Testosterone is not just a male hormone. In women it plays a direct role in sexual desire and arousal, energy, mood, muscle and bone strength, and cognitive sharpness — and for many women, levels decline meaningfully in the transition through midlife. At Midwest Mind & Body Healthcare in Papillion, we provide careful, physiologic-dose testosterone therapy for women whose symptoms and labs support treatment.
Our founder, Kim Wohlwend, MSN, APRN, is a dual ANCC board-certified Family Nurse Practitioner and Psychiatric-Mental Health Nurse Practitioner. That dual training matters here: low libido, mood flatness, and fatigue in women are often treated as a psychiatric problem, a relationship problem, or "just aging." Frequently the reality is a blend of hormone change, sleep disruption, depression or anxiety, perimenopausal transition, and stress. We look at the whole picture and start with the treatment most likely to help.
Testosterone for women is off-label in the United States. The FDA has not approved any testosterone product specifically for women. Prescribing is supported by the 2019 Global Consensus Position Statement on Testosterone Therapy for Women (Davis et al., published across multiple major endocrine societies) and by clinical guidelines from the International Society for the Study of Women's Sexual Health (ISSWSH). Off-label prescribing is a legal and common part of medicine, but it requires informed consent, careful dosing, and ongoing lab monitoring — all of which we provide. Read more in our off-label prescribing disclosure.
Who Benefits
Who we consider for testosterone therapy.
The strongest evidence for testosterone in women is in postmenopausal hypoactive sexual desire disorder (HSDD). Outside that specific indication, evidence is weaker and we are more cautious. A visit does not guarantee a prescription — we decide together after evaluation.
HSDD (main evidence-based indication)
Hypoactive Sexual Desire Disorder: persistent, distressing loss of sexual desire not better explained by relationship, medication, or medical factors. The indication with the strongest clinical-trial support for testosterone in women.
Low libido after menopause
Natural or surgical menopause can drop sexual interest sharply. When this is distressing and other causes are addressed, physiologic testosterone can help restore desire and arousal.
Fatigue and low energy
Persistent fatigue that is not explained by iron, thyroid, sleep apnea, or depression may respond to testosterone in appropriate candidates — though evidence here is weaker than for HSDD.
Loss of vitality and drive
A loss of "spark," motivation, and initiative that emerges in midlife, especially alongside other hormonal changes. Treated cautiously, with honest counseling about mixed evidence.
Mood changes in midlife
Low mood, irritability, or flatness that is not well-explained by traditional depression. We evaluate mental-health causes first and consider testosterone as part of a broader hormone and mood plan when appropriate.
Cognitive "flatness"
A loss of mental sharpness, word-finding, or sustained concentration. Evidence for testosterone and cognition in women is limited — we are transparent about what we do and do not know.
Post-hysterectomy patients
Especially women who had their ovaries removed (bilateral oophorectomy). Ovarian removal can meaningfully reduce circulating androgens, and replacement is often appropriate with symptoms and supportive labs.
Post-cancer survivors (careful screening)
Some breast and gynecologic cancer survivors may be candidates, but only after careful review with the oncology team. Active or recent androgen-sensitive cancers are a contraindication.
- Absolute contraindications: pregnancy (FDA category X), breastfeeding, active or recent androgen-sensitive cancer (including some breast cancers), severe hepatic disease, and known hypersensitivity to any component of the prescribed preparation.
- Use caution: history of polycythemia or elevated hematocrit, severe acne, androgenic alopecia, unstable cardiovascular disease, or concerning clinical features of hyperandrogenism.
- Monitoring is required while on therapy: baseline and repeat labs, and assessment for virilization at every follow-up.
- Testosterone will not improve symptoms that are not caused by androgen insufficiency. We decide together whether to continue based on response.
If there is any chance of pregnancy, testosterone is not appropriate. Testosterone can cause virilization of a female fetus and is classified FDA category X. Reliable contraception is expected in patients who can become pregnant and are choosing treatment.
