Testosterone Therapy for Women in Canada: Benefits, Risks and What the Evidence Says

A discussion about testosterone and sexual desire can quickly turn into a list of supposed benefits for energy, muscle, mood and memory. The evidence is strongest for a more specific use after menopause. That matters when deciding what you and your clinician would expect treatment to improve.

The best-supported use after menopause is treatment of hypoactive sexual desire disorder (HSDD) after a careful assessment. The term describes a persistent reduction in desire that causes personal distress and has no better explanation after assessment. A low testosterone result on its own cannot establish the diagnosis.

In Canada, there is an additional complication: testosterone products are available, but products marketed for men are not specifically authorized by Health Canada to treat HSDD in women. Clinicians may nevertheless consider off-label prescribing when appropriate.

A note about medical information: This article summarizes published research and professional guidance for general education. It is not medical advice, has not been independently reviewed by a licensed clinician, and cannot determine whether testosterone is appropriate for you. Treatment decisions belong with a qualified healthcare professional who knows your medical history.

IN THIS ARTICLE

Testosterone is not exclusively a male hormone
What does HSDD actually mean?
Who might benefit from testosterone therapy?
What benefits have studies found?
What testosterone has not been proven to treat
Is testosterone therapy available in Canada?
What are the risks?
Why monitoring matters
Questions worth bringing to an appointment
The bottom line
Sources and further reading

Testosterone is not exclusively a male hormone

The ovaries and adrenal glands produce testosterone, and tissues can make it by converting other hormones. It contributes to sexual function and other physiological processes. The fact that a hormone plays a role in a process gives researchers a question to investigate. Whether a prescription improves a particular symptom is something clinical trials have to establish.

Testosterone levels change across adulthood, and removing both ovaries can cause a more abrupt decline. Natural menopause is not a straightforward testosterone-deficiency condition. The Global Consensus Position Statement on Testosterone Therapy for Women explains that a testosterone result cannot reliably distinguish women with sexual dysfunction from those without it. Blood tests can help with treatment assessment and monitoring, alongside a discussion of symptoms, circumstances and personal distress.

What does HSDD actually mean?

Desire can change with age, health, relationships, stress and the demands of daily life. The clinical question is whether the change persists and causes distress to the woman experiencing it. A woman who is comfortable wanting sex less often has a different concern from someone who misses that part of her life. In assessing HSDD, a clinician may ask about several overlapping factors:

Pain during sex, vaginal dryness or genitourinary syndrome of menopause.
Hot flashes, night sweats and disrupted sleep.
Depression, anxiety, chronic stress or changes in body image.
Medications, including certain antidepressants.
Thyroid disorders and other medical conditions.
Relationship circumstances, emotional safety, caregiving demands and opportunities for intimacy.

A difference in desire between partners can be difficult to navigate. When considering a diagnosis or treatment, the clinician needs to understand how the woman herself feels about the change and whether something else should be addressed first.

Who might benefit from testosterone therapy?

The Global Consensus Position Statement and the International Society for the Study of Women's Sexual Health (ISSWSH) clinical guideline discuss testosterone as a possible treatment for appropriately assessed postmenopausal women with HSDD. Most established trials involved women who went through natural or surgical menopause. Some guidance also discusses selected women in the later reproductive years, where the evidence is less established. It does not support a general recommendation for perimenopause.

What benefits have studies found?

In trials involving postmenopausal women with HSDD, testosterone used at amounts intended to maintain physiological female levels improved aspects of desire, arousal, pleasure and orgasmic function, and reduced sexual distress in some women. A large analysis found approximately one additional satisfying sexual event per month compared with placebo or a comparator, alongside improvements in desire and distress. That is an average. Individual benefit can range from a noticeable change to little or none.

Guidelines describe a monitored trial so the clinician and patient can assess whether the problem that prompted treatment has improved. The Global Consensus and ISSWSH guidance recommend discontinuing testosterone if there is no meaningful benefit after approximately six months.

What testosterone has not been proven to treat

Marketing sometimes promises relief for several midlife symptoms at once. The trials support a narrower role.

