Testosterone use in females can cause a range of side effects, from mild skin changes like acne to more significant shifts in voice, hair growth, and cholesterol levels. The specific effects depend heavily on the dose and how it’s delivered. At low, physiologic doses (roughly one-tenth of a typical male dose), side effects tend to be modest and often reversible. At higher doses that push testosterone well above the normal female range of 8 to 60 ng/dL, the effects become more pronounced and some can be permanent.
No testosterone product is currently FDA-approved specifically for women. When it is prescribed, typically for low libido after menopause, doctors use off-label formulations designed for men at a fraction of the standard male dose.
Skin and Hair Changes
Acne is one of the earliest and most common side effects. Testosterone stimulates oil production in the skin, and many women notice breakouts on the face, chest, or back within the first few months of use. This effect occurs even at low, physiologic doses.
Hair growth in new places, particularly the face, chest, and abdomen, is another frequent change. This is called hirsutism, and it tends to increase gradually over time. At the same time, testosterone can trigger thinning hair on the scalp in a pattern similar to male-pattern baldness. The hair thinning on the scalp may not fully reverse after stopping testosterone, while unwanted body and facial hair often becomes less prominent over time but may not disappear completely.
Voice Deepening
A lower voice is one of the side effects women are often most concerned about, and for good reason: it can be permanent. Testosterone thickens the vocal cords, and once that structural change occurs, stopping the hormone doesn’t always reverse it. Among the various virilizing effects, vocal deepening is the one most likely to stick around. Some women can regain a higher pitch through specialized voice therapy, but this requires targeted treatment at a voice center and isn’t guaranteed.
Reproductive and Menstrual Effects
Testosterone disrupts the hormonal signals that regulate ovulation. Many women experience irregular periods, and at higher doses, periods can stop entirely, a condition called amenorrhea. This happens because elevated testosterone interferes with the delicate feedback loop between the brain and ovaries that triggers egg release each month.
This disruption can make it harder to get pregnant. Testosterone-driven anovulation (where the ovaries stop releasing eggs) is a well-established cause of infertility. In most cases, fertility returns after testosterone is discontinued, though the timeline varies. Women using testosterone who want to preserve the option of pregnancy should understand that while it suppresses ovulation, it is not a reliable contraceptive.
Cholesterol and Heart Health
Testosterone shifts cholesterol levels in an unfavorable direction. A large meta-analysis of 29 clinical trials found that after two or more years of use, HDL (“good” cholesterol) dropped by about 8.5 mg/dL, LDL (“bad” cholesterol) rose by roughly 18 mg/dL, and triglycerides increased by about 21 mg/dL. These changes begin within the first three to six months and grow more pronounced over time.
Despite this less favorable cholesterol profile, researchers have not found consistent evidence that testosterone therapy actually increases the rate of heart attacks or strokes in women. The lipid changes are real and worth monitoring with blood work, but they haven’t translated into clear increases in cardiovascular events in the studies done so far. Blood pressure effects have been inconsistent across studies, with some showing modest increases and others showing no change.
Liver Health
The risk to the liver depends largely on how testosterone is taken. Oral testosterone passes through the liver before reaching the rest of the body (called “first pass” metabolism), which puts more strain on liver cells. Transdermal forms like creams, gels, and patches bypass the liver and have not been linked to liver toxicity in studies lasting up to two years, as long as testosterone levels stay within or just above the normal female range.
The combination most likely to cause liver problems is an oral formulation at a high dose in someone who already has liver disease. This is one reason clinical guidelines specifically recommend against oral testosterone, injections, and pellet implants for women. These delivery methods make it harder to control blood levels and increase the chance of overshooting into a range that stresses the liver.
Mood and Psychological Effects
The psychological effects of testosterone in women are more nuanced than many people expect. At physiologic doses, testosterone therapy actually tends to reduce anxiety and irritability. One clinical report found that over 90% of women on testosterone therapy reported feeling less irritable, not more. Improved energy, better sleep, and increased sexual desire are among the most commonly reported benefits.
The picture changes at higher doses. Supraphysiologic testosterone levels (well above the normal female range) have been associated with psychological side effects, though the specifics vary from person to person. Weight gain is also more common at these higher doses.
Genital Changes
Testosterone can cause enlargement of the clitoris, a change known as clitoromegaly. This is a gradual process that becomes more likely with higher doses and longer duration of use. Like voice changes, clitoral growth involves structural tissue changes that may not fully reverse after stopping testosterone. At low doses used for short periods, significant enlargement is uncommon, but it remains a possibility that increases with time and dose.
Dose and Delivery Method Matter
The severity of nearly every side effect is tied to how much testosterone reaches the bloodstream and how consistently levels are maintained. The recommended starting dose for women is about 5 mg of a 1% testosterone gel daily, which is one-tenth of the standard male dose. This targets the upper end of the normal female range and carries the lowest risk of virilizing side effects.
Injections and subcutaneous pellets are specifically not recommended for women because they tend to produce spikes in testosterone that exceed the physiologic range, sometimes dramatically. These peaks are what drive the more serious and potentially irreversible side effects like voice deepening, scalp hair loss, and clitoral enlargement. Transdermal application (creams or gels applied to the skin) provides the most stable blood levels and the most predictable side effect profile.
Women with cardiovascular disease, liver disease, or hormone-sensitive cancers such as breast or uterine cancer are generally advised against testosterone therapy entirely, as the risks outweigh the potential benefits in these groups.