More Women Are Seeking Testosterone for Menopause. Many Are Hitting Pharmacy Roadblocks.

By Mrinalika Roy

Sept. 15 (Reuters) - Women are increasingly turning to testosterone therapy to manage menopause symptoms, only to encounter unexpected delays and denials when they try to fill prescriptions, according to interviews with more than half a dozen doctors, nurses and patients.

The trend reflects a broader shift in menopause care: more women are seeking hormone therapy, partly because of social media and more recently because the U.S. Food and Drug Administration has backed estrogen and progesterone as safe and effective for menopause symptoms. Some clinicians now prescribe testosterone alongside those treatments.

But there is no FDA-approved testosterone product for women in the United States. Its use remains off-label and is growing primarily to treat persistently low sexual desire related to menopause, the only condition for which medical guidelines and evidence of efficacy currently exist. Some clinicians also prescribe it for menopause-related fatigue and loss of muscle strength, even though there is no medical guidance for those uses.

The Menopause Society and half a dozen other medical organizations endorse testosterone only 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.

“What testosterone is being touted for in the lay public and on social media is not really what we have data for,” she said.

A surge in prescriptions

An exclusive data analysis for Reuters by healthcare analytics firm Truveta shows the rate of women receiving a testosterone prescription jumped 146%, nearly tripling, from January 2023 to July 2026.

The FDA will hold a public workshop on Thursday to review evidence for testosterone use in menopausal women. The issue has been promoted by Health Secretary Robert F. Kennedy Jr. and Defense Secretary Pete Hegseth, who has made an issue of testosterone levels among the troops.

While healthcare providers can prescribe approved medicines in ways they see fit, an FDA spokesperson said these off-label uses have not been evaluated by the agency for safety, efficacy or dosing.

Workarounds for women

With no approved testosterone product for women, patients often must divide packaged versions designed for men, sometimes at many times the doses they are seeking.

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.

“We’ve done (off-label testosterone prescriptions) forever. It’s clinical guidelines recommended. 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 has had some success rewriting prescriptions so 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.

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.

The result is a patchwork of off-label prescribing, pharmacy discretion and compounding, leaving many women to navigate access and costs largely on their own.

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 currently use testosterone have encountered issues with their prescriptions, including at CVS and Walgreens pharmacies. The problems began last year and have worsened, Price told Reuters.

When Amy Swan, a 55-year-old 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 because of concerns over dosing accuracy and medication safety, as well as stability, storage and contamination if single-use packaging is opened and reused. Because testosterone is a controlled substance - similar to aspirin with codeine - each state also has record-keeping requirements for the government.

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 later this year.

Aviva Bio is developing a next-generation testosterone product that would address breast cancer risk associated with use of the hormone.

Products currently 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.

(Reporting by Mrinalika Roy in Bengaluru; Editing by Caroline Humer and Bill Berkrot)