Women increasingly turning to testosterone therapy to manage menopause symptoms are running into unexpected prescription delays and denials at pharmacies, according to interviews with more than half a dozen doctors, nurses, and patients. The trend highlights a widening gap between rapidly rising patient demand and a regulatory and pharmacy system that was never built to accommodate it.
A Prescription Boom With No FDA-Approved Product
There is no U.S.-approved testosterone product for women. Its off-label use is climbing anyway, primarily to treat persistently low sexual desire related to menopause, currently the only condition for which medical guidelines and evidence of efficacy exist. Some clinicians are also prescribing it for other menopause-related symptoms, including fatigue and loss of muscle strength, despite a lack of medical guidance supporting that use.
An exclusive data analysis conducted for Reuters by healthcare analytics firm Truveta found the rate of women receiving a testosterone prescription jumped 146 percent, nearly tripling, between January 2023 and July 2026. That surge is unfolding alongside a broader rise in hormone therapy use overall, driven partly by social media interest and partly by the FDA’s recent decision to back estrogen and progesterone use for menopause symptoms as safe and effective. Some clinicians now prescribe testosterone alongside those therapies as part of a broader treatment approach.
What Doctors Say Testosterone Can and Can’t Do
The gap between patient interest and clinical evidence is significant. The Menopause Society and roughly half a dozen other medical organizations back testosterone use in menopausal women only for hypoactive sexual desire disorder, a specific diagnosis involving persistent, distressing low libido.
“We do not have any evidence in women that it will improve muscle mass or bone density or mood.”
— Dr. Stephanie Faubion, Director, Mayo Clinic Center for Women’s Health
Faubion, who is also medical director of The Menopause Society, added that what testosterone is being promoted for in the lay public and on social media doesn’t match the data currently available.
Why Prescriptions Are Getting Rejected
Part of the problem is structural. Because no testosterone product is formulated specifically for women, patients often must divide packaged versions designed for men, frequently formulated at doses many times higher than what a woman would need. That dose-splitting requirement has become a flashpoint with some major pharmacies.
Jennifer Lanoff, a women’s health nurse practitioner in Washington, D.C., said Amazon Pharmacy began rejecting prescriptions from her practice for the first time this year, adding that she wasn’t given a clear explanation beyond being told it reflected a new policy.
“We’ve done off-label testosterone prescriptions forever. It’s clinical guidelines recommended.”
— Jennifer Lanoff, Women’s Health Nurse Practitioner
Amazon Pharmacy said it does not dispense certain testosterone prescriptions that require women to customize doses, citing a need to ensure safe and compliant dispensing. The company said the policy isn’t specific to testosterone or based on a patient’s sex or gender identity, and that it refers affected customers to compounding pharmacies capable of mixing specialized doses instead.
The Financial Toll: Compounded Costs and Insurance Gaps
That referral comes with a real cost difference. Compounded testosterone can run about $100 for a three-month supply, compared with roughly $30 after discounts for a ten-month supply at a standard commercial pharmacy, according to Lanoff. Most insurance companies don’t cover testosterone for women at all, according to the doctors, nurses, and patients interviewed, leaving many paying out of pocket regardless of which pharmacy route they take.
Magen Price, a nurse practitioner and founder of Mystic Valley Sexual Wellness, said more than a third of the roughly 80 patients in her practice currently using testosterone have run into prescription issues, including at CVS and Walgreens locations. She said the problems, which first emerged last year, have continued to worsen.
One Patient’s Frustrating Experience
For patients, the practical impact can mean weeks of delay over what should be a routine pharmacy visit. Amy Swan, a 55-year-old graphic designer outside Boston, expected a straightforward experience when she tried to fill her first testosterone gel prescription in March. Instead, she spent weeks trying to get a pharmacy to honor a GoodRx discount coupon that would have cut her cost by 25 percent.
“Hours of my time were lost just being able to get this one prescription.”
— Amy Swan, Patient
CVS said its pharmacies regularly fill prescriptions for topical testosterone gel for women. Walgreens, Costco, and Walmart did not respond to requests for comment, and Kroger declined to comment.
A Pharmacist’s Perspective on Why This Happens
Not every rejection reflects arbitrary policy. Kevin Schipper, a pharmacist and director of product lifecycle management at consulting firm ProPharma, said pharmacies may decline these prescriptions over legitimate concerns about dosing accuracy, medication safety, and the stability, storage, and contamination risks that come with opening and reusing single-use packaging not designed for splitting.
Testosterone is also a controlled substance, regulated similarly to aspirin with codeine, meaning each state imposes its own record-keeping requirements that pharmacies must satisfy regardless of how routine the underlying prescription may seem clinically.
The Political and Regulatory Backdrop
The surge in prescriptions arrives alongside a notable political dimension. The FDA is holding a public workshop Thursday to review evidence for testosterone use in menopausal women, an effort that has been promoted by Health Secretary Robert F. Kennedy Jr. and Defense Secretary Pete Hegseth, who has separately made testosterone levels among U.S. troops a personal area of focus. While healthcare providers remain free to prescribe approved medicines off-label as they see clinically appropriate, an FDA spokesperson noted that these particular uses have not been evaluated by the agency for safety, efficacy, or proper dosing in women.
What’s in the Pipeline
The clinical research pipeline suggests the current gap may eventually close. More than 30 trials studying testosterone use for various health conditions in women are underway or planned, according to ClinicalTrials.gov, including a sexual dysfunction trial sponsored by Marius Pharmaceuticals expected to begin as soon as later this year. Separately, Aviva Bio is developing a next-generation testosterone product specifically designed to address breast cancer risk associated with hormone use, a concern that has shadowed testosterone therapy research for years.
Currently available products used off-label by women include branded and generic testosterone gels such as AbbVie’s AndroGel, Keenova Therapeutics’ Testim, and Upsher-Smith’s Vogelxo, none formulated with women’s dosing needs in mind. Upsher-Smith declined to comment on whether it plans to develop a testosterone product specifically for women; AbbVie and Keenova did not respond to requests for comment.
What Comes Next
Cynthia Stuenkel, a clinical professor of medicine at the University of California, San Diego, said she hopes the FDA prioritizes evaluating a testosterone product actually designed for women, rather than leaving clinicians and patients to keep working around products built for men. She said such a product would make it considerably easier for clinicians to prescribe testosterone confidently and for women to use a version specifically dosed for their needs.
Until that happens, the pattern documented across these interviews is likely to persist: rising patient demand for a treatment with narrow, well-defined clinical evidence behind it, colliding with a pharmacy and insurance system built around products that were never designed for the patients now seeking them.
This article is for general informational purposes and is not medical advice. Anyone considering hormone therapy should discuss their individual health history with a qualified healthcare provider.