Hormone Therapy for Bones and Libido: Osteoporosis AND Desire

For decades, hormone replacement therapy (HRT) has been controversial, caught between fear and renewed enthusiasm. Now, a growing number of women are asking a different question: could Hormone Therapy for Bones and Libido offer a two-for-one benefit: stronger bones and a more satisfying sex life? A recent reader report suggests exactly that, and emerging research hints she may not be alone.

A Reader Is Enthusiastic about Hormone Therapy for Bones and Libido:

Q. My doctor prescribed hormones due to bone loss. I am using an estrogen patch, progesterone and testosterone cream. My osteoporosis is now reversed. My spine is in the normal range. Hormones are the best thing I’ve ever done, and my sex drive is back!

A. That’s quite a testimonial, and it reflects a growing re-evaluation of hormone therapy. Former FDA Commissioner Dr. Marty Makary has been outspoken about the potential benefits of hormone replacement therapy (HRT).

Dr. Makary technically “resigned” from the FDA on May 12, 2026, but the word on the street suggests that he departed the agency just before he could be “removed.” You can read about this tale of woe and intrigue at this link. While Dr. Makary was at the FDA he promoted HRT to reduce the risk of bone fractures, heart disease and dementia.

Testosterone and Sexual Desire:

A study in the journal Clinical Endocrinology (March 15, 2026) reports an “improvement in sexual function” with the use of topical testosterone gel. This was not a study of men! The volunteers were post-menopausal women who were on estrogen-based HRT.

They added testosterone gel (Testogel, 16.2 mg/g) once every 3 or 4 days under medical guidance. That dose is higher than is generally recommended…though the 3 or 4 days interval may have compensated somewhat. The authors reported: “All women described clinical benefit prior to the study, with no reports of androgen-related side-effects.”

A Shortage of Estrogen Patches?

There is currently an estrogen patch shortage, though. After the FDA removed boxed warnings about breast cancer, cardiovascular disease and dementia, prescriptions for estrogen patches soared. It may take time for supply to catch up with demand.

Mixed Messages from the FDA, physicians and patients:

A week before FDA Commissioner Marty Makary “resigned” from the agency, he stated that the removal of the boxed waring on hormone replacement therapy created a huge demand for estrogen patches.

He was quoted on NBC News:

“The industry has been able to keep up but barely. They are recalibrating their distribution and manufacturing to have more robust supply. In the interim, the estrogen patches have not risen to the criteria of being on the shortage list, but it is something to manage.”

An article in Forbes (April 14, 2026) by Jessica Rendall suggests something different:

“If you’re having a hard time getting your estrogen patch prescription filled, you’re not alone. In some parts of the country, supply of estrogen patches—one of the most popular types of hormone therapy used to treat symptoms of menopause or perimenopause—hasn’t been able to keep up with demand.

“’This is front and center,’ says Alyssa Dweck, M.D., a certified menopause practitioner and gynecologist in New York City. ‘I am literally spending a good portion of my day trying to find pharmacies that still have patches.’”

Why Hormone Therapy for Bones and Libido Is Getting Attention

Many people think of estrogen when it comes to bone health. That makes sense since estrogen plays a central role in maintaining bone density. When levels drop after menopause, bones can weaken rapidly.

But testosterone may also play an underappreciated role. As researchers have pointed out in Lancet Diabetes & Endocrinology, (Dec. 2015), testosterone is:

“a critical but enigmatic female hormone.”

It’s not just a “male hormone.” In women, testosterone is actually a precursor to estradiol, the primary form of estrogen. In other words, testosterone helps build estrogen.

That biochemical relationship may help explain why some women report improvements in both bone strength and libido when testosterone is added to the mix. Is your head spinning? I am not surprised. Very few people realize that women make testosterone too.

If we say low testosterone, you might think of a TV ad starring a middle-aged man worried about “low T.” But let me repeat another message because it comes as a surprise to many people:

Women need testosterone to make estrogen!

Actually, the whole process starts with cholesterol. It is the very first building block for a bunch of precursor compounds including androstenedione, dehydroepiandrosterone (DHEA) and dihydrotestosterone (DHT). The testosterone and DHT that are created in the ovaries, adrenal glands and other body tissues are ultimately converted to estradiol.

In postmenopausal women, estrogen is also created in bones, breast, blood vessels and brain (Endocrinology, Nov. 2001). One little hiccup. Measuring testosterone in the blood of postmenopausal women is not necessarily a good way to determine “low T.” That’s because it misses intracellular testosterone. A good endocrinologist will take into account a woman’s clinical experience, not just her blood levels of testosterone.

By now, you are probably feeling a bit overwhelmed. The bottom line appears to be that testosterone has both a direct effect on women as well as an indirect effect by helping with the formation of estrogen, the quintessential female hormone. Testosterone levels reach their maximum concentration when women are in their 30s and 40s and then start declining.

