgo) and the Gynecologic Cardiology Section of the Brazilian Society of Cardiology issued a joint alert: The only recognized indication for the therapeutic use of testosterone in women is the treatment of postmenopausal hypoactive sexual desire disorder (HSDD).
“Many women turn to testosterone in search of benefits such as weight loss, increased lean mass, and improved mood and vitality, even without a proven androgenic deficiency or formal indication backed by scientific evidence,” endocrinologist Felipe Henning Gaia Duarte, president of SBEM-SP, tells Einstein Agency.
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Despite its reputation as the “male hormone,” testosterone also circulates in the female body. It is produced by the ovaries at much lower levels, and helps maintain muscle mass, strength, energy, bone health, and libido. Starting around age 30, these levels gradually decline and the decline tends to be more severe during menopause, with potential effects on behaviour, mood and sexual desire.
“In a society that values youth, vitality and strict aesthetic standards, the natural signs of female aging end up in medical treatment and are little explored in the emotional sphere,” says gynecologist José María Soares Jr., head of the Vibrasco Gynecological Endocrinology Committee. It turns out that testosterone has clear limits and it is necessary to talk transparently about its true effects and risks.
Indication only for TDSH
Replacement in women with HSDD has been studied for decades. A systematic review published in 2019 in The Lancet Diabetes & Endocrinology analyzed 46 clinical trials including more than 8,000 women and showed that physiological doses of the hormone can improve desire, arousal, pleasure, and sexual satisfaction without a significant increase in serious adverse effects in the short term.
This evidence supports the global consensus on testosterone treatment in women, and has been an international reference since 2019. The document states that testosterone has only a proven indication for HSDD in postmenopausal women, after ruling out other causes of loss of desire. It also reinforces the necessity of substitution with formulations that allow strict dose control and continuous monitoring.
Outside of this context, there is no scientific support for the use of testosterone for aesthetic or cognitive purposes, increasing muscle mass, improving mood, or preventing aging.
“There are indications and contraindications for classical hormonal therapy (estroprogestin), so it is very important for us to monitor the patient, because we can miss the opportunity up to 10 years after menopause or 60 years to start hormonal therapy,” explains gynecologist Helena Hachul de Campos, from Einstein Israelita Hospital. “But it is essential to be informed of the indication appropriately after reviewing the benefits, risks, history assessment, supplementary examination and history.”
In other areas, studies are still exploratory. An analysis based on NHANES (US National Health and Nutrition Examination Survey), published in Nature in 2022, found an association between higher testosterone levels and increased bone mineral density in women aged 40 to 60 years, but the observational design precludes drawing causal conclusions. Another study, published in 2025 in JAMA, evaluated a combination of physical therapy and testosterone in older women after hip fracture and observed modest improvements in strength and functional recovery. However, the data are preliminary and do not support changes in clinical practice.
In the cognitive domain, a study from the Journal of Clinical Endocrinology also published in 2025 analyzed the relationship between sex hormones and the risk of dementia in postmenopausal women and men. The work showed a relationship between testosterone levels and cognitive protection in females, but without determining a causal relationship between the two factors.
The use of testosterone outside of recognized indications carries a series of health risks
Use requires caution
The increase in information and, above all, misinformation about hormones on social media has changed the doctor-patient relationship. “Now, it has become common for women to arrive at the office not with complaints open to investigation, but with specific demands and content-based self-diagnosis promising testosterone as a panacea for fatigue, aging, and low libido,” says Soares Jr.
The problem is that use outside the scope of recognized indications brings a series of risks. These include signs of virilization – acne, increased male pattern hair, hair loss, deepening of the voice and clitoral enlargement – and metabolic changes such as insulin resistance and deterioration of the lipid profile, as well as potential cardiovascular impact in scenarios of prolonged or high-dose use. Mood changes, with anxiety, impulsivity, and aggression, have also been reported, as well as liver damage, such as enzyme elevations and risk of hepatotoxicity, especially in unsuitable formulations.
On the female side, menstrual disorders, endometrial atrophy, and even poor fertility appear. “Clitoral enlargement is among the most painful effects for patients and can be irreversible even after stopping the hormone,” warns the Vibrago specialist. According to him, safe use requires caution, individuality and alignment between the doctor and the patient. “This perfectly illustrates the unproven benefits, real risks, and fine line between medical treatment and the search for the cultural ideal of eternal youth,” he notes.