Treatment Options
Physiologic dosing, carefully titrated.
Our goal is the upper quartile of the physiologic female range for total testosterone — not a male level, not a supraphysiologic "peak." This target balances likelihood of symptom benefit against the risk of virilization and adverse effects.
Transdermal compounded testosterone cream (our preferred approach).
- Typical starting dose: 2 to 5 mg of testosterone cream applied daily to a consistent site (usually the inner thigh or lower abdomen).
- Compounded by a reputable compounding pharmacy at a concentration that allows fine titration.
- Steady-state absorption is reached in 4 to 6 weeks. We recheck labs at that point.
- Dose can be adjusted up or down week to week based on symptoms, labs, and side-effect profile. That flexibility is the main reason we prefer cream over pellets.
- Avoid skin-to-skin transfer to children, partners, and pets at the application site for at least 2 hours after application; wash hands after applying.
Why we generally avoid pellets.
- Subcutaneous testosterone pellets frequently deliver supraphysiologic blood levels (above the normal female range), sometimes several times higher than a physiologic target.
- Dosing cannot be adjusted once the pellet is implanted. If a patient develops virilization, acne, or elevated hematocrit, there is no way to dial it back — you wait it out.
- Variability between patients and between insertions is high. Many major professional bodies specifically caution against pellet use in women.
- We do not offer pellet insertion. If you are using pellets from another provider and want a consult, we are happy to review your labs and help you transition to a monitored cream regimen.
DHEA considerations.
- DHEA is a precursor that can convert to testosterone and estrogen. It is sold over the counter, which does not mean it is inert.
- Evidence for symptomatic benefit in women is mixed and generally weaker than for testosterone itself.
- We sometimes consider low-dose DHEA in specific situations, but we do not use it as a substitute for direct testosterone monitoring.
Combining with estradiol and progesterone.
- Testosterone is often one piece of a broader hormone plan. Many patients benefit from estradiol (with micronized progesterone if the uterus is intact) alongside testosterone.
- See our menopause HRT page for estradiol and progesterone, and our perimenopause treatment page for transition-phase care.
- Combining hormones is standard, not experimental — but it means more labs and more touchpoints, which we plan for.
Monitoring
Labs and clinical monitoring.
Baseline labs
Before starting: total and free testosterone, SHBG, complete metabolic panel, lipid panel, and CBC. Thyroid function and vitamin D if not recently checked. These catch alternate causes and establish your starting point.
6-week lab check
Total and free testosterone repeated approximately 6 weeks after starting therapy. We aim for the upper quartile of the normal female reference range, not above it. Dose adjusted as needed before the next visit.
Ongoing every 6 months
Recheck testosterone, SHBG, CBC, and lipids every 6 months once stable. We reassess benefit, side effects, and whether to continue, adjust, or stop treatment.
- Acne — especially new or worsening inflammatory acne on the jawline, chest, or back.
- Hirsutism — new or increased coarse, dark hair on the face, chin, chest, abdomen, or inner thighs.
- Scalp hair thinning — particularly at the crown or temples (androgenic pattern).
- Voice changes — deepening or hoarseness. This can be irreversible; we act early.
- Clitoral changes — clitoromegaly. Also potentially irreversible; we taper or stop at the first sign.
- Elevated hematocrit — picked up on routine CBC; managed by dose reduction or discontinuation.
- Mood or sleep changes — irritability, anxiety, or insomnia that tracks with dose.
Our Approach
How treatment works here.
Comprehensive evaluation
First visit reviews your symptoms, medical history, current medications, and prior hormone work. We order or review baseline labs and rule out contributors like thyroid disease, iron deficiency, depression, or sleep disorders. Informed consent for off-label use is part of the visit.
Start low, titrate carefully
If testosterone is appropriate, we start transdermal cream at a physiologic dose, typically 2 to 5 mg daily. Follow-up at 6 weeks with repeat labs. Dose is adjusted based on symptoms, levels, and tolerability — not on a fixed protocol.
