If you are a woman of a certain age, there’s a new wonder drug that is flooding your feeds: testosterone. The hormone — which both men and women naturally have, but produce less of as they grow older — is being touted as a cure to low libido, low energy, and other symptoms. The Real Housewives are on it. Halle Berry is too. TikTok is obsessed with it.
Testosterone’s role in the body helps with bone and muscle development, as well as sexual function. But the Food and Drug Administration has not approved testosterone treatment for women for perimenopause or menopause, so they have to seek it out off-label. However, numerous studies have shown that a low dose of the hormone can improve menopausal women’s libido.
But some women are taking testosterone at far higher doses, ones that approach those taken by transgender people, who use hormone replacement therapy to address gender dysphoria. New York Times Magazine writer Susan Dominus spoke to many of them for an article that’s taken the internet by storm.
“There were women who told me that they had hit the wall and how much weight they could lift, and suddenly they were breaking through,” Dominus told Today, Explained co-host Noel King. “They were toned. Women were having orgasms for the first time in years and years. One woman told me that her entire relationship to sex changed, that even when she was having sex, she was thinking about the next time they were gonna have sex.”
Dominus spoke to King about the benefits and side effects of testosterone treatment for women, why the FDA has been hesitant to approve it, and the sprawling economy that’s formed to provide the hormone.
Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.
As women have less testosterone over time, what starts to happen? What changes?
Well, we’re not exactly sure, to be honest. It is one of these situations in which we know what happens when you replenish their testosterone. If you restore women to the levels of testosterone that they had in their 30s when they are actually, let’s say, in their 50s, research suggests that it restores some of their libido and other things, such as mood or energy.
And in your article, you very hilariously described what happens when women start taking testosterone. It was inspiring! Tell us what you learned.
So I mean, there’s really two very different experiences, right?
In the United States, when women take what is considered — I’m just going to use this colloquially — a “standard” dose of testosterone [to restore their testosterone levels to that of someone in their 30s]…those women report a minimal but meaningful restoration of their libido.
However, there’s an entirely different cohort of women who are getting prescribed what are known as pellets [of testosterone that dissolve in the body over a period of months] or they’re taking a lot more of the cream than their doctors would advise. And these women are getting into their systems several times the level of testosterone that they ever would’ve had in their bodies, even as very young women in their 20s. And those women are having unpredictable but fairly dramatic results.
Some women report really intense, almost uncomfortable sex drives. Some women report irritability or even rage. Some women report side effects like having chunks of hair fall out, hair growth on their faces or elsewhere on their bodies where they’re not used to having hair grow.
I have seen this on my own Instagram: Contact this company and they’ll run a test for you. But insurance doesn’t cover it, right?
“I think there are a lot of people who stand to make a lot of money off of these high doses of testosterone because insurance doesn’t get involved. They can charge women a lot of money.”
Oh, it’s not even FDA-approved for women in any dose. So basically a bunch of medical societies got together and issued a consensus statement in 2019, and they said, Look, we know it’s not approved by the FDA for women, but we’re going to go out on a limb here and say that the safety data looks pretty good — at least in the short term for postmenopausal women, who are the women who’ve been studied the most for this. But it’s not approved by the FDA even at that level. And so insurance definitely does not cover any of this for women.
I think there are a lot of people who stand to make a lot of money off of these high doses of testosterone because insurance doesn’t get involved. They can charge women a lot of money. Sometimes they certainly don’t get addicted to it, but they have a hard time walking away from it. And it can cost upwards of easily upwards of a thousand dollars at a time to take these pretty high-dose testosterone pellets, for example.
But it’s not the only way women get high testosterone. I saw a job listing on one kind of aesthetic spa that was offering nurses a hundred dollars per shot of testosterone that they gave women in their spa. So the nurse is highly incentivized to provide it. Women are sort of being told, Take our word for it, you’re going to love it. Like, go book a hotel for you and your husband this weekend. You’re going to be so busy. That’s a very hard sell.
And sometimes women love it and sometimes they discover midway through, let’s say a pellet, which can take three months to dissolve, that they’re miserable. But there’s nothing you can do about it once it’s been inserted underneath the skin of your buttock.
Why hasn’t the FDA approved this as a treatment for women?
Well, the last time that a drug company got it together and actually did some trials of a testosterone patch was Procter & Gamble. That did show that women were having incrementally more satisfying sexual experiences. Their libidos were restored. But that was right after another study came out, in 2002, that caused a big menopausal hormone therapy scare.
As I understand it, the people in the panel were concerned about cancer risks, breast cancer specifically, and there were even a couple of excess cases in a fairly small sample size. And they just didn’t have enough long-term data, is what they said, to endorse it and give it FDA approval.
Now, a lot of feminist followers of medical history have said, Well, that it was not required for testosterone to be approved for men. There was no long-term data for men required. All that the drug companies had to prove back then was that it restored men to the level of testosterone that would make them virile and youthful and strong again, to which other people would then say, right, but they don’t get breast cancer and women do, so that’s the concern with women.
Perhaps not surprisingly, some of the conversation around this has turned political. You wrote about the parallels between women, often conservative women who are taking testosterone and gender-affirming care for transgender people. Tell me a little bit about what you explored here.
I just thought it was interesting. One of the most influential testosterone influencers is this lovely person named Marcella Hill, who was a member of the Church of Latter Day Saints, and she was still in the church when she started taking really, really high doses of testosterone. According to her, there are these aesthetic and wellness spas offering pellets and high doses of testosterone all over Utah, which is largely a Mormon community.
And I pointed out to her, You were taking so much testosterone that you were approaching the levels that people who are transitioning take. She said, I never really sat and thought about what I even think about that. She’d never really made the connection.
It is just interesting because many, many women across a political spectrum are also on, frankly, you could say, a transitioning spectrum or gender-affirming care spectrum. I think that they feel in a way that testosterone is helping them do gender-affirming care in making them feel more sexual and therefore more wifely, maybe. And maybe a lot of them talk about how it tones their arms and they feel like they look great, but it actually is a hormone that has typically been associated with masculinity. So it just, to me, kicks up all kinds of interesting questions.
