Talk to women using testosterone, especially in high doses, and you’ll quickly notice a pattern: they often speak with fervent enthusiasm, describing it as a miracle drug. They’re energized, focused, and typically have no intention of reducing their dosage, despite potential risks like increased facial hair. Why worry about a little extra fuzz when they feel so alive? A quick waxing is a small price to pay for the newfound energy to manage family life, excel at work, and still have amazing sex — perhaps even better than the night before, regardless of their age.
“It’s completely transformed my marriage,” shared Jessica Medina, a 41-year-old marketing consultant from Orange County, California. Before testosterone, intimacy was rare; now, with four children at home, she and her husband are having sex six times a week – so much so, they’ve had to put a lock on the bedroom door! Despite years of marriage counseling, she credits testosterone with bringing them ‘100 times closer.’ Jessica finds herself less emotional and sentimental, focusing instead on efficiency: ‘It’s more like: Get stuff done, handle business, work out.’ She adds, ‘To manage all that and still be there for our kids and their sports, there’s simply no time to complain about difficulties.’
Catherine Lin, a single mother and executive at a bicoastal fashion media company, started testosterone in her early 40s to combat flagging energy. Not only did she achieve her goal, enabling her to lift heavier weights and pursue a degree in holistic nutrition, but she also experienced an unforeseen and welcome benefit: orgasms, which she hadn’t experienced in years, returned to her life.
Both Medina and Lin are taking testosterone doses that elevate their levels beyond what women naturally produce at any stage of life. Their accounts, along with many others on high doses, often sound like romantic fantasies: incredible stories of sexual revitalization and profound intimacy. One woman in her 50s confessed that after years of finding her husband’s presence distasteful, she now eagerly anticipates intimacy nearly every night, even during sex, she’s already thinking about their next encounter. Another woman claimed to have experienced more orgasms in two years on testosterone than in her entire life prior, while a third, who once felt enraged by her husband’s touch, now actively seeks sex with him, occasionally worrying she desires it more than he does.
‘It has truly transformed my marriage.’
Just as estrogen is vital for men, testosterone plays a crucial role in women’s health, impacting bone density, muscle mass, and sexual function. Women’s testosterone levels typically peak in their late teens and early twenties, then gradually decrease, falling by approximately half by age 60. (For comparison, men begin adulthood with about ten times the testosterone of women, and their levels decline less dramatically over time.) This reduction in available testosterone can lead to fewer erotic thoughts and a decreased desire for sexual activity. It can also disrupt the biological processes that contribute to sexual pleasure, such as the production of nitric oxide, a key molecule for relaxing clitoral muscles and increasing blood flow.
Despite the FDA approving over 30 testosterone products for men since the 1950s to address symptoms like low libido, fatigue, and muscle loss, no FDA-approved testosterone treatment currently exists for women. This is true even though women experience a more significant drop in testosterone levels as they age compared to men. While a decline in libido isn’t solely linked to testosterone—factors like fatigue, body image, and relationship issues also play a role—major medical societies advocate for testosterone use in appropriate, standard doses for postmenopausal women with low libido after other concerns are addressed. Robust research confirms that testosterone, when administered in doses that return a woman’s levels to those of her late 30s, can significantly boost sex drive.
Still, the lack of FDA approval means many doctors are reluctant or unsure how to prescribe testosterone for women, and insurance typically won’t cover the cost. This hasn’t deterred women, however. Often facing rejection from traditional OB-GYNs, women in their 40s and older are increasingly turning to alternative providers like med-spas, longevity clinics, wellness centers, and nutritionists, all of whom are eager to provide the hormone.
A concerning trend is the rising number of women receiving testosterone doses significantly higher than the recommended standard. These women often spend over $1,000 annually, risking uncomfortable—and potentially permanent—side effects in pursuit of a powerful ‘high.’ Stephanie Faubion, Director of the Mayo Clinic Center for Women’s Health and Medical Director of the Menopause Society, notes, “I see more and more of these places popping up because of all the hype around testosterone. And a lot of them are giving women testosterone in doses that get them to levels that are normal in a man — but definitely not in a woman.”
Enthusiastic stories of renewed sexual vitality are widespread on social media, with ‘testosterone influencers’ openly sharing their journeys. Marcella Hill, an influencer from Utah, revealed in a 2022 Instagram post, “I went years with no sex drive.” After starting a high dose of testosterone that year, she recounted rediscovering her attraction to her husband: “My body would heat up just from him walking in the room.”
