What Are The Side Effects Of Testosterone In Women?

Testosterone therapy in women can cause side effects that range from mild skin changes to more serious effects on the heart and liver. The most common side effects include acne, excess facial and body hair growth, voice deepening, and changes in mood or sex drive. These effects are not rare, and they are the main reason doctors monitor women closely when testosterone is prescribed.

Why Do Women Take Testosterone?

Testosterone is often called a “male” hormone, but women produce it too. The ovaries and adrenal glands make small amounts of it. In women, testosterone supports bone strength, muscle mass, and sexual desire.

Doctors sometimes prescribe testosterone for women with low desire for sex after menopause. This is the most studied use. Some women also take it for fatigue or low energy, but evidence for those uses is weaker.

Testosterone for women is not approved by the FDA in the United States. Doctors can still prescribe it, but this is considered off-label use. That means the drug is approved for men, and the doctor decides it may help a woman based on clinical judgment.

What Are The Side Effects Of Testosterone In Women?

The side effects of testosterone in women are well documented. They depend on the dose, the form of testosterone, and how long a woman takes it. Some side effects appear within weeks. Others take months or years to develop.

Common side effects include:

• Acne and oily skin
• Increased facial and body hair
• Male-pattern hair loss on the scalp
• Deeper voice
• Enlarged clitoris
• Mood changes, including irritability or aggression
• Changes in cholesterol levels

Voice deepening and clitoral enlargement are often permanent. They do not always reverse when the medication is stopped. This is why doctors start with low doses and increase slowly.

How Common Are Androgenic Side Effects?

Androgenic side effects are the ones related to male characteristics. Acne and extra hair growth are the most frequently reported. Studies of women taking testosterone after menopause find that these effects occur in a meaningful number of users, though estimates vary.

Some research suggests that up to one in three women may notice unwanted hair growth. Acne is also common, especially in the first months of treatment. These effects are dose-related. Higher doses cause more side effects.

Voice deepening is less common but more concerning because it can be permanent. Women who notice their voice getting husky or lower should report it to their doctor immediately. The drug may need to be stopped or the dose lowered.

What Happens To The Heart And Blood Fats?

Testosterone affects cholesterol levels in women. Research consistently shows that oral testosterone can lower HDL cholesterol, which is the “good” cholesterol. This effect is less pronounced with patches, gels, or injections, but it can still occur.

The effect on heart disease risk is not fully clear. Some studies suggest testosterone may increase cardiovascular risk in women, while others show no clear harm. The evidence is mixed, and no large long-term trials have settled the question.

What is clear is that women with a history of heart disease or stroke should be cautious. Doctors typically avoid testosterone in these patients unless the benefits are strong and other options have failed.

Does Testosterone Affect The Liver?

Oral testosterone can stress the liver. The liver processes the medication, and some forms are harder on it than others. Methyltestosterone, an oral form, is known to carry a higher risk of liver damage. Many doctors avoid it for this reason.

Non-oral forms like patches, gels, and injections bypass the liver more directly. They are generally considered safer for liver health. Still, doctors may check liver function tests before starting treatment and periodically during it.

Women with existing liver disease should not take testosterone without close supervision. The risk is real, and the benefit may not justify it.

Can Testosterone Affect Mood And Mental Health?

Testosterone can change mood, but the direction of that change is not predictable. Some women report feeling more energetic and mentally sharper. Others report irritability, anxiety, or aggression.

These mood effects are not well studied in women. Most of what we know comes from men on testosterone therapy or from small studies in women. The evidence is not strong enough to predict who will have mood side effects and who will not.

Women with a history of mood disorders should discuss this with their doctor before starting testosterone. Monitoring mood during treatment is wise, especially in the first few months.

What About Long-Term Risks Like Cancer?

The long-term cancer risk of testosterone in women is not established. Testosterone converts to estrogen in the body. Estrogen can fuel certain breast cancers. This has raised concern that testosterone might increase breast cancer risk.

Some observational studies have suggested a possible link between higher testosterone levels and breast cancer. Other studies have not confirmed this. The evidence is inconsistent, and no clinical trial has directly tested this question.

Women with a personal or strong family history of breast cancer should have a careful discussion with their doctor. The current evidence does not support a clear answer, and the decision requires weighing uncertain risks against potential benefits.

How Do Doctors Monitor Women On Testosterone?

Monitoring is essential. Doctors typically check testosterone levels in the blood before starting and again after a few weeks or months. The goal is to keep levels within the normal range for women, not the male range.

Blood tests may also include cholesterol, liver enzymes, and sometimes blood counts. These checks catch problems early. If a side effect appears, the doctor may lower the dose, switch the form, or stop the treatment.

Women should report any voice change, unusual hair growth, or mood shift promptly. Waiting to see if it resolves on its own is not a good strategy, especially for voice changes that may become permanent.

Are There Side Effects Specific To Each Form?

Yes. The form of testosterone changes the side effect profile.

Gels and creams can cause skin irritation at the application site. They can also transfer to other people through skin contact. A partner or child touching the treated area could absorb the hormone. Washing hands after application and covering the area with clothing reduces this risk.

Injections cause peaks and valleys in hormone levels. Some women feel a surge of energy or mood lift right after the injection, followed by a low period before the next one. This cycling can be uncomfortable.

Implants are placed under the skin and release hormone slowly. They last several months. The main risk is infection at the implant site or the implant moving. Removal requires a small procedure.

Who Should Not Take Testosterone?

Some women should not take testosterone at all. This includes women who are pregnant or breastfeeding. Testosterone can affect a developing fetus, and no safety data supports use during breastfeeding.

Women with breast cancer or uterine cancer should generally avoid testosterone. Women with severe liver disease, uncontrolled heart failure, or a history of blood clots also fall into this category.

These are not flexible recommendations. They are based on known risks that outweigh any potential benefit. A doctor who suggests testosterone in these situations should be asked to explain the reasoning clearly.

What Should A Woman Do If Side Effects Appear?

The first step is to tell the doctor. Do not stop the medication on your own without medical advice, because sudden changes can cause other issues. The doctor will decide whether to lower the dose, switch forms, or stop treatment entirely.

Some side effects like mild acne may improve on their own or with a lower dose. Others like voice deepening may not reverse. Acting early gives the best chance of preventing permanent changes.

Women should also keep a simple record of any changes they notice. Date, symptom, and severity. This information helps the doctor make a better decision than a vague memory of “feeling off.”