Key Takeaways: At The Menopause Society 2025 Annual Meeting (Orlando, October 21-25, 2025), Professor Susan Davis of Monash University delivered an evidence review concluding that in 2025 there is no justification for treating women with testosterone to prevent muscle loss, fractures, heart disease, depression, cognitive decline, or fatigue. Davis stated there is no such thing as a testosterone insufficiency syndrome in women and no blood level below which symptoms reliably emerge. The presentation, recapped in mainstream medical press on May 13, 2026, underscores that the only evidence-based indication for testosterone in women remains hypoactive sexual desire disorder (HSDD) in postmenopausal women -- the same position held by the Endocrine Society, International Society for Sexual Medicine, and the 2019 Global Consensus Position Statement. This sits in direct tension with a wave of social media claims and direct-to-consumer telehealth marketing positioning testosterone as a treatment for energy, mood, brain fog, and physical performance in women.
What the Menopause Society Said
The Menopause Society 2025 Annual Meeting was held October 21-25, 2025 in Orlando, Florida. The meeting brings together menopause clinicians, researchers, and policy experts to set practice direction for the year ahead.
The session that has reverberated through medical press for the past seven months was titled "Androgens for muscles, mood, and more." It was delivered by Susan R. Davis, PhD, MBBS, AO, FRACP, professor and head of the Monash University Women's Health Research Program in Melbourne, Australia. Davis is widely regarded as the leading global authority on testosterone in women. She led the panel that wrote the 2019 Global Consensus Position Statement on the Use of Testosterone Therapy for Women and has published more randomized trial data on female testosterone than any other researcher.
Davis reviewed the full body of clinical and observational evidence on testosterone use in women across muscle, bone, heart, mood, cognition, and fatigue. Her conclusion, quoted in the May 13, 2026 recap by The American Journal of Managed Care:
"In 2025, there is no justification for treating postmenopausal women or premenopausal women with testosterone to prevent muscle loss, to prevent bone or muscle fracture, to prevent heart disease, to treat depression or cognitive decline, and I would also add in fatigue." [1]
She went further. Asked about "testosterone insufficiency syndrome" -- a phrase circulating online and in some telehealth marketing materials -- Davis was direct: there is no such syndrome, and no blood level below which testosterone reliably causes symptoms in women. [1]
This is significant because Davis is not an opponent of testosterone therapy. She has spent her career building the evidence base that supports it -- specifically, for HSDD. She is saying: the data only supports it for one thing, and treating it as more than that is overstating what is known.
Why the Evidence Does Not Support Broader Indications
To understand the position, it helps to look at what the randomized trials actually show across each claimed indication.
Muscle
The strongest evidence on testosterone and muscle in women comes from athletic performance studies and recovery trials in older adults. The findings are consistent: at physiologic doses, testosterone has minimal-to-no effect on muscle mass or strength in women. Even at supraphysiologic doses (up to 210 ng/dL, well above normal female range), the documented effect was approximately 15 extra seconds of running time in young female athletes -- a meaningful sports performance effect, but not a functional muscle effect for non-athletes.
In older women recovering from hip fractures, high-dose testosterone combined with exercise did not improve walking distance, bone density, or daily functional outcomes compared to exercise alone. The biology argues for an effect; the trials do not show it at clinically meaningful magnitudes for women.
Bone
Women's bone density depends primarily on estrogen, not testosterone. Postmenopausal women receiving estrogen therapy show meaningful improvements in bone mineral density and fracture risk reduction. Adding testosterone has not been shown to improve those outcomes in randomized trials. Davis's review found no consistent association between testosterone and bone mineral density or fracture risk in women.
This contrasts with men, where the TRAVERSE bone substudy actually showed a higher fracture rate in the testosterone group despite improved bone density -- a reminder that bone density measurements and clinical fractures are not the same outcome.
Heart Disease
The case for testosterone preventing heart disease in women rests on associations seen in observational data, not on randomized trials. When randomized, the cardiovascular effects of testosterone in women are neutral at physiologic doses. The recent women's testosterone cardiovascular safety review confirms that the data is not yet strong enough to support either harm or benefit at standard doses -- but it certainly does not support cardiovascular prevention as an indication.
Mood and Depression
This is where the gap between observational reports and randomized data is widest. Observational studies and patient self-reports describe mood improvements on testosterone. Randomized placebo-controlled trials have not replicated this consistently. Davis's systematic review found no significant benefit on mood, anxiety, psychological well-being, or general vitality at the population level.
Two interpretations are possible: (1) testosterone genuinely helps mood in some women, but the effect is too variable or selection-dependent to show in randomized trials, or (2) the observed mood benefits are placebo response, regression to the mean, or expectancy effects in unblinded settings. The honest answer is the data cannot distinguish between these yet.
Cognitive Decline
Trials of testosterone for cognitive symptoms in women have shown either no effect or very small effects that did not reach clinical significance. The proposed mechanism (testosterone as a neuroactive steroid affecting memory and executive function) is biologically plausible, but the randomized data has not delivered. The 332-woman observational study reported delayed cognitive gains emerging at 4 to 6 months, but again, that is observational, not placebo-controlled.
Fatigue
Davis specifically added fatigue to her list of unsupported indications. This is the indication women most frequently report benefiting from in clinical practice and is the lead symptom in many telehealth testosterone protocols. Yet randomized data does not show testosterone treats fatigue at the population level.