Even reality television has highlighted the trend, with three stars of “The Real Housewives of Orange County” discussing their testosterone routines. Gretchen Rossi, for instance, was filmed receiving a small, potent testosterone pellet implanted under her skin, designed to release the hormone over four months. She later shared that she had to reduce her dosage, explaining, “I had to take mine down because I was humping everything.” Her co-star, Jennifer Pedranti, humorously agreed, saying, “You’ll just hump and hump and hump away.”
Through casual conversations in group chats, at children’s soccer games, and over drinks, the transformative power of testosterone has become a hot topic. Carrie Simpson, a 55-year-old from Gardnerville, Nevada, began high-dose testosterone on a friend’s recommendation for general fatigue. After her first dose, her family quickly observed a significant change: she became noticeably more opinionated and intensely argumentative. Simpson recalled her daughter remarking, “My daughter told me at one point I was acting like a teenage boy,” an understandable observation given her testosterone levels were nearing those of a typical adolescent male. She describes the change as profound: “It’s night and day. You’re like: Holy cow. A lightbulb goes on. I’m on fire.”
In her book, “T: The Story of Testosterone, the Hormone That Dominates and Divides Us,” Carole Hooven highlights testosterone as the hormone most closely associated with aggression and sex drive in male animals. For instance, male song sparrows given supplementary testosterone neglect their nests, instead focusing on territorial singing and attracting new mates, sometimes leading to the starvation of their offspring. Similarly, female rats administered extra testosterone exhibit increased aggression, biting and attacking rivals over food. Testosterone levels are known to fluctuate in response to specific environmental and social cues: men’s levels often surge in competitive scenarios but decrease once they become fathers, with longer periods spent with newborns correlating to a greater decline.
‘My daughter once told me I was behaving like a teenage boy.’
While testosterone’s role in women is less understood, decades of extensive trials involving patches, creams, and gels have demonstrated that standard doses can enhance women’s desire, arousal, sexual responsiveness, and even self-image. However, in 2004, the FDA chose not to approve a Procter & Gamble testosterone patch, which increased satisfying sexual encounters by an average of one per month. The agency deemed this improvement insufficient without more extensive long-term safety studies—a requirement it had not imposed on men’s testosterone products.
Dr. Susan Davis, a prominent endocrinologist and testosterone researcher at Monash University in Australia, emphasizes that while ‘one a month’ was an average, many women experienced greater improvements. She argues that even a single additional satisfying sexual encounter could be profoundly transformative for women currently experiencing none—boosting pleasure, confidence, and strengthening relationships. Merely alleviating the common dread many women feel about intimacy with their partners could have warranted approval. This perspective is shared by several other nations: Australia, South Africa, New Zealand, and the United Kingdom have all approved standard-dose testosterone cream for women, with demand in the U.K. surging by nearly 400 percent between 2019 and 2022.
Currently in the U.S., women seeking standard-dose testosterone (typically five milligrams daily) face a circuitous path. First, they must locate a practitioner willing to prescribe it. Then, they either purchase men’s testosterone cream, intended for full-tube use by men, and painstakingly estimate a tenth of the amount, paying out of pocket. Or, they can opt for a more expensive route: a prescription from their doctor to a compounding pharmacy, which, unregulated by the FDA, customizes medications with appropriate dispensers.
Finding a practitioner willing to prescribe testosterone can be incredibly frustrating. Kimberly Solo, a 44-year-old therapist in Massachusetts, sought testosterone from her OB-GYN after her libido “was just gone.” Her doctor declined, citing the lack of FDA approval and concerns about side effects. Eventually, Solo discovered Midi, a virtual care platform specializing in middle-aged women’s health, which now prescribes standard-dose testosterone in 12 states. Solo described her experience as “amazing”: “My sex drive returned. I wouldn’t say that it has returned to its previous level, but it’s not zero, like it had been.”
Lindsey Lister, a dental hygienist from New York, encountered a similar challenge; two doctors initially dismissed testosterone before she found a compounding pharmacy-prescribing physician. She also characterized her revitalized libido as a return to her earlier self: not an overwhelming surge, but a welcome increase in her receptiveness to intimacy with her husband, a change she hadn’t felt in years.
While official medical guidelines limit standard-dose testosterone recommendations to postmenopausal women, reflecting the primary focus of existing research, many practitioners extend prescriptions to premenopausal women deemed suitable candidates. Some doctors begin with doses below the standard for caution, while others comfortably exceed recommended guidelines. However, a significant number of women start testosterone without a thorough discussion of its pros and cons with a physician, often influenced by compelling anecdotes from friends or persuasive online advertisements. This often leads to their first experience being a high-dose, high-impact, and highly unpredictable journey.
