Testosterone Therapy Menopause: 10-Year Study Results
Women come to me after years with zero libido, flat energy, and a mood that sits somewhere south of fine. They’ve been to multiple doctors. They’ve been told it’s just menopause, or just stress, or just getting older. Nobody ever ran their testosterone. Nobody ever discussed testosterone therapy as part of their menopause care. In the United States, there is no FDA-approved testosterone product for women. So in most offices, the conversation never starts. That silence has a real cost.
A long-term study published in December 2025 followed women receiving testosterone pellet therapy over 10 years and measured outcomes across all 11 categories of the Menopause Rating Scale. The results: rapid and sustained improvement in menopause symptoms across every age group evaluated. The benefits appeared quickly after starting testosterone therapy and held throughout the decade of follow-up. This is exactly the kind of long-term data I have been waiting for, because it answers the question I hear constantly: “Will this actually keep working?”
Conventional medicine barely acknowledges that women need testosterone. The whole framework for testosterone therapy was built around men. Women are an afterthought, which means the doctors who should be talking to their patients about this have no protocol to follow, no approved product to prescribe, and no training to draw from. That is a system failure. And the women sitting in my office who haven’t slept well in four years, haven’t wanted sex in two, and can’t figure out why they feel so flat: they are the ones paying for it.
Testosterone Therapy for Menopause: What 10 Years of Data Showed
The Menopause Rating Scale measures menopausal symptom severity across 11 categories: hot flashes and night sweats, sleep problems, depressed mood, irritability, anxiety, mental and physical exhaustion, sexual problems, bladder issues, vaginal dryness, joint and muscle discomfort, and heart discomfort. It is a comprehensive picture of how menopause affects quality of life, not just a hot flash count.
The 10-year study published in December 2025 tracked women who received testosterone pellet therapy for androgen deficiency symptoms. Here’s what they found: median symptom scores across all 11 MRS categories dropped significantly, quickly after starting treatment, and stayed down across a full decade. This wasn’t a short-term result. It was 10 years of sustained improvement in quality of life.
Here’s what that means: testosterone therapy for menopause produced meaningful improvements in mood, energy, sleep, sexual function, and mental clarity. Not just in the first months. Year after year. And it worked across all age groups, not only in younger menopausal women.
Women come to me with symptom profiles that overlap exactly with androgen deficiency: flat energy, zero interest in sex, difficulty building muscle, brain fog, low motivation, and a mood that never quite lifts. Standard blood work from their primary care doctor never included testosterone. So nobody connected the dots.
One patient in her mid-50s had been told by two different doctors that her symptoms were age-related and her labs were normal. When I ran a full hormone panel, her free testosterone was near zero. Within three months of starting testosterone therapy, she told me she hadn’t felt that way since her 30s. That kind of result is not unusual in my practice. It is what I see when we finally close the gap between a real evaluation and what the standard system provides.
Why Women Are Left Out of the Testosterone Conversation
Here is the core problem: there are no FDA-approved testosterone products for women in the United States. Every testosterone prescription a woman receives is off-label. That doesn’t make it inappropriate or unsafe. But it does mean that most doctors never learned a protocol for it, never trained in dosing for women, and never got comfortable with it in practice.
So women go undiagnosed. Their testosterone levels never get measured. Their symptoms get attributed to depression, or to “just menopause,” or to stress. And the treatment that might address the root cause stays off the table entirely.
This is not a niche issue. Androgen deficiency in women is common, and it becomes more pronounced through perimenopause and after menopause. The ovaries produce testosterone, and as they slow down during the transition, androgen levels fall alongside estrogen. Nobody is explaining this to most women. Their doctors never bring it up.
The Menopause Society has acknowledged the evidence for testosterone in women, particularly for low sexual desire. But even that limited clinical recognition hasn’t translated into widespread testing or treatment. Most women never have their testosterone level checked once in their entire menopause care history. That is the gap.
The Testosterone Therapy Menopause Gap: Who Actually Benefits
The 10-year data is worth sitting with for a moment. This wasn’t a short placebo-controlled trial. It was a decade of real clinical follow-up. And the results held not just for sexual symptoms, which are the ones most often cited in testosterone research for women, but across energy, mood, sleep, mental clarity, and physical symptoms including joint discomfort and heart discomfort.
Every age group improved. That directly challenges the assumption that testosterone therapy is only relevant for younger menopausal women, or only for one category of symptoms. The data says otherwise, clearly.