Honest reassessment
If you are not benefiting at a therapeutic level by 6 months, we stop rather than continue indefinitely. If you are, we move to every-6-month monitoring. You stay in control of the decision, and the reasoning is always shared.
Pricing
Transparent, self-pay pricing.
Initial Visit
- Full history and symptom review.
- Baseline lab orders (total and free testosterone, SHBG, CMP, lipids, CBC).
- Informed-consent discussion for off-label use.
- Prescription and pharmacy coordination if appropriate.
Follow-Up Visit
- Symptom and side-effect review.
- Lab review and dose adjustment.
- Virilization screening at every visit.
- Prescription renewal and pharmacy coordination.
Testosterone therapy for women is a self-pay service — it is not billed to insurance. Lab costs and pharmacy costs are separate from visit fees and vary with your insurance and pharmacy of choice. A good-faith estimate is available on request.
Nebraska patients only.
We see patients in person at our Papillion, Nebraska office and by secure telehealth for patients physically located in Nebraska. Testosterone therapy for women is not available in the other 15 states where we provide other services. Please book a different service if you are outside Nebraska.
Note: Council Bluffs patients are welcome in person at our Papillion office; telehealth visits require the patient to be physically located in Nebraska at the time of the appointment.
FAQ
Common questions.
Is testosterone therapy for women legal?
Yes. Prescribing testosterone to women is legal in the United States, but it is considered off-label because the FDA has not approved any testosterone product specifically for women. Off-label prescribing is a common, legal, and accepted part of medicine when supported by clinical evidence. It is supported by the Global Consensus Position Statement (Davis et al., 2019) and ISSWSH guidelines. See our off-label disclosure.
Why only Nebraska?
Testosterone for women is off-label, and acceptance of off-label prescribing varies between state boards of nursing, medicine, and pharmacy. Our practice currently offers this treatment only to patients physically located in Nebraska. It is not available in the other 15 telehealth states we serve for other services.
What is HSDD?
Hypoactive Sexual Desire Disorder is a persistent or recurring deficiency of sexual desire that causes distress and is not better explained by another medical condition, medication, or relationship factor. HSDD in postmenopausal women is the specific indication with the strongest evidence supporting testosterone therapy.
Will testosterone make me look masculine?
At the physiologic doses we prescribe (2 to 5 mg of transdermal cream daily, targeting the upper quartile of the normal female range), virilization is uncommon. We monitor at every visit for early signs — acne, increased facial or body hair, scalp thinning, voice changes — and adjust or stop treatment if they appear. Most concerns about masculinization come from supraphysiologic dosing, especially pellets, which we do not use.
Are pellets safe?
Testosterone pellets for women are controversial. Pellets frequently produce supraphysiologic blood levels, carry a higher risk of virilization, and cannot be dose-adjusted once implanted. We generally do not use pellets. Our preferred approach is transdermal compounded cream at a physiologic dose that can be titrated week to week based on symptoms and labs.
Do you monitor with labs?
Yes. Baseline labs include total and free testosterone, SHBG, a complete metabolic panel, a lipid panel, and CBC. We repeat total and free testosterone at 6 weeks, then every 6 months. Clinical monitoring for virilization happens at every visit.
How long before it works?
Most patients who are going to respond notice a change in desire, arousal, or energy within 8 to 12 weeks. Clinical trials evaluate response at 12 to 24 weeks. If there is no benefit by 6 months at a therapeutic level, we stop rather than continue indefinitely.
Can I combine testosterone with estradiol?
Yes — many women benefit from estradiol (with progesterone if the uterus is intact) plus testosterone together. See our menopause HRT page and our perimenopause treatment page for how estrogen and progesterone fit into the overall plan.
Low libido is not just in your head.
If you are a Nebraska patient and your energy, drive, or desire have changed and you want a real evaluation, we can help. Off-label, physiologic dosing, honest monitoring, and transparent pricing.
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