Why do women need testosterone?

Testosterone is often labeled a male hormone, but women produce it in the ovaries and adrenal glands. It begins gradual decline from the late 30s, reaching about half of early-30s levels by menopause. It influences not just libido but energy, muscle mass, bone density, cognition, and mood. Maintaining appropriate levels contributes to menopausal quality of life.

Is female testosterone prescription available in Korea?

In Korea, prescribing testosterone for women is off-label, not formally approved by the MFDS. Some gynecology and functional medicine clinics prescribe it after hormone testing, but it is not insurance-covered and is out-of-pocket. Monthly cost runs 40,000-100,000 KRW. Prescriber clinical judgment and monitoring are essential.

What are the side effects?

When dosing stays within physiological female range, side effects are rare. Excess dosing can cause acne, hirsutism (facial/abdominal hair), voice deepening, hair loss (male-pattern), and clitoral enlargement. Periodic monitoring of total testosterone every 3-6 months is essential, with immediate dose adjustment or discontinuation if side effects appear. Voice changes and clitoral enlargement may be irreversible.

BMS Updates January 2026 Tool for Prescribing Testosterone in Menopausal Women

Prescribing testosterone for women has long been a medical gray zone. Effects are documented, but the absence of formal indications and dosing standards has split clinicians on whether and how to prescribe. The British Menopause Society’s January 2026 updated clinician’s tool is the most coherent guide to date for clearing the gray zone.

Primary indication: HSDD

The BMS guide’s first indication is clear. Hypoactive Sexual Desire Disorder (HSDD): personally distressing reduction of libido during menopause or perimenopause. Not simple libido change, but distress-accompanied loss meaningful to the individual.

Secondary indications include.

Chronic fatigue or low energy (persistent after HRT)
Strength loss not responding to exercise
Cognitive and concentration loss (persistent after HRT)
Emotional flatness or low mood (persistent after HRT)

The key qualifier is “persistent after adequate HRT trial.” HRT is first-line; testosterone sits as adjunct or addition.

Pre-prescription assessment

BMS recommends the following before starting.

Total testosterone, free testosterone (calculated from SHBG), DHEA-S
TSH, FT4 (thyroid panel)
Perimenopause/menopause stage (FSH, LH or clinical assessment)
Depression screen (PHQ-9, etc.)
Routine blood, liver function, cholesterol
Personal history of breast or uterine cancer

Baseline testosterone goal: maintain within premenopausal female normal range (approximately 0.6-2.5 nmol/L). Prescribing above this range raises side effect risk.

Dose and form

BMS standard prescription is transdermal cream.

Concentration: 0.5-2% transdermal cream (female-specific formulation)
Daily dose: approximately 5mg (0.5g of 1% cream)
Application sites: outer thigh, abdomen, buttocks (avoid face, breasts, genitals)
Starting dose: lowest effective dose, adjusted every 4-6 weeks

Splitting male testosterone gel (e.g., AndroGel) is a common off-label pattern in Korea and the U.S., but accurate dosing is difficult and side effect risk is high. Female-specific low-concentration cream (notably Australia’s AndroFeme 1% or compounding pharmacy preparations) is recommended.

Onset timing

BMS guideline summarizes clinical observation patterns.

4-8 weeks: energy and physical motivation recovery
6-12 weeks: libido recovery (the clearest change)
12-24 weeks: strength and body composition change
24+ weeks: bone density and cardiovascular effects

Libido sounds like it would emerge last but actually comes through as the clearest first change. Many women describe “energy returning before libido.” If no libido change at 12 weeks, reassess prescription.

Monitoring

Every 3-6 months, evaluate.

Total testosterone (maintain physiological range)
SHBG, free testosterone
Symptom changes (questionnaire or interview)
Side effects (acne, hirsutism, hair, voice)
Liver function, lipid profile (annually)

If levels exceed normal range, immediate dose reduction or discontinuation. Most side effects are reversible, but voice changes and clitoral enlargement may not be, making early detection essential.

Safety: 2019 Lancet meta-analysis

BMS most often cites the 2019 Lancet Diabetes & Endocrinology systematic review. Across 46 randomized trials, female physiological-dose testosterone showed no significant adverse effects on.

Cardiovascular health
Breast tissue (no change in breast cancer incidence)
Endometrium
Liver function

Long-term data beyond 5 years remains limited, and prescribing is contraindicated in breastfeeding, pregnancy, or possible-pregnancy women. Hormone-dependent cancer history (breast, endometrial) generally excludes prescription.

Korean context

In Korea, female testosterone prescription is off-label, not MFDS-approved. Prescribing clinics are limited to select gynecology offices and functional/hormone clinics, with no insurance coverage. Monthly cost runs 40,000-100,000 KRW, plus a baseline hormone panel (150,000-300,000 KRW).

The K-beauty/wellness space has popularized “female hormone balance” language, but testosterone prescription remains medical territory. Dietary supplements (maca, tongkat ali, tribulus) are tried as natural alternatives, but clinical effect sizes don’t compare with pharmacology.

What to verify

Items to check when considering female testosterone.

HRT first: estrogen (± progesterone) is first-line for perimenopause/menopause. Testosterone adds when symptoms persist.
Formal prescription: start with a gynecologist or menopause specialist. Self-import or oral preparations carry safety risk.
Blood test prior: baseline testosterone, SHBG, DHEA-S, TSH before prescribing.
Periodic monitoring: 3-6 month intervals. Report side effect signals immediately.
Duration: not indefinite; reassess every 6-24 months. Discontinue if no benefit.

What’s next

The BMS update is one step in female testosterone prescribing settling into clinical standard. The U.S. NAMS updated its 2023 guidance, and Australia and the UK are refining prescribing standards further. Korea is expected to gradually integrate through menopause clinics, with formal MFDS approval still some distance away. Next-generation female-specific testosterone drugs like AVA-291 are in clinical trials, raising the possibility of formally approved alternatives from 2027 onward.

Source: British Menopause Society / 2026