In 2022, Thuy, a 47-year-old California entrepreneur and mother of four, was battling severe exhaustion when an Instagram ad caught her eye. It promised increased vitality, enhanced desire, and a return to her ‘best self.’ That September, she visited the advertised doctor’s Beverly Hills clinic. After a small incision and local anesthesia in her left buttock, a pellet was implanted, elevating her testosterone levels to more than three times that of an average 30-year-old woman. (Thuy uses her middle name for family privacy.)
Thuy had dedicated her adult life to building three financial-services businesses alongside her husband. Initially unable to afford childcare and later accustomed to managing everything herself, she consistently worked grueling 18-hour days to balance her children’s schedules with her professional life. Each morning, she struggled to get out of bed, and by day’s end, her body ached from chronic exhaustion.
Within weeks of the testosterone pellet dissolving into her bloodstream, Thuy experienced a profound shift. It was as if she had awakened with a ‘second heart’—a feeling of being super-oxygenated, light, desirable, and incredibly energetic. Her primary goal had been to wake up easily, but she also found herself eagerly anticipating intimacy with her husband each night. Once, she bought lingerie to hasten his interest; now, she was buying racier pieces for her own pleasure. After two decades of what she described as ‘rote sex’ (‘It felt like a job’), she began consistently experiencing orgasms during intercourse.
‘If you experience side effects, there’s no immediate remedy until the pellet naturally dissipates, which typically takes three to four months.’
Around Christmas, another change emerged: alarming amounts of hair accumulating on her shower floor. She began to notice visible white patches on her scalp, and her hair, overall, had significantly thinned. By the three-month mark, she estimated she had lost nearly half of it.
Hair loss is a recognized side effect of high testosterone doses, presenting an ironic contrast to men who use specific drugs to prevent balding. While these drugs preserve hair by modifying testosterone levels, men may achieve a youthful, full head of hair but, for the first time, grapple with low libido and erectile dysfunction.
Thuy quickly learned there was no immediate solution for her hair loss. Kathleen Jordan, chief medical officer of Midi, a telehealth provider, explains that once a testosterone pellet is implanted, it gradually dissolves and cannot be removed. “So if you’re experiencing side effects, there’s nothing you can do about it until the pellet has run its course, which can typically take three to four months.” After her pellet dissolved, Thuy sought a new doctor who prescribed a lower dose.
Paradoxically, the side effects of high-dose testosterone can diminish a woman’s sense of attractiveness even as her desire increases. Alongside head hair loss, women may experience increased, darker hair growth in unwanted areas, such as above the lip or on the upper thighs. Acne is also a possible side effect. (While a small fraction of women on standard doses report similar, milder, and typically reversible symptoms.)
Long-term use of high-dose testosterone can lead to thickened vocal cords, resulting in a hoarser or deeper voice, and may enlarge the clitoris. This clitoral enlargement can range from barely noticeable to significantly uncomfortable. Notably, one Austin, Texas, medical practice that offers high-dose testosterone explicitly lists clitoral enlargement as a common side effect on its website, while also offering a surgical solution for it.
Lisa Steinbach, whose OB-GYN prescribed high-dose testosterone for post-hysterectomy fatigue and overall wellness, experienced no improvement in her energy or sex life—the latter never having been a problem. However, about a year into treatment, her voice began to sound like she had a persistent cold, worsening over time. “It’s very raspy,” she explained, “and people are always asking me, ‘Oh, are you sick?’ Or they think it’s a man’s voice.” Despite discontinuing testosterone, the raspiness persisted, becoming a constant source of distress for her.
For some women, high-dose testosterone induces such an intense level of arousal that it becomes uncomfortable. Susan Davis, a decades-long researcher of testosterone, recounts a patient who sought to lower her dose after injuring her back while having sex with her husband in their car—she had insisted he pull over, unable to wait.
Tammy Nelson, a California-based sex therapist, also found her arousal to be excessively high. The testosterone made her so irritable, easily annoyed, and frankly disgusted by the perceived shortcomings of men—especially her husband—that she couldn’t bring herself to be intimate with him. “I wanted to have sex with my husband,” she stated, “I was just too pissed off at him to do it.” Similarly, Angie Knierim, a women’s health advocate on high-dose testosterone, spent months experiencing uncontrollable rage towards her husband before realizing that while their marriage wasn’t flawless, her fury was predominantly fueled by the hormone.
