Testosterone Beyond the Gym: Perimenopause, “Looksmaxxing,” and What the Evidence Actually Says

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Testosterone is no longer just a bodybuilding staple. In 2025–2026 it’s being marketed for perimenopausal symptom relief, “looksmaxxing,” and general vitality. The problem is that the evidence, dosing, and risk profiles differ dramatically between medically supervised therapy and appearance-driven use.

Why testosterone is back in the conversation for women

Testosterone levels in women decline with age, and many notice changes in sexual desire, energy, and body composition during perimenopause and menopause. The strongest, guideline-supported indication for testosterone in women is hypoactive sexual desire disorder (HSDD)—persistent, distressing low libido after other causes are addressed. Multiple randomized trials show that low-dose transdermal testosterone improves sexual desire, satisfying sexual events, and sexual satisfaction in postmenopausal women.Some women also report benefits for fatigue, brain fog, joint pain, and muscle strength. These claims are plausible—testosterone receptors exist in brain, muscle, bone, and joint tissue—but major guidelines still consider the evidence insufficient to recommend testosterone for these broader symptoms. Research is ongoing, and several 2025–2026 reviews emphasize that symptom relief likely comes from restoring physiologic (premenopausal female-range) levels, not from supraphysiologic dosing.

What safe, evidence-based use looks like

  • Who should consider it: Postmenopausal or late-perimenopausal women with HSDD, after optimizing other factors (sleep, mood, medications, relationship issues, vaginal dryness).
  • Formulation: Prefer transdermal preparations (cream/gel) designed or compounded for female dosing. Avoid pellets in women; they can produce unpredictable, high levels and are not FDA-approved for female use.
  • Dosing goal: Keep serum testosterone within the normal premenopausal female range. Benefits are tied to physiologic replacement; risks rise when levels exceed this range.
  • Monitoring and duration: Check baseline and follow-up levels, watch for androgenic side effects, and reassess benefit at 3–6 months. If there’s no meaningful improvement by six months, discontinue.
  • Side effects: Acne, increased facial/body hair, oily skin are most common. Less common but important risks at higher levels include scalp hair thinning, voice deepening, clitoral enlargement, and lipid changes. Short-term data are reassuring; long-term safety in women remains limited.

In short, testosterone is not a cure-all for perimenopause, but it is a reasonable, evidence-aligned option for HSDD when used carefully.

The “looksmaxxing” turn—and why clinicians are concerned

“Looksmaxxing” is an online subculture focused on maximizing physical attractiveness, often via rapid or extreme changes. Recent coverage highlights that some participants pursue testosterone shots alongside other interventions to alter appearance (e.g., more muscle, sharper jawline).

For men without diagnosed hypogonadism, exogenous testosterone suppresses the hypothalamic–pituitary–gonadal axis, lowering endogenous production and sperm production. Known side effects include reduced sperm count, testicular atrophy, and impaired fertility. Other risks—especially at higher doses—include acne, hair loss, irritability, hypertension, and metabolic/lipid effects.

Mental health is another concern. Excessive appearance preoccupation is linked to anxiety, depression, body dysmorphia, and disordered eating. Social-media-driven appearance focus can amplify these risks, turning “self-improvement” into a harmful cycle.

Practical takeaways for a wide audience

  • For women with distressing low libido in perimenopause/menopause: discuss HSDD evaluation and, if appropriate, low-dose transdermal testosterone with monitoring.
  • For general perimenopausal symptoms (hot flashes, sleep, mood): testosterone is not first-line; established therapies remain primary.
  • For aesthetic “maxing” goals: avoid self-directed testosterone. The endocrine and fertility risks are real, and benefits are uncertain compared with supervised care.

Testosterone’s move from the gym to mainstream wellness isn’t inherently bad—but it does demand clarity about indication, dose, and monitoring. Used wisely, it can help specific patients; used as a shortcut for appearance, it can create new problems faster than it solves old ones.

Mykola Iabluchanskyi together with Andriy Yabluchanskiy


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