At Living Well Dallas, testosterone is part of every comprehensive hormone evaluation for women in perimenopause and beyond. I measure total testosterone, free testosterone, and SHBG (sex hormone-binding globulin), which controls how much testosterone the body can actually use. A woman can have a “normal” total testosterone and still have nearly no usable testosterone because her SHBG is binding all of it.
The form of delivery matters too. Pellets, topical creams, and injections all behave differently. I look at what each patient needs and how her body responds. This is not a one-size protocol.
Key Takeaways
- A 10-year study of testosterone therapy for menopause showed rapid and sustained improvement across all 11 Menopause Rating Scale categories, not just sexual symptoms.
- All age groups showed significant benefit, not only younger menopausal women.
- There are no FDA-approved testosterone products for women in the US, which is why most women never get tested or treated for androgen deficiency.
- Testosterone levels drop alongside estrogen during perimenopause, and androgen deficiency is a common but routinely missed cause of flat energy, zero libido, brain fog, and mood decline.
- A complete hormone evaluation must include free and total testosterone alongside SHBG to give the full picture.
Frequently Asked Questions
Can women take testosterone safely during menopause? Yes, and the 10-year study published in December 2025 provides long-term data supporting both safety and effectiveness. Like any hormone therapy, testosterone for menopause requires proper dosing and monitoring. Doses well above normal female levels carry real risks. At doses that restore normal female testosterone levels, the risk picture is very different. This is why working with a doctor who is experienced with testosterone dosing for women matters.
What symptoms does testosterone therapy for menopause actually treat? The 10-year study measured outcomes across all 11 categories of the Menopause Rating Scale: hot flashes, sleep, mood, anxiety, exhaustion, sexual function, bladder symptoms, vaginal health, joint discomfort, and heart discomfort. Across all of them, women showed significant improvement. In practice, the symptoms I see respond most clearly are flat energy, zero libido, brain fog, difficulty building muscle, and low motivation.
Getting Tested for Androgen Deficiency
What lab tests do I need to check for androgen deficiency? Total testosterone alone is not enough. I run free testosterone and SHBG in every evaluation. SHBG binds testosterone and makes it unavailable for the body to use. A woman with normal total testosterone but very high SHBG may have very little usable testosterone available. I also check DHEA-S, a precursor hormone the body uses to make testosterone, alongside the full estrogen and progesterone panel.
How do I find a doctor who will test and prescribe testosterone for menopause? Look for a doctor who practices functional medicine, integrative medicine, or who specializes in hormone therapy for women. Ask specifically whether they test free testosterone and SHBG, and whether they have experience prescribing testosterone for women. Most primary care doctors and OBGYNs do not have this training and are not comfortable with off-label testosterone prescribing, even when the clinical need is clear.
What to Expect from Testosterone Therapy
How quickly does testosterone therapy work for menopause symptoms? The 10-year study found rapid initial improvements after starting treatment, with effects sustained over the full decade. In my practice, many women notice changes within 6 to 12 weeks, particularly in energy and libido. Full optimization can take several months, since it involves dialing in the right dose and watching how the body responds. Patience and monitoring both matter here.
What form of testosterone is best for menopausal women? There is no single best form. Pellet therapy, topical creams, and injections all deliver testosterone differently, with different absorption rates and consistency. Pellets, which are the form studied in the December 2025 research, offer steady hormone levels over several months. Topical forms allow more frequent dose adjustment. Which form fits you depends on your lifestyle, how your body absorbs the hormone, and your clinical goals. That is something to work through with your doctor over time.
Dr. Betty’s Bottom Line
Testosterone deficiency in women is one of the most overlooked gaps in menopause care. The symptoms are real, they significantly affect quality of life, and they respond to treatment. But because there is no FDA-approved product for women, most doctors never test for it. So women go years, sometimes decades, with flat energy, zero libido, brain fog, and declining muscle mass. A connection nobody makes. A problem nobody solves.
The 10-year study published in December 2025 is the kind of long-term data I wish we had more of. It followed women for a full decade. It measured outcomes across every major category of menopause symptoms. And the results held: rapid improvement, sustained across 10 years, in every age group tested.
What I want you to take from this: ask for your testosterone levels. Ask specifically for free testosterone and SHBG, not just total testosterone. If your doctor doesn’t test those, or doesn’t know why they matter, that is useful information about whether you’re getting comprehensive care.
In-person hormone care at Living Well Dallas is available for patients in the Dallas area. Menrva Health offers comprehensive androgen evaluation and testosterone therapy for menopause through telehealth in all 50 states.
Source: Chan J, Cunningham J, Cunningham C, et al. “The benefits of testosterone therapy for menopausal symptoms.” Published December 2025. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12808602/