Testosterone for women: Global consensus and physiologic dosing

Sharon J. Parish, MD, IF, NCMP, speaking with Bruce Door, MD, FACOG, URPS, IFMCP, highlights a 2019 meta-analysis in The Lancet, with Islam as first author, that examined the safety and efficacy end points of testosterone therapy in women.¹ That analysis supported the Global Consensus Position Statement on the Use of Testosterone Therapy for Women, led by Susan Davis, AO. Parish describes the statement as a multidisciplinary, multisociety effort involving internists, endocrinologists, researchers, urologists, gynecologists, and sexual medicine experts. It reinforced that physiologic testosterone can be safe and effective for hypoactive sexual desire disorder, and she says its conclusions still stand.

She then addresses recent media coverage, including a New York Times Magazine cover story describing women who report greater strength, cognition, mood, and well-being on testosterone.² Some of those women, Parish notes, are on supraphysiologic doses. She questions the rationale for raising women to levels they never had, and Dorr agrees that clinicians must distinguish where evidence ends and clinical judgment begins.

Parish says hoped-for benefits for bone, sarcopenia, cognition, and mood are being discussed at professional meetings, and the Princeton guidelines are expanding to include women. Small early trials show promise, but randomized data are lacking. She says a recent FDA meeting on testosterone in women reached the same conclusion, and that FDA approval for broader outcomes will require dedicated trials.

Parish explains that the International Society for the Study of Women's Sexual Health guideline translated the global statement into practical guidance on evaluation, blood testing, dosing, follow-up, and titration. Pellets, oral formulations designed for men, and higher doses fall outside that standard. The clinicians agree that patients sometimes report benefits beyond sexual function. Parish says she would not take those away, but she emphasizes that research is still needed and that she believes in physiologic dosing.

In the next episode, Parish walks through monitoring, adverse androgenic effects, and realistic timelines for response, and the clinicians discuss local androgen therapy for genitourinary symptoms.

REFERENCES

1. 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

2. Dominus S. "I'm on fire": Testosterone Is giving women back their sex drive. New York Times Magazine. October 22, 2025. Accessed November 13, 2026. https://www.nytimes.com/2025/10/22/magazine/testosterone-women-health-sex-libido-menopause.html