Hormone Therapy for Bones and Libido: The Osteoporosis Connection

There is evidence that bone mineral density is affected by testosterone levels.

To quote from an article titled The Safety of Testosterone Therapy in Women,

“Bone mineral density is significantly related to testosterone levels in postmenopausal women.

“Although limited, the existing evidence indicates that testosterone therapy has positive protective effects on bone health.”

To be fair, though, the relationship between testosterone and bone mineral density remains controversial.

A study in Scientific Reports (March 25, 2023) reports:

“Using a highly sensitive hormone assay method, our study identified a significant association between testosterone and BMD [bone mineral density] of the hip in women over 65 years of age, suggesting that lower testosterone increases the risk of osteoporosis.

“The finding of a significant positive influence of testosterone in bone mineral density of the hip in older women should encourage further research into testosterone deficiency in elderly women, with a potential impact in the prevention and treatment of postmenopausal osteoporosis. The effects of testosterone on the bone of older postmenopausal women are not very well documented but it is known that testosterone may have direct effects on bone via the androgen receptor, or indirect effects via aromatization.”

Whether extra testosterone will prevent osteoporosis or fractures in postmenopausal women with low T remains to be determined.

We remain disappointed that there remain so many questions and so few answers about testosterone replacement therapy.

Here is what two researchers from Australia and Denmark say about this issue (Lancet Diabetes & Endocrinology, Dec. 2015):

“Testosterone is an essential hormone for women, with physiological actions mediated directly or via aromatisation to oestradiol throughout the body. Despite the crucial role of testosterone and the high circulating concentrations of this hormone relative to oestradiol in women, studies of its action and the effects of testosterone deficiency and replacement in women are scarce. The primary indication for the prescription of testosterone for women is loss of sexual desire, which causes affected women substantial concern. That no formulation has been approved for this purpose has not impeded the widespread use of testosterone by women—either off-label or as compounded therapy…Clinical trials suggest that exogenous testosterone enhances cognitive performance and improves musculoskeletal health in postmenopausal women.”

Hormone Therapy for Bones and Libido: The Libido Connection

Many women are far more aware of testosterone’s impact on sexual health.

A review in the journal U.S. Pharmacist (Aug. 19, 2019) reports that:

“TRT has been shown to be effective for improving libido, sexual desire, arousal, sexual frequency, and sexual satisfaction in women.”

The long-term effects of this off-label use have not been well studied, though, and safe dosing guidelines are not well established.

An oral medicine, Estratest, was once prescribed to treat symptoms of menopause. This is now only found as a generic pill, esterified estrogens with methyltestosterone.

Readers have been telling us for years that testosterone, in the right dose, can be helpful for lowered libido.

Q. After a friend told me that she had great success with testosterone cream, I asked my gynecologist about it. She prescribed a low-dose cream and I have been using it for years.

I am happy with the results. I have more energy, better mood, a high sex drive, amazing orgasms and less body fat. My husband is happy because I’m happy and our sex life is great. Why don’t more women know about this?

Another woman wrote:

“My libido had dropped to zero after menopause. A new doctor prescribed testosterone cream specially formulated by a compounding pharmacy.

“I was like a teenage boy until I found the right dose! It doesn’t take much. My bone density is excellent, and I now have an active sex life.”

A. The FDA has not approved testosterone for women.

The agency cautions that:

“prescription testosterone products are approved only for men who have low testosterone levels caused by certain medical conditions.”

The only way to get this topical medicine is with a prescription at a compounding pharmacy. Doctors are allowed to prescribe drugs “off label” if they feel the benefits outweigh the risks. The FDA does not approve of such actions, especially in the case of TRT (testosterone replacement therapy).

Testosterone Implants:

Some physicians advocate implanted testosterone pellets. This is also an off-label use. The FDA does not approve of such treatment for women, and it remains highly controversial.

One physician wrote this in the Journal of Personalized Medicine (Aug. 2022):

“There is growing evidence to support the use of physiologic doses of testosterone for sexual function, osteoporosis prevention, brain protection, and breast protection. The safety of testosterone use in women has been evaluated for the past 80 years. A recent publication on the complications of subcutaneous hormone-pellet therapy, looking at a large cohort of patients over 7 years, demonstrated long-term safety. In addition, there have been two large long-term peer-reviewed studies showing a significant reduction in the incidence of invasive breast cancer in women on testosterone therapy. Perhaps it is time for the FDA to consider approving products that would benefit testosterone-deficient women.”

These claims are provocative, but not yet settled science. The FDA is not yet on board.

One woman shares her story:

Q. I am a woman with undetectable testosterone levels. My doctor prescribed a low-dose testosterone pellet that he inserted under my skin. It lasted for several months. This was not covered by insurance, but the results were worth it.

