By Dr. Jennifer Frangos, D.O., DABOM. Published October 2026.
The most common side effects of testosterone in women are acne and extra hair growth. In clinical trials, women taking testosterone were about one and a half times as likely to get each as women taking a placebo. The more serious effects, such as a deeper voice or thinning scalp hair, are tied to levels that run too high. A result within the reference range does not rule out side effects, so symptoms and labs both need review.
Have questions about side effects before you start, or while you are on it? Book a free consultation.
Side effects of testosterone in women
| Side effect | What the research shows | What usually happens next |
|---|---|---|
| Acne | About 1.5 times as likely as with placebo | The dose is usually lowered |
| Extra hair on the face or body | About 1.5 times as likely as with placebo | The dose is usually lowered |
| Weight gain | Trials recorded an overall increase in weight | Talk it through with your provider |
| Deeper voice | Not increased in the cited physiologic-dose trials; this does not guarantee an individual will not experience it. | Report it right away. Level rechecked, dose lowered or stopped. |
| Thinning scalp hair | Not increased in the cited physiologic-dose trials; this does not guarantee an individual will not experience it. | Level rechecked, dose lowered or stopped |
| Clitoral enlargement | Not increased in the cited physiologic-dose trials; this does not guarantee an individual will not experience it. | Level rechecked, dose lowered or stopped |
| Higher LDL cholesterol | Seen with testosterone pills, not with the skin-applied form | One reason pills are not recommended |
The pattern is the point. Dose matters, but a normal laboratory result does not exclude a treatment-related symptom.
Not on testosterone yet? See how to get testosterone prescribed as a woman.
Signs your dose may be too high
Contact your provider, without waiting for your next visit, if you notice:
- Your voice getting hoarse or lower
- New or worsening acne
- New coarse hair on your chin, upper lip or body
- More hair in the brush or the shower drain
- Any change that worries you
The usual response is simple. Your level is rechecked with a blood test and the dose is brought down. Do not change the dose on your own.
What labs are checked, and when
Labs are how a provider catches a level that is drifting too high before you feel it. The guideline lays out a schedule:
| When | Why |
|---|---|
| Before you start | To set a baseline. A testosterone level does not diagnose anything by itself. |
| 3 to 6 weeks after starting | To see where the first dose landed |
| Within 6 weeks of any dose increase | To check the new dose |
| Every 4 to 6 months once you are steady | To make sure nothing has drifted |
At Amazing Meds, testosterone always starts with labs, and you are not left to guess when the next test is due.
Book a free consultation
Thinking about testosterone but worried about side effects? Or on it somewhere else and nobody is checking your labs? Start with a free call. Here is how it works at Amazing Meds.
- Free consultation. Our care team listens to what is going on, answers your questions, and explains the care process and next steps. Coverage and out-of-pocket costs depend on your insurance plan.
- Labs. If you want to move forward, we book your lab work right then, at a lab near you. Labs are billed to your insurance.
- Provider visit. We book your visit to go over your results and build your plan. Visits are billed to your insurance.
We work with Aetna, Cigna, TRICARE, Blue Cross Blue Shield, UnitedHealthcare and other major plans, and we treat patients by telehealth in all 50 states. Medication is self-pay.
What is a normal testosterone level for a woman?
There is no single number. The guideline is plain about it: there is no universal reference range for women, and no blood level that counts as a treatment goal.
What providers aim for is the range of a healthy woman before menopause. Your lab report prints its own reference range beside your result, and ranges differ from lab to lab. That is why your provider reads your result against that lab’s range, and why comparing your number with a friend’s tells you little.
A good lab number is not the whole story
A level in range is one part of monitoring; symptoms and side effects still matter. It does not prove the treatment is working. Follow-up looks at three things together:
- How you feel. Has the reason you started improved, whether that was sex drive, mood, energy or strength?
- Side effects. Anything from the list above?
- The labs. Is your level where it should be?
There is also a time limit. If you see no real improvement after six months, the guideline says treatment should stop. Staying on a hormone that is not helping makes no sense, even when the labs look perfect.
Long-term safety: what is known and what is not
Here is the plain picture.
- Known: shorter trials have not shown an increase in serious adverse events with physiologic-dose transdermal treatment. A four-year open-label extension provides additional, limited reassurance; it is not four years of randomized safety evidence.
- Not known: what happens beyond that. The guideline says there is not enough data to judge long-term breast cancer risk or heart risk.
That is a reason for regular follow-up, and for using the lowest dose that works.
Who needs extra caution
The guideline says testosterone is not for you, or needs a specialist’s sign-off, if:
- You are pregnant or could become pregnant.
- You have had a hormone-dependent cancer. It should only be considered together with your cancer specialist.
- You have liver disease or high cholesterol.
- You already have signs of high testosterone, such as marked acne or excess hair growth.
Questions to ask at your follow-up visit
Bring this list.
- What was my level, and where does it sit in the female range?
- Has the reason I started improved enough to keep going?
- Could any change I have noticed be a side effect?
- Should my dose change?
- When is my next blood test?
- What should I report before then?
If you want to know how the forms compare, see our weekly injection guide and pellets vs injections.
Frequently asked questions
Does testosterone cause hair loss in women?
Excessive testosterone levels can contribute to thinning scalp hair, but a normal total testosterone result does not rule out androgenic side effects. Report new shedding to your clinician for assessment.
Will testosterone make my voice deeper?
The cited physiologic-dose trials did not show an increase in voice changes, but this does not guarantee that they cannot occur. Report a new hoarse or deeper voice promptly, even if your latest blood result was in range.
Does testosterone cause weight gain in women?
Trials did record an overall increase in weight with testosterone. If your weight is changing, raise it at your follow-up.
Are the side effects permanent?
Most ease once the dose comes down, which is the first thing a provider does. Voice changes are the one to act on fastest, because they may not fully reverse.
How often are labs checked?
Three to six weeks after you start, within six weeks of any dose increase, and every four to six months once your level is steady.
Are side effects different with cream and injections?
Both blood levels and formulation-specific risks matter. Injections can push a level too high if the dose is wrong, which is why we use small weekly doses and check labs. Cream can rub off on other people, which injections cannot. Our cream vs injections comparison covers the rest.
Want someone watching your labs?
Book the free consultation. Tell us what you are taking or thinking about, and we will tell you whether we can help and what the next step would be.
Sources
- International Society for the Study of Women’s Sexual Health. Clinical practice guideline for the use of systemic testosterone for hypoactive sexual desire disorder in women. 2021.
- U.S. Food and Drug Administration. AndroGel (testosterone gel) prescribing information, boxed warning on secondary exposure. Revised October 2016.
This article is for education and is not personal medical advice. A consultation does not guarantee a prescription. Talk with a qualified provider about your own health.