Testosterone Therapy for Women at Live Young Medical
Blending the latest evidence, two decades of hands-on experience, and insights from today’s leading menopause-care educators
Why testosterone matters in mid-life women
Endogenous testosterone peaks in a woman’s early 20’s and then drifts downward starting in her mid 30’s. By age 50 most women have testosterone levels that are about half their 20 year-old levels. Unlike estradiol, testosterone does not rapidly decline at menopause—that means that symptoms linked to low levels can emerge years before a woman’s final period. Well-conducted trials and consensus statements (Endocrine Society, ISSWSH, IMS, Menopause Society, SOGC) agree on one clear evidence-based indication for testosterone therapy in women: Acquired, Generalized Hypoactive Sexual Desire Disorder (HSDD) in post-menopausal women. Plainly put, this is low libido or sex drive that causes distress. Benefits of testosterone therapy are modest but clinically meaningful when the transdermal dose produces a serum testosterone level within the normal female physiologic range.
Additional, off label but potentially beneficial uses for testosterone are: as adjunctive therapy for persistent bladder symptoms and forms of vaginal pain in addition to localized estradiol or DHEA treatments approved for Genitourinary Syndrome of Menopause (GSM); lean body mass support for both muscle and bone; and mental clarity- not all but some women will feel more focused and vital.
Side effects are rare when testosterone levels are kept in the physiological range. Even if in the normal range, oilier skin, break outs and worsening facial hair can occur; if bothersome testosterone can be discontinued or a dose reduction made.
Live Young Medical’s perspective
“Hormone optimisation is never ‘one size fits all.’ Over 20 years of prescribing menopause hormone therapy—including testosterone—have taught me that the right dose, delivered with careful monitoring and integrated lifestyle support, can be transformative.”
— Dr Maureen Sweeney, MD, ABAARM, Diplomate ABLSM
Since 2003 Dr Sweeney has combined board-certified age management training with family practice roots to build a whole-person model of care which includes: metabolic screening, nutrition, physical activity, sleep and stress interventions and precise hormonal support. In her experience:
- About one in five mid-life women who seek help for low libido or vitality ultimately benefit from a supervised testosterone—after estrogen loss, thyroid issues, iron deficiency, genitourinary syndrome of menopause (GSM) and relationship factors are addressed.
- Physiologic dosing. The dose for women is approximately 10% or less of the male dose. Testosterone for women is typically delivered through transdermal gels or creams. Pellets are not recommended for women due to potential unsafe, sustained blood levels.
- Monitoring is required. Total T and SHBG at baseline, 6-12 weeks, after adjustments and annually. Testosterone is discontinued if physiological levels are attained but without symptomatic gain after six months.
- Screening such as Pap, FIT, mammography/breast ultrasound are recommended.
Voices that sharpen women's sexual healthcare
What they add | Dr Heather Hirsch, MD MS NCMP | Dr Rachel S. Rubin, MD |
Clinical focus | Internist & menopause specialist; founder, Menopause & Midlife Clinic, Brigham & Women’s Hospital (heatherhirschmd.com) | Fellowship-trained urologist/sexual-medicine physician; lead author, 2025 AUA / ISSWSH guideline on GSM (auanet.org) |
Key publications / platforms | Unlock Your Menopause Type (St Martin’s, 2023) – pragmatic algorithms for oestrogen, progesterone and testosterone (amazon.ca); Heather Hirsch Academy CME for clinicians (heatherhirschacademy.com) | Virtual Sexual-Medicine Collaborative; “Prescriber’s Pocket Guide to Local Vaginal Hormones” aligned with 2025 GSM guideline (rachelrubinmd.thinkific.com) |
Core testosterone message | “Keep dosing physiologic—testosterone is powerful medicine, not a bio-hack.” | “Sexual health is health; testosterone can help, but always as part of a biopsychosocial plan.” (urologytimes.com) |
How we apply it | Confirms our low-dose, lab-guided algorithm; her menopause-type framework helps stratify which patients might benefit most. | Reinforces comprehensive sexual-function work-up (pelvic floor, GSM, partner factors) before adding testosterone; her GSM guideline dovetails with our routine vaginal estrogen counselling. |
Our step-by-step care pathway
- Clinical evaluation – Full Age Management personalized evaluation which includes assessment of thyroid, iron, medication, psychosocial and GSM contributors.
- Baseline labs – Including total testosterone, SHBG, estrdiol, CBC.
- Shared decision-making – Discuss evidence, off-label status of testosterone therapy in Canada, expected benefit (~1 additional satisfying sexual event per month), and androgenic side-effects.
- Physiologic dosing – Start lower range for dosing; adjust at 6-12 weeks and as needed if serum testosterone and symptoms persist or side effects develop.
- Whole-health optimisation – Nutrition (protein adequacy, insulin sensitivity), cardio and resistance training, sleep hygiene and stress tools— embedded in Live Young Age Management program.
- Ongoing monitoring – Once a stable dose is achieved, monitoring annually and as needed based on symptom or side effects
- Research & education loop – Practice protocols regularly updated based on new clinical trials and other research, society statements, and insights from thought leaders
The Live Young difference
Combining the rigour of current best evidence, 20 years of clinical hormone-therapy insight, and the teaching of today’s most respected menopause and sexual-health educators ensures patients receive care that is both grounded and progressive. Testosterone is never a stand-alone “fix”; it is one finely calibrated tool within a broader strategy to restore vitality, protect long-term health, and help women thrive through mid-life and beyond.