The hormone is difficult to measure
In addition to the lack of evidence for uses outside of TDSH and the risks associated with it, testosterone has another important hurdle: measuring the hormone in women is difficult. Laboratory tests are essential to confirm disability and monitor people undergoing treatment, but interpretation of results faces significant limitations.
The main problem is the concentration of the hormone itself. Women have much lower physiological levels than men, sometimes approaching the detection limit of conventional tests. Most laboratories use immunoassay, a technique that loses accuracy in these ranges.
“For this reason, some laboratories correctly indicate only that the value of testosterone in women is below a certain point, such as ‘less than 63 nanograms per deciliter’, rather than ‘12 to 63’,” explains the head of the SBEM-SP.
The lack of widely accepted reference values also complicates reading. The ranges used in practice tend to come from small populations, in different ways and without taking into account relevant differences, such as age, stage of the menstrual cycle, menopause, or ethnic differences.
Another obstacle is the difference between methods. Testosterone can be measured by immunoassay, radioimmunoassay or mass spectrometry – this is considered the gold standard due to its greater sensitivity at low concentrations, but is limited in availability. “There is no calibration so that the results from each method are equivalent, so each method generates a different value, which makes determining the normal level for the same patient more complicated, if she tests in different places with different methods,” says Felipe Duarte.
There are also analytical interferences and a lack of standardization between laboratories. Similar molecules, such as other steroid hormones and sex hormone binding globulin (SHBG) itself, can affect the reading. Differences in methodology enhance the difficulty of comparing tests or determining a global value of normality.
“Laboratory dosing should be performed using appropriate methods and carefully reviewed, giving preference to mass spectrometry, and always placed in the context of the patient’s clinical condition and other relevant hormonal variables, as well as taking into account the issue of the lack of a suitable universal reference at the hormonal level for each phase of the female cycle,” the endocrinologist concludes.
Medical response to stress
The increased search for testosterone among women has multiple origins. There are real complaints about menopause, but there is also a culture that treats aging as a failure that needs to be corrected. For Soares Junior, this movement expresses a medical attempt to respond to the pressures on youth, performance and aesthetics. “This perspective lacks a strong scientific basis,” he points out.
“Testosterone does not reverse aging, does not improve physical performance in healthy women, and its aesthetic benefits are questionable given its significant androgenic risks.”
Tackling misinformation is a key part of the response. When the discussion is dominated by simplistic promises, marketing, or influencers without technical qualifications, the risk of frustration and complications increases. “High-quality information, provided it is obtained from appropriate sources, can empower patients, increase participation in therapeutic decisions and enhance the sharing of decision-making power between doctor and patient,” says the Vibrago gynecologist.
It’s also worth noting that many of the symptoms of menopause, such as mood changes, insomnia, weight gain, fatigue, and low self-esteem, feed off of each other. A hormonal decline can trigger a cascade: mood affects sleep; Lack of sleep increases fatigue. Fatigue reduces exercise. The weight is rising. Self-esteem declines and sexual desire follows this cycle. “We really need to understand what a person is going through, what their complaints are and what is the best treatment for this cascading effect,” says Einstein’s gynecologist.
This broader view includes emotional and marital factors. Empathy between partners, division of tasks, and emotional dynamics are part of the diagnosis. For example, a pilot study conducted by Hospital das Clínicas of the University of São Paulo (USP), published in 2022 in the Journal of Clinics, showed good results from group cognitive behavioral therapy for the treatment of low sexual desire.
Sex education, psychological support, and lifestyle modification can also be effective and lasting strategies. According to the SBEM endocrinologist, there are also non-hormonal options and specific medications that can be considered.
“Choosing the ideal route should take into account the global assessment of the patient’s health, underlying causes and preferences, reserving hormonal therapy only for selected cases and with clear criteria,” he explains.
Investigating poorly controlled chronic diseases—such as diabetes, hypothyroidism, and cardiovascular dysfunction—is another necessary step, as all of them can affect libido and energy. “In addition, strategies such as improving sleep, regular exercise, and nutritional adequacy are essential interventions,” Soares Jr. says.
The truth is that the passage of time does not need to be treated as a threat. Maintaining healthy habits helps, but turning “eternal youth” into a goal can be harmful. “We lose a little speed, but we gain maturity, we gain experience,” says Helena Hachul. “It’s important to accept these changes, do what you can, but don’t live as a job of always being younger. That’s not healthy.”
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