Testosterone may have a role in carefully selected patients—but chronically high levels, especially from non-FDA-approved formulations like pellets, carry real risks. Possible permanent side effects when testosterone levels are too high in women include: • Deepening of the voice • Facial and body hair growth • Male-pattern hair loss • Clitoral enlargement Other concerns: • Lipid changes and cardiovascular risk • Mood changes (irritability, aggression) • Difficulty controlling dosing with pellets