Rachel Rubin, a urologist specializing in sexual medicine, stresses the importance of clearly informing women about these potential side effects. Yet, many women tell Rubin they are unconcerned; some even appreciate the increased sensitivity from a larger clitoris. (Rubin notes that hormonal birth control often suppresses testosterone, leading to a smaller clitoris than naturally occurring.) She observes, “Testosterone is like a religion. People have strong feelings when it comes to testosterone.”
There’s scarce research on the long-term health risks for women taking such high doses for libido. Kathleen Jordan of Midi admits, “The fact is we just don’t know.” While trans men take significantly higher doses without apparent health risks, Rubin criticizes pellet manufacturers for not conducting rigorous, long-term studies on their products. In February, the FDA mandated warning labels for all approved male testosterone products, citing risks of high blood pressure.
‘I desired intimacy with my husband, but I was simply too frustrated with him to act on it.’
Doctors worried about health risks often struggle to convince women to reduce their testosterone levels once they’ve experienced the ‘high.’ Jennifer Key, a writer from Oxford, Mississippi, started high-dose testosterone five years ago, finding the sensation of feeling “like a teenage boy” both fascinating and appealing. “It was interesting to be like, Oh, this is what people talk about when they talk about wanting sex and being into sex and missing sex,” she remarked. Her doctor mandated a dosage reduction due to the levels she was reaching, but Key still tries to negotiate her way back. She simply says, “I have a good magnifying mirror. I just pluck.”
The widespread enthusiasm for testosterone transcends political divides. Several women interviewed, despite belonging to religious communities that vehemently oppose gender-affirming care, were taking testosterone in doses comparable to those used by some trans men. Marcella Hill, a prominent testosterone influencer on Instagram, initially began her high-dose regimen and advocated for its benefits while still a member of the Church of Jesus Christ of Latter-day Saints. Though she has since left the church, partly due to its perceived shaming of women’s sexual desire, many of her friends within the church continue to use high doses of the hormone. Hill stated, “I’d never really sat with myself and thought about what I think about gender-affirming care. But I think everyone should get to decide how they want to live in their body.”
Martin Makary, President Trump’s former FDA commissioner, has expressed support for hormone therapies for middle-aged women. Marius Pharmaceuticals is currently in discussions with the agency to initiate clinical trials for a standard-dose testosterone pill for women. Marius CEO Shalin Shah cautiously optimistic, stating that while “it won’t be easy by any means, but I think the new F.D.A. will be reasonable, which represents a step in the right direction.” He noted that the agency’s past responses to hormones for postmenopausal women had often felt “like running into a brick wall.” (The FDA declined to comment on past testosterone decisions, citing a government shutdown.)
In July, Makary hosted a hormone therapy panel featuring Kelly Casperson, a urologist with over 400,000 Instagram followers and a fervent advocate for making standard-dose testosterone accessible to women. While her push for FDA-approved products aligns with mainstream menopause specialists, some colleagues are concerned by the expansive promises she makes about the hormone’s benefits.
During the panel, Casperson enthusiastically claimed that women on testosterone “start businesses!” She reported that patients notice improved math skills, with one even recalling her first language, German, after starting treatment. However, Dr. Davis cautions that while there are “signals” suggesting standard-dose testosterone might improve women’s cognition, mood, bone, and muscle strength, scientific research has not yet confirmed these benefits. “I just don’t like women being promised things that haven’t been proven true,” Davis stated.
Stephanie Faubion of the Mayo Clinic reports a significant rise in women inquiring about testosterone, many with unrealistic expectations—even from standard doses—fueled by social media influencers. “It isn’t an anti-aging drug,” she asserted. “And it won’t make women want to have sex with their partner if there are communication issues and they no longer feel connected with their partner.”
The allure of promises from some testosterone providers regarding energy, strength, and mood is undeniable in today’s landscape. Middle-aged women, regardless of political affiliation, often feel neglected by conventional medicine. Their social media feeds are inundated with promises of “biohacking” or spending their way (through GLP-1s, cosmetic procedures, or supplements) to an idealized self. Some women interviewed sought testosterone to salvage their marriages (‘Gotta keep ’em happy,’ as one Real Housewife phrased it); others craved energy to manage the overwhelming demands placed on working mothers. Ultimately, many were simply seeking to reclaim their lost desire. Women, whether on high or low doses of testosterone, frequently speak as though embarking on a new era of sexual liberation.
Thuy, the California business owner, now takes a testosterone dose at the higher end of what women in their 30s naturally produce. Yet, she yearns for those ‘megadose’ days when she’d awaken feeling capable of conquering the world, pursuing a Ph.D., and freely exploring her sex life. Despite retaining very little of the hair she lost, when asked if she would do it again, she emphatically declared, “Yes, yes, yes!”