By Dr. Tulsi Kotecha, MD & Dr. Laura Ruof, DDS

Menopause can feel like someone quietly changed the rules of your body overnight: sleep shifts, mood feels less steady, energy dips, muscle tone changes, and intimacy can start to feel…different. In our clinic, we see women who are doing “all the right things” and still don’t feel like themselves.

Testosterone is one of the tools we may use – carefully and intentionally – to help the right patient at the right time. We’re pro-testosterone when it’s appropriate, but we’re even more pro-evidence-based dosing, safety monitoring, and physician oversight.

TDLR: This blog is meant to help you understand what testosterone therapy is, who it may help most, what risks to know, and why doing this with medical supervision matters.

First: Testosterone is a normal female hormone

Testosterone isn’t a “male hormone.” Women naturally produce testosterone in the ovaries and adrenal glands, and levels tend to decline with age and around menopause. Testosterone influences multiple systems – brain, skin, muscle, and sexual function – though the strength of evidence for benefits differs by symptom.

Here’s the key evidence-based headline:

The strongest, most consistent medical evidence supports testosterone therapy for postmenopausal women with hypoactive sexual desire disorder (HSDD) – a persistent, distressing loss of sexual desire not better explained by relationship stress, depression, medications, pain, or other medical issues. 

What symptoms women hope testosterone will improve

Many women ask about testosterone because they’re experiencing some combination of:

• Low libido / fewer sexual thoughts
• Reduced arousal or orgasm intensity
• Fatigue or low drive
• Brain fog
• Low mood or reduced motivation
• Loss of strength / muscle tone
• Body composition changes

We want to be transparent: for most of these symptoms (fatigue, mood, cognition, muscle, “overall vitality”), data is limited, and major medical statements emphasize that evidence is strongest for HSDD specifically. 

That doesn’t mean you’re “wrong” to ask. It means you deserve a plan that doesn’t overpromise – and a clinician who can evaluate why you feel the way you do and whether testosterone is a good fit.

Who is a good candidate in our practice

We consider testosterone most often when a woman is:

1. Peri- or postmenopausal, and
2. Experiencing low sexual desire that feels distressing, and
3. We’ve done a thoughtful biopsychosocial assessment (medical contributors, relationship factors, stress, sleep, meds like SSRIs, pain with sex, vaginal dryness, etc.). 

We also look at the broader hormone picture. For many women, optimizing estrogen therapy (when appropriate) + progesterone (when needed), sleep, thyroid status, iron stores, and lifestyle moves the needle significantly before testosterone is even necessary.

How testosterone is prescribed safely (and why dosing matters so much)

One of the biggest safety issues we see in the real world is women being overdosed – sometimes to testosterone levels comparable to men – often from pellets, high-dose injectables, or poorly standardized compounding. That’s when side effects become more likely and sometimes irreversible. 

Our goal is not “more testosterone.” Our goal is “physiologic female levels.”

Guidelines emphasize using formulations and dosing that keep levels in the normal premenopausal female range, with follow-up and monitoring. 

What form of testosterone is best?

Most evidence and guidelines focus on systemic transdermal testosterone (commonly gel/cream applied to skin) in carefully titrated low doses. 

We generally avoid approaches that make it hard to control dose or reverse quickly if you get side effects (for example, long-acting pellets), and we’re cautious with any approach that reliably drives levels above the female physiologic range. 

The benefits you can realistically expect

For appropriately selected postmenopausal women with HSDD, testosterone can provide a moderate improvement in sexual desire and related distress. 

A practical way to think about it:

• This is not a “switch” that turns libido on overnight.
• It can help restore responsiveness, sexual thoughts, and interest.
• Results are typically assessed over weeks, and continued only if there’s meaningful benefit.

Risks and side effects you should know (and why monitoring protects you)

When testosterone is kept in the physiologic female range, side effects are usually mild and manageable. When it’s too high, side effects become more common – and a few may be difficult to reverse.

