A Tale of Two Therapies: TRT and HRT in Women
Medically Reviewed by Dr. Shaya Taghechian
Urogynecology / Women’s Pelvic Health Specialist
Georgia Urology
In collaboration with Aayla
Media coverage of hormone replacement therapies has seen a surge in the last several months, spotlighting a surprising trend: women taking high-dose testosterone. Articles from moguls like the New York Times and ABC News weighed in, raising questions about safety, effectiveness, and long-term health impacts on women using testosterone as a “boost” for libido, energy, and vitality.
Adding to the conversation, the FDA made headlines in November 2025 by removing black box warnings from female hormone replacement therapies (HRT), a regulatory change that reignited public and clinical interest in hormone therapies for women. It seems to have coincided with a wave of curiosity.
Can testosterone safely restore energy or sexual desire in women? Can it be combined with HRT? When might high-dose supplementation cross the line from helpful to harmful?
There’s a lot of information flying around right now. The time is ripe for talking about hormones and addressing the tales of potential benefits and risks, for TRT, HRT, and testosterone, alongside traditional hormone therapies for women.
Estrogen and Progesterone in Women
Hormone replacement therapy (HRT) for women is focused on balancing estrogen levels alone or with progesterone, and can be delivered locally (as in vaginal estrogen) or systemically (as in injectable, oral, or transdermal). Estrogen supports vaginal and urinary tract health, bone density, cardiovascular function, and skin elasticity, while progesterone protects the uterus from unopposed estrogen exposure.
A portion of testosterone in the body is converted to estrogen in specific tissues, contributing to libido, mood, and tissue health. Meanwhile, estrogen influences sex hormone-binding globulin (SHBG) levels, which in turn affect how much circulating testosterone is biologically available to tissues. For women, testosterone therapy often needs to be adequately estrogenized.
Testosterone in Women
We usually think of testosterone as the epitome of maleness, but women naturally produce it in the ovaries, adrenal glands, and peripheral tissues. With levels much lower than in men, it’s still influential in female sexual function, bone and muscle health, mood, energy, and even cognition. Before menopause, women produce significantly more testosterone; then levels gradually decline with age or drop abruptly after surgical menopause (ovary removal).
Testosterone circulates mostly bound to proteins like SHBG, leaving only a small fraction available to tissues. This free fraction is biologically active, affecting sexual desire, arousal, and genitourinary health. Unlike men, women require much lower testosterone levels to maintain normal physiological function.
Adequate levels support vaginal tissue health and sexual arousal, while a deficiency can exacerbate symptoms like vaginal dryness or reduced libido as well as become the root of fatigue, decreased muscle mass, mood swings, and cognitive fogginess. Exceeding the appropriate serum range can lead to androgenic side effects such as acne, increased facial or body hair, male-pattern baldness, enlargement of the clitoris, changes in the menstrual cycle, and voice deepening.
Though there are no FDA-approved testosterone replacement therapies (TRTs) for women, off-label guidelines suggest aiming for testosterone levels that match the upper end of the premenopausal range.1 SHBG levels can affect how much testosterone is available to tissues and may influence therapeutic response; blood testing is suggested to make sure levels stay safe.
TRT is typically only considered for women with clinically significant symptoms of low testosterone after other causes (relationship, psychological, or medication-related) have been evaluated and ruled out.
To Use or Not to Use
Low-dose testosterone supplementation is specifically acknowledged for off-label use in the treatment of hypoactive sexual desire disorder (HSDD),1 which is characterized by an overwhelming lack of sexual desire that causes personal as well as relationship stress. Women with HSDD tend to have difficulty becoming aroused, avoid sexual situations, or feel disconnected during intimacy. They can experience physical symptoms such as vaginal dryness, discomfort during intercourse, or trouble reaching orgasm. It winds up being a combination of psychological (emotional), social (relationship), physiological (hormones), and, sometimes, medical (medication and chronic illness) causes.
The high-dose, male-level treatments women are talking about on social media, unfortunately, are not evidence-based, and the long-term safety is unknown – sorry to crush the fantasy, but testosterone isn’t exactly a magic wand. Women taking testosterone without supervision face potentially serious health risks. Therapy should always be individualized, carefully monitored, and guided by a healthcare professional.
Clinical experience and published guidelines suggest several principles for safe use of testosterone:¹
- Individualized dosing: Women require much lower doses than men, and therapy must be titrated based on blood levels, symptoms, and side effects.
- Monitoring: Serum testosterone, SHBG, liver function tests, lipid profiles, and evaluation for androgenic side effects (e.g., developing male physical characteristics) should be tracked regularly.
- Limiting duration: Trials generally last 3 to 6 months, and therapy may be discontinued if there is no symptom improvement.
- Backing off: Persistent androgenic side effects, excessively high serum levels, or lack of symptomatic relief usually indicate dosing should be reduced or therapy stopped.
Personalizing Care
Considering both therapies? Testosterone and HRT can be combined safely under professional guidance. Estrogen and progesterone therapies provide systemic benefits for bone, cardiovascular, and urogenital health, while carefully titrated testosterone can target specific symptoms like low sexual desire or arousal. Sex hormones work in harmony, and it’s a balance you want to strike with the help of a doctor.
So…
Can testosterone safely restore energy or sexual desire in women? Yes.
When might high-dose supplementation cross the line from helpful to harmful? When there is a lack of medical oversight, testosterone serum levels rise too high, or adverse side effects make TRT or HRT an unpleasant experience.
And can TRT be combined with HRT? Absolutely.
The testosterone-taking women of TikTok aren’t totally wrong: hormone replacement therapy, including testosterone, can be a game changer. Some women experience a night-and-day difference. The best part about it is when it’s done safely and with expert guidance.
If you’re curious about whether testosterone, HRT, or a combination could be right for you, schedule a consultation with Dr. Shaya Taghechian.
Specialized Women’s Health Services
Through Aayla, a women’s health program within Georgia Urology, Dr. Shaya Taghechian offers comprehensive evaluation and personalized treatment for intimate health concerns, sexual wellness, and hormonal changes that impact quality of life.
Resource:
- Davis, S. R., Baber, R., Panay, N., Bitzer, J., Cerdas Perez, S., Islam, R. M., Kaunitz, A. M., Kingsberg, S. A., Lambrinoudaki, I., Liu, J., Parish, S. J., Pinkerton, J., Rymer, J., Simon, J. A., Vignozzi, L., & Wierman, M. E. (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Climacteric : the journal of the International Menopause Society, 22(5), 4
