Just last week, Midi Health announced the launch of their testosterone program, currently covering women in 12 U.S. states—including California, Texas, Florida and New York (the four most populous states)—and a waitlist to “be first to know when your state is live.”
Advocates describe it as a missing link in women’s health—promising renewed energy, stronger libido, and sharper focus—while critics warn that the science hasn’t caught up to the enthusiasm.
As interest grows, so do the questions: What role does testosterone actually play in women’s health? When is treatment appropriate? And what risks come with using a hormone that, for women, remains unapproved by the U.S. Food and Drug Administration?
To understand what’s driving the surge—and what women should know before considering it—Flow Space spoke with medical experts who specialize in midlife and hormonal health to break down the science behind the treatment.
The Hormone That Quietly Shapes Women’s Health
Although often thought of as a “male hormone,” testosterone is also essential to women’s wellbeing. Produced in smaller amounts by the ovaries and adrenal glands, it supports sexual desire, mood, energy, and muscle and bone health.
“Around menopause, testosterone levels naturally decline, which can contribute to lower libido or energy,” Dr. Kate McLean, an internal medicine physician who specializes in midlife women’s health said. “Still, those symptoms are often multifactorial, so testosterone is just one piece of a larger hormonal picture.”
That nuance is critical, because menopause is rarely about one hormone alone. Fluctuating levels of estrogen and progesterone also contribute to hot flashes, brain fog, and fatigue—symptoms often lumped together under the broad umbrella of “hormone imbalance.”
Dr. Lennox Hoyte, a board-certified OBGYN and female pelvic medicine specialist, notes that testosterone’s most clearly understood role is in sexual health. “Testosterone increases female libido,” he explains. “During and after menopause, women experience a decline in all hormones—including testosterone—and many experience a decline in desire for sex.”
That decline begins earlier than most realize. According to Dr. Stacy Heimburger Smalley, an internal medicine doctor, testosterone levels start to drop after age 20—and that fall “is actually independent of the hormonal changes seen in peri-menopause or menopause.”
Why Testosterone for Women Isn’t FDA-Approved
Despite decades of use in men, testosterone remains unapproved by the FDA for women, meaning any prescription is considered “off-label.”
“The FDA hasn’t approved a female-specific testosterone product because long-term safety and dosing data in women are still limited,” McLean said. “It’s legal, but it requires extra care—like informed consent, appropriate lab testing, and clinical follow-up—since safety data and standardized dosing aren’t yet robust.”
This lack of regulation has created a fragmented landscape. Some doctors prescribe low-dose testosterone creams or gels, while others turn to custom-compounded pellets or injections. The formulations, doses, and follow-up protocols vary widely.
“The FDA has not conducted any large-scale studies to validate results for women,” Hoyte said. “Consequently, women do not have clinical results to rely on. This is an unfortunate situation for many women, but for those who want to try testosterone, they have to find an experienced practitioner who is familiar with their individual medical history and who can work with her to find a custom solution.”
Smalley points out that other countries—like Australia and the U.K.—have established guidelines and dosing standards for women, but the U.S. has yet to follow suit. “There are protocols from other countries that can be followed,” she said, “but the U.S. does not have an approved form for women at this time. There are a number of experts fighting this battle because the safety data is more robust than the men’s safety data was at the time testosterone was approved for men.”
Until that gap is addressed, testosterone for women remains a gray area—legally permissible, but inconsistently regulated.
What the Science Actually Shows
The best evidence to date supports a very narrow use case: treating hypoactive sexual desire disorder (HSDD), a condition defined by a persistently low libido that causes personal distress.
“Clinical studies suggest testosterone can modestly improve sexual desire and satisfaction for some postmenopausal women, especially those with HSDD or after surgical menopause,” McLean said. “The benefits are measurable but not universal, and most experts agree that more research is needed to understand long-term outcomes and broader effects.”
In other words, testosterone can help some women—but not all, and not for every symptom tied to menopause. Claims that it improves mood, cognition, muscle tone, or metabolism aren’t yet backed by rigorous data. “Testosterone for women has proven benefit in HSDD,” Smalley said. “Unfortunately, there have not been any studies that prove increased lean muscle mass, improved cognition, or any of the other ‘wonders’ of testosterone therapy.”
The enthusiasm, however, has outpaced the research. As online testimonials multiply, so do misconceptions—and potential risks.
“Possible side effects include acne, unwanted hair growth, voice deepening, or clitoral enlargement—some of which may be irreversible with high doses,” McLean said. “Because long-term heart and breast safety data are limited, careful monitoring and using the lowest effective dose are key.”
Hoyte has seen similar concerns in his practice. “Mood changes, hair loss, and increased body hair are among the undesirable effects of testosterone in women,” he says. And as Smalley adds, “Irreversible voice changes are scary, but weight gain and acne are the most common. We want levels near the higher end of the normal range for reproductive-age women, but going too high comes with risks.”
Without standardized testing and monitoring guidelines in the U.S., clinicians rely on personal experience, scattered studies, and international guidance to inform care. “There aren’t standardized testing or monitoring protocols,” McLean said. “Practices vary widely between clinicians, which highlights how much we still have to learn.”
Filling a Gap—or Creating New Risks?
That knowledge gap has left space for telehealth programs like Midi Health to step in. Their newly launched testosterone offering promises evidence-based care delivered by licensed clinicians, filling a void in menopause medicine that many women have long felt.
For some experts, these programs represent a positive step toward access. “Programs like Midi Health are meeting a real need—many women struggle to access thoughtful menopause care,” McLean said. “When done responsibly, with experienced clinicians and consistent monitoring, they can improve access. But safety depends on clinical oversight, realistic expectations, and clear communication about benefits, risks, and follow-up.”
Others are more cautious. “I’m unaware of Midi Health specifically,” Hoyte said, “but there are many private practitioners and companies that are successfully using testosterone in women. The generalizations about the use and effectiveness of testosterone are at best premature. More clinical evidence and studies must be conducted in order for women to truly benefit from this hormone treatment.”
The social media conversation around testosterone hasn’t helped. Influencers and “meno-celebs” often tout dramatic transformations—better energy, stronger muscles, higher libido—while critics dismiss testosterone as dangerous or unnecessary. “Social media has opened up important conversations about menopause and sexual health,” McLean said, “but it often oversimplifies the science. Some influencers portray testosterone as a miracle fix, while critics dismiss it entirely. The truth lies in between: it can help some women, but only with proper evaluation, dosing, and monitoring.”
For now, the safest approach is a personalized one. “Start with an honest conversation with a healthcare provider who understands midlife women’s health,” McLean said. “Share your symptoms, medications, and goals, and ask about all evidence-based options—hormonal and non-hormonal.”