Women increasingly turning to testosterone therapy to manage menopause symptoms are running into unexpected prescription delays and denials at pharmacies, according to interviews with more than half a dozen doctors, nurses and patients.
There is no U.S.-approved testosterone product for women, though its off-label use is on the rise, primarily to treat persistently low sexual desire related to menopause, the only condition for which medical guidelines and evidence of efficacy exist.
Some clinicians also prescribe it for menopause-related symptoms such as fatigue and loss of muscle strength, despite a lack of medical guidance for that use.
The Menopause Society and half a dozen other medical organizations only back testosterone use for hypoactive sexual desire disorder in menopausal women.
"We do not have any evidence in women that it will improve muscle mass or bone density or mood or well-being or really any other metric," said Dr. Stephanie Faubion, director of Mayo Clinic's Center for Women's Health and medical director of The Menopause Society.
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"What testosterone is being touted for in the lay public and on social media is not really what we have data for," she said.
Testosterone gel is displayed Sept. 9 in Melrose, Mass.
Prescriptions surge
Testosterone's rise comes as more women turn to hormone therapy overall, also driven by social media and, more recently, by the U.S. Food and Drug Administration, which backed estrogen and progesterone use for menopause symptoms as safe and effective. Some clinicians prescribe testosterone alongside these therapies.
An exclusive data analysis for Reuters by healthcare analytics firm Truveta shows the rate of women receiving a testosterone prescription jumped 146% from January 2023 to July 2026.
The FDA will hold a public workshop Thursday to review evidence for testosterone use in menopausal women, which is promoted by Health Secretary Robert F. Kennedy Jr. and Defense Secretary Pete Hegseth, who made an issue of testosterone levels in the military.
While healthcare providers can prescribe approved medicines any way they see fit, an FDA spokesperson said the agency did not evaluate these off-label uses for safety, efficacy or dosing.
Defense Secretary Pete Hegseth says the military will start testing male service members' testosterone levels every year.
Workarounds for women
With no approved testosterone for women, patients must divide packaged versions designed for men often at many times the doses they seek.
Jennifer Lanoff, a women's health nurse practitioner in Washington, D.C., said Amazon Pharmacy rejected prescriptions from her practice for the first time this year.
"Amazon has not given us a problem before," she said. "I don't know exactly what happened or why they rejected. They say it was a new policy."
Lanoff said she had some success rewriting prescriptions under which patients discard leftover gel rather than splitting doses for later use.
Amazon Pharmacy said it does not dispense some testosterone prescriptions that require women to customize doses in order to ensure safe and compliant dispensing. It added that the policy is not specific to testosterone or based on a patient's sex or gender identity.
A major international study suggests very low testosterone may signal higher long-term cancer risk in men. Researchers from the Androgens In Men Study analyzed more than 26,000 men across 11 long-running studies in Australia, the United States and Europe. Men in the lowest one-fifth for testosterone had an 18% higher risk of dying from cancer than those in the highest one-fifth. Cancer risk began increasing below 8.6 nmol/L of testosterone. Researchers stress the findings do not prove testosterone causes cancer, and men should seek medical evaluation rather than start hormone supplements. Disclosure:This video contains stock footage and content created or enhanced using Ai-assisted tools ai-generated WooGlobe Ref : WGA150216
The company said it refers customers to compounding pharmacies that mix ingredients for specialized doses.
Compounded testosterone can cost about $100 for a three-month supply compared with $30 after discounts for a 10-month supply at a commercial pharmacy, Lanoff said.
Most insurance companies do not cover testosterone for women, the doctors, nurses and patients said.
Magen Price, a nurse practitioner and founder of Mystic Valley Sexual Wellness, said more than one-third of the 80 patients in her practice who use testosterone encountered issues with their prescriptions, including at CVS and Walgreens pharmacies.
The issues that began last year worsened, Price told Reuters.
When Amy Swan, 55, a graphic designer outside Boston, tried to fill her first testosterone gel prescription in March, she expected a simple pharmacy visit. Instead, she spent weeks trying to get a pharmacy to honor a GoodRx discount coupon that would reduce the cost by 25%.
"Hours of my time were lost just being able to get this one prescription," Swan said.
CVS said its pharmacies regularly fill prescriptions for topical testosterone gel for women. Other retailers with large pharmacies, including Walgreens, Costco and Walmart, did not respond to requests for comment. Kroger declined to comment.
Kevin Schipper, a pharmacist and director of product lifecycle management at consulting firm ProPharma, said pharmacies may decline prescriptions due to concerns over dosing accuracy and medication safety, as well as stability, storage and contamination if single-use packaging is opened and reused.
Because it is a controlled substance — similar to aspirin with codeine — each state also has recordkeeping requirements.
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Trials for safety
More than 30 trials studying testosterone use for various health conditions in women are underway or planned, according to ClinicalTrials.gov, including a Marius Pharmaceuticals-sponsored sexual dysfunction trial due to start as soon as this year.
Aviva Bio is developing a next-generation testosterone product that would address breast cancer risk associated with use of the hormone.
Products used by women include branded and generic testosterone gels, such as AbbVie's AndroGel, Keenova Therapeutics' Testim and Upsher-Smith's Vogelxo.
Upsher-Smith declined to comment on whether it plans to develop testosterone products specifically for women. AbbVie and Keenova did not respond to requests for comment.
Cynthia Stuenkel, a clinical professor of medicine at the University of California, San Diego, said she hopes the FDA will prioritize evaluating a testosterone product designed for women.
"This would certainly ease the ability of clinicians to more confidently prescribe testosterone and for women to more easily and confidently use testosterone specifically dosed for them," she said.
