Why Canadian women are turning to testosterone for menopause and what the evidence 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 for menopause symptoms, yet a Reuters report published September 15, 2026 documented a measurable rise in off-label prescriptions for women across North America, and a CBC News investigation published the same week found multiple Canadian researchers and clinicians pushing back on social media claims that the hormone is a broad fix for perimenopause. For Canadian patients, the practical upshot is this: testosterone can be prescribed off-label by a licensed Canadian physician, but no provincial drug plan covers it for menopause indications, no Health Canada product is formulated specifically for women at menopause doses, and the clinical societies that guide Canadian gynaecology practice have not endorsed its routine use.

Perimenopause is the multi-year transition before menopause when hormone levels fluctuate unpredictably, producing symptoms that range from hot flashes and insomnia to mood changes and low libido. Menopause itself is confirmed when a woman has gone 12 consecutive months without a period. Both stages are now better served by approved hormone therapies than they were a decade ago, but that progress has also opened space for less-studied options to gain traction online.

What this means in Canada

Health Canada has not approved any testosterone product specifically for menopausal women. Physicians can prescribe testosterone off-label using compounded formulations or products approved for other indications, but patients pay out of pocket in virtually every province. OHIP, RAMQ, MSP, and AHCIP do not list testosterone for menopause among covered benefits, and Canada's national pharmacare framework, still in early rollout as of 2026, does not include it.

The Society of Obstetricians and Gynaecologists of Canada (SOGC) has not issued a standalone position statement on testosterone for menopause. The SOGC did back the removal of black-box warnings on conventional menopausal hormone therapy in 2025, a move that reflected growing confidence in estrogen and combined estrogen-progesterone regimens. That endorsement does not extend to testosterone.

The Canadian Menopause Society is more specific. Dr. Shafeena Premji, founder of the Milestone Menopause Centre of Southern Alberta and a board member of the Canadian Menopause Society, told CBC News that testosterone has never been part of the standard therapy framework for menopause. Most of the research that does exist focuses narrowly on post-menopausal women with hypoactive sexual desire disorder, a condition defined as low libido causing personal distress. Outside that indication, Premji said, "we can't make false claims and promise things to women when we don't actually have the research to back that up."

Canadian telehealth platforms including Cleo (a Canadian women's health platform), Felix, and Science and Humans (scienceandhumans.com) have expanded menopause hormone services in recent years. None currently lists testosterone as a standard menopause offering, though compounding pharmacies across Canada will fill prescriptions written by licensed physicians. US-only platforms such as Midi Health and Winona do not serve Canadian patients.

What changed

On September 17, 2026, the US Food and Drug Administration (FDA) held a public workshop on testosterone use in menopausal women, the first formal regulatory review of the question in the United States. Dr. Dorothy Fink of the Eunice Kennedy Shriver National Institute of Child Health and Human Development told the workshop that "women deserve to have testosterone options that are formulated and dosed specifically for them." The FDA is now accepting public comment through mid-October, though a full regulatory decision could take years.

The FDA review is US-specific. Health Canada has not announced a parallel process. However, Canadian regulators typically monitor FDA proceedings closely, and a US approval would likely accelerate pressure on Health Canada to evaluate the evidence independently.

The broader backdrop is a genuine rehabilitation of menopausal hormone therapy. A 2002 US clinical trial appeared to show that combined estrogen-progesterone therapy raised risks of breast cancer, heart disease, and stroke. Later analysis found the trial had focused on older post-menopausal women whose baseline risk was already elevated, skewing the results. A 2021 guideline in the Journal of Obstetrics and Gynaecology Canada identified menopausal hormone therapy as the most effective option for managing hot flashes and related symptoms, and said it can be used safely in most women under 60 or within 10 years of menopause. That rehabilitation created a more receptive environment for hormone conversations generally, and testosterone rode that wave.

What Canadian patients should know

The strongest evidence for testosterone in menopausal women applies to one specific group: women who have had their ovaries surgically removed. Dr. Jerrilyn Prior, professor emerita of endocrinology and medicine at the University of British Columbia, explained to CBC News that unlike estrogen and progesterone, which drop sharply at menopause, testosterone declines gradually over decades beginning in a woman's early-to-mid thirties. The ovaries continue producing testosterone at lower levels well past menopause. Women who have had an oophorectomy lose that production entirely, which is why Prior said testosterone "is necessary, and very helpful" in that specific situation.

For women with intact ovaries, the picture is less clear. Rajita Patil, director of the UCLA Comprehensive Menopause Care Program, told the FDA workshop there is insufficient data to recommend testosterone for mood, cognition, or general well-being. Oral testosterone is not recommended at all because of unfavourable effects on cholesterol. Topical formulations carry a narrow margin between a therapeutic dose and doses that produce unwanted androgenic effects: increased body hair, oily skin, and scalp changes.

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, framed the problem plainly: "In the past, a lot of the fear around hormone therapy was really not based on evidence. And now a lot of the salesmanship of hormone therapy is also not based on evidence."

Premji also cautioned that not every symptom in midlife is a menopause symptom. Thyroid disorders, mood disorders, medication side effects, and other medical conditions can produce fatigue, low libido, and cognitive changes. A full health assessment before attributing symptoms to perimenopause is standard practice at Canadian menopause clinics, including the Complex Menopause Clinic at BC Women's Hospital, which opened in January 2025 and had seen more than 1,000 patients across British Columbia by the time of this report.

Provincial access to menopause specialists varies. Alberta, British Columbia, Ontario, and Quebec have dedicated menopause clinics; wait times in smaller provinces can be long. Telehealth options through Maple and Telus Health can connect patients with physicians who have menopause training, though coverage for consultations varies by province.

Limitations and open questions

The FDA review is ongoing and its outcome is uncertain. Health Canada has not announced any review timeline. The SOGC has not issued a position statement specific to testosterone in menopause. Long-term safety data for testosterone in women, particularly for cardiovascular outcomes and hormone-sensitive cancers, does not yet exist at the scale that informed the current guidance on estrogen therapy. The Canadian Institutes of Health Research (CIHR) has not announced dedicated funding for women-specific testosterone trials as of this publication date.

What is known is that the social media conversation has moved faster than the clinical evidence. That gap is the reason multiple Canadian researchers contacted by CBC News asked for more rigorous, women-specific research before broader prescribing becomes routine.

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.