Fatigue and low energy

Persistent fatigue can be miserable, especially alongside poor sleep, work and caregiving. Fatigue alone does not establish testosterone deficiency, and studies have not established testosterone as a reliable treatment for fatigue or general wellbeing in postmenopausal women. Sleep disruption, anemia, thyroid disease, medication effects and mood disorders are among the other causes a clinician may consider.

Brain fog, memory and mood

Some women report feeling sharper or more motivated after starting testosterone. That experience can be discussed at follow-up, though an individual improvement cannot establish its cause. Randomized evidence has not established testosterone as a treatment for brain fog, depression, memory impairment or cognitive decline.

Muscle, bone health and weight

Research at doses intended to maintain physiological female levels has not established meaningful improvements in strength, lean body mass or total body fat. Evidence is also insufficient to recommend testosterone to improve bone density or prevent fractures. Claims for weight loss, muscle building and anti-ageing go beyond the evidence.

Is testosterone therapy available in Canada?

Canada has testosterone products, including transdermal gels marketed for male hypogonadism. The regulatory information reviewed for this article did not identify a Health Canada-authorized product specifically for HSDD in women. Check the Health Canada Drug Product Database for changes in authorizations or availability. A clinician may consider using an authorized product off label, with a clinical rationale, informed consent and consideration of applicable professional and prescribing rules.

Health Canada’s Drug Product Database lists marketed testosterone gels as controlled drugs under Schedule IV of the Controlled Drugs and Substances Act. Those federal requirements are distinct from provincial pharmacy scheduling and insurance coverage.

The formulation and application instructions need professional oversight. Products marketed for men were designed for different amounts, and transdermal testosterone can transfer through skin contact. Ask the prescriber and pharmacist how to use the specific product safely.

What are the risks?

Acne and increased facial or body hair occurred in some women in clinical studies. Excessive exposure can also be associated with scalp hair loss, voice deepening, clitoral enlargement and other androgenic effects. Some changes, particularly to the voice, may not fully reverse.

Short studies of non-oral testosterone at physiological female levels generally did not find significant adverse changes in several measured cardiometabolic markers. Many of the trials excluded women with substantial cardiometabolic risk. The available evidence leaves long-term cardiovascular, breast and other serious health outcomes uncertain. A current or previous hormone-sensitive cancer calls for particular caution and specialist input. Other medical circumstances, the formulation and the level of exposure also affect the balance of benefit and risk.

Why monitoring matters

Monitoring helps establish whether treatment is helping and whether testosterone exposure is excessive. A clinician may assess symptoms and order baseline and follow-up blood tests. The ISSWSH guideline describes testing after treatment starts or changes, then periodic checks once treatment is stable. Those are decisions to make with the prescriber.

At follow-up, discuss changes in desire or distress alongside acne, unwanted hair growth, scalp hair loss or voice changes. The lab result is one part of that review. The point of treatment is an improvement in the concern that brought you in.

Questions worth bringing to an appointment

If testosterone is something you are considering, these questions may help make the conversation more productive:

Does my experience meet the clinical criteria for HSDD?
Could pain, sleep problems, medication effects or another health issue be contributing?
What evidence supports testosterone for my particular concern?
Would the prescription be off label in Canada?
What benefits would be realistic to expect?
What side effects or longer-term uncertainties should I understand?
How would the clinician assess whether treatment is helping?
What would prompt a decision to stop treatment?
What costs or pharmacy arrangements should I anticipate?

The bottom line

For some postmenopausal women with distressing low desire, testosterone may offer a meaningful improvement. If you are considering it, ask the clinician what improvement you would both look for, how you would check for adverse effects and when you would reconsider treatment. Fatigue, brain fog and weight concerns call for their own assessment.

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Sources and further reading

Medical information disclaimer: This article is intended for general educational purposes. It is based on published research and professional guidance but has not been independently reviewed or endorsed by a licensed healthcare professional. It does not provide diagnosis, treatment recommendations or individualized medical advice. Medication suitability, prescribing, monitoring and follow-up should be discussed with a qualified healthcare professional. Maple Menopause does not endorse any particular testosterone product or treatment provider.