Inclusion Criteria:  Women, age 60 years and older. Chronic non-cancer back pain. Use of opioid analgesics for at least 6 months. Serum total testosterone <8.7 ng/dL and/or free testosterone <0.47 pg/mL. Normal mammogram within the last 12 months Endometrial thickness of <4 mm in women with an intact uterus assessed by endometrial ultrasound. Ability and willingness to provide informed consent.  Exclusion Criteria:  History of breast or endometrial cancer Estrogen therapy in the past 3 months Baseline hematocrit >48%. Serum creatinine >2.5 mg/dL. HbA1c >9.0%. Subjects on insulin therapy will be excluded. BMI >40 kg/m2. Uncontrolled congestive heart failure. Myocardial infarction, acute coronary syndrome, revascularization surgery or stroke within the past 3 months. History of genetic thromboembolic disorder. Diagnosis of bipolar disorder or schizophrenia. Use of testosterone, spironolactone, finasteride or systemic ketoconazole in the past 3 months.