Why Canadian doctors are cautious about testosterone for menopause and what the science actually shows

This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

Testosterone is not approved by Health Canada or the U.S. Food and Drug Administration to treat menopause symptoms, yet a September 2026 Reuters report documented a measurable rise in off-label testosterone prescriptions for women in North America, and on September 17, 2026, the FDA held a public workshop calling on drugmakers to produce women-specific research. For Canadian patients, that regulatory gap is the starting point: no Health Canada-approved testosterone product is indicated for menopause, which means any prescription a Canadian woman receives is off-label, sits outside provincial pharmacare formularies in most provinces, and comes with limited long-term safety data.

The practical consequence is real. A woman in Ontario, British Columbia, or Alberta who asks her family doctor about testosterone for hot flashes, low libido, or fatigue will likely be told the same thing: the evidence is not strong enough to recommend it routinely, and provincial drug plans such as OHIP, MSP, and AHCIP do not cover it for this indication. Private menopause clinics, including those operating in Canada such as Science & Humans (scienceandhumans.com), Cleo, and Maple, may offer off-label testosterone as part of a broader hormone assessment, but patients typically pay out of pocket.

What this means in Canada

Health Canada has not approved any testosterone formulation specifically for menopausal women. Products that exist on the Canadian market are approved for other indications, and physicians who prescribe them for menopause do so off-label under their own clinical judgment. The Society of Obstetricians and Gynaecologists of Canada (SOGC) has not issued a position statement specifically endorsing testosterone for menopause symptom management. The SOGC did back the removal of U.S. black-box warnings on conventional menopausal hormone therapy (MHT) last year, signalling support for estrogen and progesterone options, but that statement did not extend to testosterone.

Provincial pharmacare programs generally do not list testosterone for menopause on their formularies. Quebec's RAMQ, Ontario's OHIP-linked drug benefit programs, and British Columbia's PharmaCare all cover MHT products containing estradiol (sold in Canada as Estrace or the Estradot patch) and progesterone (Prometrium), but testosterone for this purpose falls outside standard coverage. Women who obtain it pay privately, and compounded testosterone preparations from Canadian compounding pharmacies add another layer of variability in dosing and quality.

The Canadian Menopause Society, through board member Dr. Shafeena Premji, founder and medical director of the Milestone Menopause Centre of Southern Alberta, has been direct on this point. Most research on testosterone and menopause focuses narrowly on post-menopausal women with hypoactive sexual desire disorder (HSDD), a condition defined as low sexual desire causing personal distress. That is a specific, diagnosable condition. It is not a synonym for the full range of menopause symptoms being marketed to women on social media.

What changed

The immediate trigger for renewed debate is the FDA's September 17, 2026 public workshop on testosterone use in menopausal women, where Dr. Dorothy Fink of the Eunice Kennedy Shriver National Institute of Child Health and Human Development said women deserve testosterone options formulated and dosed specifically for them. That statement reflects a real gap: virtually all testosterone products on the market were developed for men, and dosing for women is extrapolated downward rather than studied independently.

At the same workshop, Rajita Patil, director of the UCLA Comprehensive Menopause Care Program, stated there is insufficient data to recommend testosterone for mood, cognition, or general well-being in menopausal women. Oral testosterone was specifically flagged as problematic because of unfavourable effects on cholesterol. The FDA is accepting public comment through mid-October 2026, though a full regulatory decision could take considerably longer.

Meanwhile, social media has moved faster than regulators. Influencers and some physicians have promoted testosterone as a solution to fatigue, brain fog, weight gain, and low libido during perimenopause. Perimenopause is the multi-year transition before menopause when hormone levels fluctuate unpredictably, typically beginning in a woman's forties. The problem, as Dr. Marie Christakis, a gynecologist and researcher at the Weston and O'Born Centre for Mature Women's Health at Mount Sinai Hospital in Toronto, told CBC News, is that the salesmanship of hormone therapy has outrun the evidence just as surely as the old fears did.

What Canadian patients should know

The one scenario where Canadian researchers express the most clinical agreement on testosterone is surgical menopause: women who have had their ovaries removed lose the steady, gradual testosterone production that intact ovaries maintain into older age. Dr. Jerrilyn Prior, professor emerita of endocrinology and medicine at the University of British Columbia, told CBC News that testosterone may be necessary and helpful in that specific situation. For women going through natural menopause, the physiological case is weaker because testosterone levels decline gradually over decades, not sharply the way estrogen does.

For women experiencing low libido specifically, the evidence base is stronger than for other symptoms, though still not sufficient for Health Canada approval. The Canadian Menopause Society and the Menopause Society (formerly the North American Menopause Society) both acknowledge a body of evidence supporting low-dose testosterone for HSDD in post-menopausal women, while stressing that long-term safety data remain limited.

Side effects at doses that cross into supraphysiological range include acne, excess hair growth, oily skin, and voice changes. These are not hypothetical. They reflect what happens when dosing is imprecise, which is a genuine concern when products are compounded or when male-formulated products are used at reduced doses without validated female-specific pharmacokinetic data.

Women in Canada who want a thorough menopause assessment have access to specialized clinics. The Complex Menopause Clinic at BC Women's Hospital has seen more than 1,000 patients since opening in January 2025. A Winnipeg clinic is planned for 2027. Privately, platforms such as Science & Humans, Cleo, and Maple offer virtual menopause consultations, though coverage and prescribing practices vary. Patients should ask any prescriber specifically whether a proposed testosterone prescription is off-label, what monitoring is planned, and whether non-hormonal causes of their symptoms have been ruled out.

Dr. Premji's point about screening is worth holding onto: not every symptom that appears during perimenopause is caused by perimenopause. Thyroid disorders, mood disorders, sleep apnea, and medication side effects can all produce overlapping symptoms. A full clinical assessment before attributing everything to hormones is standard care, not an obstacle.

Limitations and open questions

The FDA's evaluation process is ongoing and could take years. Health Canada has not announced a parallel review, and the SOGC has not issued guidance specific to testosterone for menopause. The Canadian Institutes of Health Research (CIHR) has not, as of publication, funded a large Canadian trial on testosterone in menopausal women.

There is no long-term safety data on testosterone use in women comparable to the datasets that exist for estrogen. The cardiovascular and breast-tissue effects of sustained testosterone use in women are not well characterized. Compounded testosterone products, which are common in off-label prescribing, are not subject to the same manufacturing standards as Health Canada-approved drugs.

What the science does support, clearly, is that conventional MHT with estrogen and progesterone is effective and safe for most women under 60 or within 10 years of menopause onset, per the 2021 Journal of Obstetrics and Gynaecology of Canada guideline. Testosterone sits in a different category: plausible for specific indications, under-researched for broad use, and not yet endorsed by Canadian regulators or the SOGC for routine menopause care.

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This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

Editorial note

Hormone Journal articles are written by our editorial team and reviewed against published clinical guidelines, with a focus on Canadian patient access. We do not promote specific clinics or providers.