Potential side effects (dose-related):

• Acne / oily skin
• Increased facial or body hair (hirsutism)
• Scalp hair shedding (androgenic-pattern hair loss)
• Irritability or mood changes
• Voice deepening (rare, but can be irreversible)
• Clitoral enlargement (rare, usually associated with excessive dosing) 

Health risks and unknowns:

• Effects on cholesterol and cardiometabolic risk depend on formulation/dose; long-term safety data in women remain limited, which is why conservative dosing and follow-up matter. 

Who should generally avoid testosterone (or only consider with specialist-level nuance):

• Pregnancy or trying to conceive (testosterone can affect fetal development)
• Active hormone-sensitive cancers (case-by-case with oncology guidance)
• Severe untreated acne/hirsutism
• Uncontrolled medical conditions where risks outweigh benefits

What “doctor-supervised” actually means at Refine by Tulsi

A safe testosterone plan isn’t just a prescription – it’s a process:

1) We confirm the right problem

Low libido can come from:

• Vaginal dryness/pain (often estrogen-responsive)
• Relationship stress, trauma history, body image changes
• Depression/anxiety or SSRI use
• Sleep disruption and chronic stress
• Thyroid dysfunction, iron deficiency, under-fueling, overtraining

Guidelines recommend a structured assessment—because testosterone won’t fix what isn’t androgen-related. 

2) We establish baselines

Typically includes symptom review plus labs to help guide safe dosing and avoid over treatment. There is no single testosterone blood level that “proves” you need treatment (and guidelines emphasize that), but levels help with safe monitoring. 

3) We use conservative dosing and re-check

We aim to keep you in the female physiologic range, reassess symptoms, and adjust carefully. 

4) We monitor for side effects early

If you’re getting acne, hair changes, agitation, or voice changes, we don’t “push through.” We pause, adjust, or stop – because the goal is benefit without trade-offs.

5) We reevaluate whether it’s worth continuing

If it’s not meaningfully improving your quality of life, we pivot. Medicine should be personalized, not trendy.

A candid note on “testosterone for everything”

You may see testosterone marketed online as the solution for fatigue, weight loss, brain fog, and “anti-aging.”

We understand why that message is appealing. But reputable medical consensus statements caution that evidence is insufficient for many of these claims, and they emphasize avoiding supraphysiologic dosing and loosely monitored prescribing. 

Our stance:

• We’re not anti-testosterone.
• We’re anti-hype.
• We’re pro-you feeling better with a plan that’s medically sound.

Testosterone Myths — Busted

Myth #1: “Testosterone is a male hormone.”

Truth: Women naturally produce testosterone throughout life. It plays an important role in sexual health, motivation, muscle integrity, and overall vitality. The issue is not the hormone—it’s how much and how it’s prescribed.

Myth #2: “More testosterone means better results.”

Truth: More is not better. Excess testosterone increases the risk of acne, hair changes, mood shifts, and potentially irreversible side effects. Physiologic female dosing is the goal.

Myth #3: “If my testosterone level is normal, I can’t benefit.”

Truth: Hormone levels do not tell the full story. Symptoms, distress, and clinical context matter more than a single lab value.

Myth #4: “Testosterone fixes all menopausal symptoms.”

Truth: Testosterone is not a cure-all. It does not replace estrogen, progesterone, sleep, stress management, or metabolic care. It is one tool used thoughtfully in the right patient.

Myth #5: “Pellets are the most natural way to get hormones.”

Truth: “Natural” does not equal safe. Pellets often deliver supraphysiologic doses and lack flexibility. Precision and reversibility matter more than marketing claims.

Myth #6: “If I start testosterone, I’m committed forever.”

Truth: Testosterone therapy should be reassessed regularly. If it does not meaningfully improve quality of life, it should be adjusted or discontinued.

Myth #7: “Cautious doctors are anti-testosterone.”