What "No Testosterone Insufficiency Syndrome" Means
Davis's specific phrasing -- "there is no such thing as a testosterone insufficiency syndrome" -- is doing real work.
Unlike estrogen, testosterone in women does not have a clean clinical syndrome attached to its deficiency. Three reasons:
First, testosterone does not drop at menopause. The Australian Women's Midlife Years Study (8,096 women, published in eBioMedicine in October 2025 by Davis and colleagues) used liquid chromatography-tandem mass spectrometry to measure testosterone in women aged 40-69 across all menopausal stages. The finding: testosterone declines gradually from about age 20 onward but does not change at menopause itself. [2] This is in sharp contrast to estradiol, which drops 90%+ at menopause. There is no menopause-related testosterone cliff to "replace."
Second, the range of normal is huge. Female testosterone normal ranges span roughly a 5-fold difference between low and high physiologic levels, with substantial overlap between symptomatic and asymptomatic women at any given number. There is no defined threshold below which symptoms reliably emerge.
Third, the symptoms attributed to low testosterone -- fatigue, brain fog, low libido, mood -- are non-specific. They are caused by many things in midlife women: perimenopause itself, sleep disruption, thyroid disease, iron deficiency, depression, life stress, and aging. Attributing them to low testosterone requires either (a) clear randomized evidence that testosterone fixes them (which only exists for HSDD), or (b) a defined clinical syndrome with measurable biomarkers (which Davis argues does not exist).
This does not mean testosterone is irrelevant to women's health. It means the framing of "you have low testosterone, that explains your symptoms, replacing it will fix them" is not supported by the data outside HSDD.
Where the Major Guidelines Stand
The Menopause Society's position is not an outlier. Every major women's hormone guideline issued in the past five years converges on the same point:
| Guideline | Indication Supported |
|---|---|
| 2019 Global Consensus Position Statement [3] | HSDD in postmenopausal women |
| Menopause Society (2025) | HSDD in postmenopausal women |
| Endocrine Society | HSDD in postmenopausal women |
| International Society for Sexual Medicine | HSDD in postmenopausal women |
| British Menopause Society (Jan 2026) [4] | HSDD in postmenopausal women |
None of the major societies currently endorse testosterone for muscle, bone, cardiovascular protection, mood, cognition, or fatigue in women. The Society messaging is unusually consistent across continents and regulatory frameworks.
The Telehealth Reality
In tension with this guideline picture is what is actually happening in the women's testosterone market.
Direct-to-consumer telehealth platforms in the US, UK, and Australia have built businesses prescribing testosterone to women for energy, mood, brain fog, and general well-being. Women's testosterone has gone from a niche prescription for HSDD to a mainstream wellness category. The market has grown roughly in parallel with the removal of FDA black-box warnings on hormone therapy and growing public interest in menopause care.
The case for this prescribing pattern, as made by experienced clinicians, runs:
- Observational evidence (including the recent 332-woman cohort study) shows broad symptom improvements that exceed plausible placebo effects.
- The biological plausibility is real: testosterone is a neuroactive steroid with effects on serotonin, GABA, and brain regions involved in mood and energy.
- Women receiving physiologic-dose testosterone with monitoring report meaningful quality-of-life improvements.
- The lack of randomized trial data reflects research funding priorities, not safety or efficacy concerns.
The case Davis and the Society make in response:
- Observational data without placebo controls cannot distinguish drug effect from placebo response, regression to the mean, or selection bias.
- Multiple randomized trials in cognitive and mood domains have not shown benefit.
- Treating something as evidence-based when only observational data supports it lowers the bar for the entire field.
- The next step is randomized trials, not broader prescribing.
Both positions are defensible. The honest framing for a patient is: experienced clinicians sometimes prescribe testosterone off-guideline for symptoms the data does not yet support, and women sometimes report meaningful benefits, but the official medical position is that this is not yet evidence-based.
What This Means for Choosing a Clinic
If you are considering testosterone therapy as a woman, the Menopause Society position should change what you look for in a prescriber. Three signals separate evidence-aligned care from marketing-driven care.
Signal 1: How is the indication being framed?
An evidence-aligned clinic will name HSDD or related sexual function concerns as the supported indication, and will explicitly discuss the limits of evidence when prescribing for energy, mood, or other symptoms. A marketing-driven clinic will treat low testosterone as a definitive cause of fatigue, brain fog, or weight gain and offer testosterone as the established treatment.
Signal 2: Are labs and monitoring real?
The Global Consensus Position Statement (the document Davis co-authored) requires baseline testosterone testing, target levels in the upper premenopausal physiologic range, and follow-up labs at 6-12 weeks. Clinics that prescribe testosterone without baseline labs, at fixed doses, or without follow-up monitoring are not delivering the standard the evidence-based indication requires.
Signal 3: What dose and route?
The evidence supports transdermal (cream, gel, patch) dosing in the 4-6 mg/day range for most women, titrated to bring free testosterone into the upper premenopausal range. Pellet doses translate differently and are harder to titrate. Injection protocols in women are less common, require careful monitoring, and can easily overshoot physiologic range. A clinic defaulting to non-physiologic dosing or to pellets without clear rationale is a yellow flag.
