Jury Still Out on Testosterone Benefit to Menopause

Amid a rising interest in testosterone therapy among women going through menopause, researchers warn that evidence remains inconsistent and incomplete.

Speaking at The Menopause Society 2025 Annual Meeting, Susan R. Davis, PhD, MBBS, AO, FRACP, professor and head of the Monash University Women’s Health Research Program in Melbourne, Australia, presented a data-driven overview of clinical and observational studies evaluating testosterone’s role in women’s health.1 The short of it: it has no role, at least not yet.

“In 2025, there is no justification for treating postmenopausal women or premenopausal women with testosterone to prevent muscle loss, to prevent bone muscle fracture, to prevent heart disease, to treat depression or cognitive decline, and I would also add in fatigue, because the psychological general wellbeing questionnaires also include a domain of vitality,” Davis explained. “It is not the silver bullet; it is not the missing hormone. Women are not missing out if they're not getting testosterone.”

Data are inconclusive surrounding testosterone's benefit for menopausal women. | Image credit: jarun011 – stock.adobe.com

Measuring Testosterone in Women

Davis began by addressing a fundamental problem: how testosterone is measured in women.

“Testosterone concentrations in women are very low, and most of you will only have access to immunoassays, which are very imprecise in a female range,” she said. Although mass spectrometry offers more precise measurement, she noted, reference ranges are often based on small samples and vary across laboratories. Just trying to find out what a “normal” range is for women is difficult.

“And there’s absolutely no such thing as a testosterone insufficiency syndrome,” Davis added. “There’s no blood level below which testosterone is associated with any syndrome or symptoms.”

Davis cautioned clinicians to be wary of misleading online narratives that frame testosterone as a missing hormone for midlife women. Instead, doctors should understand that inconsistent trial results mean something is variable, or the answer just isn’t known yet.

“Social media is very good at cherry-picking what suits the argument at the time,” she said.

No Proven Benefit for Muscle or Bone

Despite claims that testosterone can restore vitality or prevent frailty, studies have not demonstrated consistent physical benefits. A 2019 meta-analysis of randomized controlled trials found no improvements in lean body mass or muscle strength at physiological doses of testosterone, and most studies had fewer than 20 participants per treatment arm.2

“We don’t know, but you can’t say to patients that testosterone will prevent muscle loss,” Davis said.1

Even supraphysiologic doses as high as 210 ng/dL showed only minimal effects, including an extra 15 seconds of running time in young athletes.3 In older adults recovering from hip fractures, high-dose testosterone combined with exercise did not improve walking distance, bone density, or daily functioning.

Data on bone health were similarly inconclusive. Although some analyses suggest a weak correlation between testosterone and bone mineral density, Davis emphasized the wide confidence intervals and lack of clinical fracture data.1 Larger randomized controlled trials are needed to better understand the association.

Mixed Results for Mood, Cognition, and Heart Health

Clinical trial results for mood and cognitive outcomes were also underwhelming, with Davis’ systematic review showing no benefit on mood.2 Trials also found no improvement in anxiety, psychological well-being, or general vitality.1

For cognition, findings were “inconsistent and inconclusive,” she explained. One small study showed a subtle improvement in immediate recall, but it was unclear whether it was a chance finding or a real one; further research and meta-analyses are needed in this area.

Cardiovascular findings offered no clear rationale for treatment either. While some older women with naturally higher testosterone levels had better lipid profiles and grip strength, Davis noted that these were observational associations.

“It may be that their adrenal function is different, or that testosterone is a surrogate marker of some other favorable aspect of health, and I think we have to take that across all the observational studies,” she explained. “Just because something’s found in an observational study does not mean it translates to hormone replacement. And just because something's found in one clinical trial… be very cautious of single outcome studies.”

References

1. Davis SR. Androgens for muscles, mood, and more. Presented at: The Menopause Society 2025 Annual Meeting; October 21-25, 2025; Orlando, FL.
2. Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754-766. doi:10.1016/S2213-8587(19)30189-5
3. Binder EF, Bartley JM, Berry SD, et al. Combining exercise training and testosterone therapy in older women after hip fracture: the STEP-HI randomized clinical trial. JAMA Netw Open. 2025;8(5):e2510512. doi:10.1001/jamanetworkopen.2025.10512