A. As we have already explained, women make testosterone as well as estrogen. Testosterone treatment for women remains controversial, however. The FDA has not approved this hormone for women. Some doctors have prescribed it for decades to ease certain menopausal symptoms, including vaginal dryness and low sex drive.

When testosterone levels are very low, women may feel depressed and have decreased sexual desire. Your doctor should monitor your testosterone levels to make sure your hormone levels remain within normal limits.

The most common side effects of testosterone pellet therapy are acne and facial hair growth. Concerns have been raised that high levels of testosterone might deepen the voice and cause anger or hostility. An article titled “The Safety of Testosterone Therapy in Women” published in the Journal of Obstetrics and Gynaecology Canada, Sept. 2012 notes that: “Anger and hostility are not observed in women with serum testosterone within physiologic limits.” To read more about the benefits and risks of testosterone in women, please take a moment to read this journal article from Canada. It is quite comprehensive.

Why Doctors Remain Cautious About Hormone Therapy for Bones and Libido

Despite some enthusiasm, there are important caveats.

• Testosterone is not FDA-approved for women
• Most prescriptions are off-label or compounded
• Long-term safety data are limited

There are also risks:

• Acne and unwanted hair growth
• Voice deepening (potentially irreversible)
• Possible cardiovascular and metabolic effects
• Uncertain impact on breast cancer risk

Women who are still menstruating may notice changes in their periods. Liver problems and blood clots are other potentially serious reactions to testosterone.

Analyzing the effects of estrogen separately from those of testosterone is important.

An analysis of data from the Nurses’ Health Study from 1978 to 2002 reported that (Archives of Internal Medicine, July 24, 2006):

“Among women with a natural menopause, the risk of breast cancer was nearly 2.5-fold greater among current users of estrogen plus testosterone therapies than among never users of PMHs [postmenopausal hormones].”

Sadly, there hasn’t been nearly enough research into both the benefits and risk of testosterone for women. We find this very disappointing.

Testosterone and Low Libido?

Some doctors will consider testosterone for a woman only if she has persistent difficulty with libido. However, measuring testosterone levels to make a diagnosis does not seem to be straightforward (Journal of Obstetrics and Gynaecology Canada, March 2017). Women’s sexual desire is not a simple barometer of testosterone in their systems. Psychological well-being and the state of the relationship also have strong effects on a woman’s interest in sexual activity (Journal of Sexual Medicine, March 2017).

A group of women approaching menopause reported on their libido and symptoms and provided blood for testing (Menopause, Nov. 2018). Those whose testosterone levels fluctuated most were more likely to report diminished interest in sex. Women who were depressed, those who reported vaginal dryness and those whose children were living at home were more likely to report decreased libido regardless of their testosterone levels.

Does Testosterone Help Women Athletes?

A study in the British Journal of Sports Medicine reveals that elite female athletes who have naturally high testosterone perform better than those with normal androgen levels. The investigators analyzed data for both male and female athletes from the 2011 and 2013 track and field world championships (Bermon & Garnier, British Journal of Sports Medicine, online, July 3, 2017 ).

Male sprinters tended to have higher free testosterone levels than men in other events. On the other hand, those in throwing events averaged lower testosterone than men in other events. Testosterone levels in women didn’t appear to vary by the event.

How Does High Testosterone Affect Competition?

When women with high testosterone were compared to those with low levels of this male hormone, performance differed slightly. Nonetheless, the small differences were significant.

Although the improvements in events such as pole vault, 400 meter hurdles, 800 meter runs and the hammer-throw were modest, at this level of competition, even a small advantage can lead to a championship. The women competing in the hammer-throw did 4.53 percent better if they had elevated testosterone levels. That was the greatest difference among all the contestants.

So…Is Hormone Therapy the Answer?

The idea of Hormone Therapy for Bones and Libido is undeniably appealing:

• Stronger bones
• Reduced fracture risk
• Improved sexual desire and satisfaction

But the reality is more nuanced.

We are left with a familiar People’s Pharmacy dilemma:

• Promising benefits
• Incomplete data
• Real risks

The Bottom Line

Hormone therapy, especially when it includes testosterone, may help some women reclaim both skeletal strength and sexual vitality.

But it is not a one-size-fits-all solution. Women considering this approach should ask:

• What are the expected benefits for me?
• How will risks be monitored?
• Will testosterone plus estrogen and/or progesterone increase my risk for breast cancer?
• What dose and formulation make sense?
• What happens long term?

Final Words

We remain both intrigued and cautious.

The possibility that a carefully tailored hormone regimen could restore bone density and revive libido is powerful. But until better long-term studies are available, this remains a medical frontier, one where patients and clinicians must navigate uncertainty together.

Share Your Experience:

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