Truth: Thoughtful prescribing reflects respect for female physiology and long-term health—not opposition to treatment.

Considering testosterone? A personalized Refine Her consultation is the safest place to determine whether it truly fits your body, symptoms, and goals.

If you’re considering testosterone, here’s how to think about it

Testosterone can be a powerful, positive part of menopausal care when it’s used for the right indication, at the right dose, with the right follow-up.

If you’re curious whether you’re a candidate, your next best step is a consult focused on:

• A full symptom + medical review
• A relationship context assessment
• Baseline labs and risk review
• A personalized plan (which may or may not include testosterone)

Your hormones aren’t a trend. They’re your physiology – and they deserve medical precision.

Frequently Asked Questions About Testosterone for Women

Is testosterone safe for women in menopause?

When prescribed at physiologic female doses and monitored by a physician, testosterone can be safe for select women—particularly those with distressing low sexual desire. Safety depends on appropriate dosing, formulation, and regular follow-up. Problems most often arise when testosterone is overprescribed or inadequately monitored.

What symptoms does testosterone actually help in women?

The strongest medical evidence supports testosterone therapy for postmenopausal women with hypoactive sexual desire disorder (HSDD). Benefits may include improved sexual desire, arousal, and reduced distress around intimacy. Evidence for improvements in mood, energy, or cognition is mixed and varies by individual.

Do testosterone levels need to be “low” to qualify for treatment?

No. There is no specific testosterone blood level that determines who should or should not receive therapy. Decisions are based on symptoms, clinical context, and patient distress—not labs alone. Blood work is used primarily to guide safe dosing and monitoring.

Can testosterone cause facial hair, acne, or hair loss?

Yes—if the dose is too high. Acne, increased facial or body hair, and scalp hair thinning are dose-dependent side effects. This is why conservative dosing and physician oversight are essential. When levels are kept within the female physiologic range, side effects are typically mild and reversible.

Will testosterone deepen my voice or cause masculinization?

Voice deepening and other masculinizing effects are rare and most often associated with supraphysiologic dosing over time. Proper physician supervision significantly reduces this risk.

Do all women in menopause need testosterone?

No. Many women experience significant improvement by optimizing estrogen, progesterone, sleep, stress, vaginal health, or metabolic factors. Testosterone is considered only when clinically appropriate and never as a one-size-fits-all solution.

How long does it take to notice benefits?

When effective, improvements in sexual desire or responsiveness are typically assessed over several weeks. Testosterone is not a quick fix and should only be continued if it leads to meaningful improvement in quality of life.

Why don’t you recommend testosterone pellets?

Pellets can deliver excessively high or inconsistent hormone levels and are difficult to adjust or reverse once placed. At Refine by Tulsi, we prioritize precision dosing, reversibility, and patient safety.

Can testosterone help with weight loss?

Testosterone is not a weight-loss medication. While it may help support lean muscle in some women, it should never be prescribed for weight loss alone. Sustainable metabolic health requires a comprehensive approach.

Is testosterone included in the Refine Her program?

Testosterone may be included as one component of the Refine Her program when clinically appropriate. It is never automatic and is always part of a broader, physician-led hormone and longevity plan.

The Refine Her Women’s Wellness Program

Refine Her is built on the understanding that women’s symptoms during menopause are multifactorial, not just “low testosterone.”

Within Refine Her, we evaluate:

• Estrogen status (and whether optimization is appropriate)
• Progesterone needs (sleep, anxiety, endometrial protection when indicated)
• Testosterone
• Thyroid function
• Adrenal health and stress physiology
• Sleep quality and recovery
• Body composition and metabolic health
• Sexual health, vaginal health, and pelvic comfort
• Nutritional status and micronutrients
• Lifestyle, training load, and nervous system balance

This comprehensive lens allows us to determine whether testosterone in combination with other peptides and hormones is truly the right tool.