Dear HER-Health: Testosterone 101
Dear HER-Health,
I asked my gynecologist about testosterone and she said she could prescribe it off-label, but that nothing is actually approved for women. She seemed almost apologetic about it. I left more confused than when I went in. I’m 51. I’m exhausted, I have no interest in sex, and it hurts when I do. Everything I read about menopause is about estrogen and hot flashes. What does testosterone even do for a woman, and why would I need it?
— Worn Out in Wilmington
Dear Worn Out,
Your gynecologist told you the truth, and her apologetic tone was appropriate. Let me answer the question underneath your question first, because almost nobody explains this part.
Testosterone Is Not Just a Men’s Hormone
That framing is backwards, and it has cost women a great deal. Across most of your adult life, testosterone has been the most abundant active sex hormone in your body, present in greater quantity than estrogen. Your ovaries make it. Your adrenal glands make it. It has been circulating and doing work the entire time.
What work? It contributes to sexual desire, to energy and stamina, to mood, to bone density, to muscle mass. And critically for what you’re describing, it maintains the tissue of the vulva, the vestibule, the urethra, and the bladder.
That last point is the one I wish every woman knew. The tissue at the vaginal opening, the vestibule, is densely populated with androgen receptors. So is the urethra. These tissues are not merely estrogen-dependent. They require androgens to stay healthy, elastic, and comfortable. When androgen levels fall, that tissue can become thin, fragile, and exquisitely painful to touch.
Now, Where It Goes
Testosterone doesn’t fall off a cliff at menopause the way estrogen does. It declines gradually across your thirties and forties, so that by your late forties you may be running at roughly half the level you had at twenty-five. It’s a slow fade, which is precisely why it goes unnoticed and undiagnosed. Nobody wakes up one morning and announces a testosterone event. You simply become a person with less energy, less desire, and more discomfort, and you conclude that this is what getting older feels like.
If you’ve had your ovaries removed, the fall is not gradual at all. It’s immediate and substantial.
So Let’s talk About What You Actually Described
Exhaustion. No interest in sex. Pain when you do.
I want to be careful here, because I am not your clinician and I cannot tell you what’s causing your symptoms. But I can tell you that the combination you’ve described is a recognized pattern, and that hormonal changes are among the things a thorough evaluation should consider, not as an afterthought, but as a real possibility.
I’d particularly encourage you to ask about the pain. Pain with sex in a woman your age is too often waved off as dryness, met with a lubricant recommendation, and left there. When the problem is in the vestibule rather than the vaginal canal, lubricant doesn’t touch it, and the woman concludes she’s broken. She isn’t. She has a tissue problem in a place nobody examined.
Ask your gynecologist to examine the vestibule specifically. Ask whether hormonal changes could be contributing. Those are legitimate questions and you are entitled to real answers.
Now The Part That Should Make You Angry
There are more than thirty testosterone products approved by the FDA for men. There is not one approved for women. Not one.
That’s why your doctor was apologetic. She can prescribe off-label, or send you to a compounding pharmacy, but she cannot hand you a product that has been through dosing studies in women, manufactured to a standardized strength, with long-term safety data attached. Every man walking into that same office takes all three for granted.
This is not a scientific accident. It’s the accumulated result of decades of decisions about whose symptoms were worth studying.
What Happened in September
On September 17, 2026, the FDA held its first public workshop on testosterone use in menopausal women. Clinicians, researchers, patients, and agency officials spent the day examining the current evidence and the critical knowledge gaps, specifically to inform future research and drug development.
The framing mattered enormously. The agency wasn’t ruling on whether women should use testosterone. It was asking what a proper development pathway would look like. By the end of the day, the FDA had issued a call to action to drug companies, researchers, and insurers, and signaled it was ready to work with them on developing approved products for women. That’s the question that actually leads somewhere.
Here’s the part I want you to sit with: women put this on the agenda. When the FDA held a public meeting on testosterone therapy for men last December, more than 80 percent of the public comments came from women, many asking why there was still no approved product for us. At the September workshop, the agency acknowledged again and again that those voices are why we’re here.
It follows a genuine run of movement: development-pathway guidance issued in January for a female-specific formulation, and the black box warning removed from estrogen-containing menopausal hormone therapy in February, a change that had been announced the previous November. That warning shaped how two generations of women were counseled, and how many were counseled out of treatment entirely.
How To Make Your Voice Heard
The workshop is over, but the conversation isn’t, and the FDA has made clear that women’s voices are what moved this forward. Here’s where to add yours:
Comment to the FDA: The public docket stays open until 11:59 p.m. Eastern on October 19, 2026. Go to Regulations.gov, search docket number FDA-2026-N-5479, and click “Comment.” You don’t need credentials, and you can submit anonymously if you prefer. Every comment becomes part of the official record the FDA must consider. Be specific: name the symptom, the year you first raised it, and how many clinicians you saw before anyone took it seriously. Specificity is what turns a comment into evidence rather than sentiment.
Call Your Members of Congress: The day before the FDA workshop, Congress held a hearing on closing the menopause care gap. Lawmakers are paying attention, so tell yours that women deserve FDA-approved testosterone options and real funding for menopause research. You can find your representatives and their contact information at Congress.gov.
Find a Clinician Who Takes This Seriously: The Menopause Society’s online directory lists clinicians with specialized menopause training. If your current doctor can’t give you real answers, you’re allowed to find one who can. https://portal.menopause.org/NAMS/NAMS/Directory/Menopause-Practitioner.aspx
Learn How to Advocate: Jennifer Weiss-Wolf, the attorney and advocate behind the national campaign to end the tampon tax, has just published When in Menopause: A User’s Manual and Citizen’s Guide. It’s devoted entirely to the “how-to” of menopause advocacy, from demanding better care in your doctor’s office to organizing your workplace and pushing lawmakers to fund research and protect access to care. If this column made you angry, her book shows you exactly what to do with that anger. https://bookshop.org/p/books/when-in-menopause-a-user-s-manual-and-citizen-s-guide-jennifer-weiss-wolf/b38c9d00c0d4c911
And go back to your gynecologist. Not for testosterone necessarily, but for the examination and the conversation you didn’t get the first time.
You are not worn out because you’re 51. You’re worn out because something is happening in your body that deserves a name and a workup. Thirty products for men, zero for us, is the reason it’s taken this long for anyone to give it one.
Heather Florio
She/Her
Chief Executive Officer
