Testosterone and Libido in Women: What the Evidence Shows
The short answer
Testosterone contributes to sexual desire in women, but a blood level alone can't tell you whether low libido is caused by low testosterone. In postmenopausal women with distressing low desire, a 2019 meta-analysis of 36 trials found testosterone therapy added about 0.85 satisfying sexual events per month versus placebo, and international guidelines support it only for that use.
What does testosterone do in women?
Women make testosterone every day, in the ovaries and adrenal glands, and also convert it from precursor hormones such as DHEA. Blood levels are far lower than in men, but testosterone acts on androgen receptors throughout the body, including in brain areas involved in sexual motivation and in genital tissue. It is also a raw material the body uses to make estrogen.
Testosterone is one input to desire among many. Sexual interest in women is shaped by estrogen, mood, sleep, stress, pain, medications, body image and the quality of the relationship. That is why fixing a hormone level rarely fixes low libido on its own, and why a careful clinician looks at the whole picture first (Clayton 2018). For the broader hormonal picture, see how hormones affect sexual desire.
When do testosterone levels drop?
Testosterone in women declines gradually with age, starting in the 20s and 30s. Natural menopause does not cause a sudden drop, because the ovaries keep making some testosterone afterward. A few situations do cause larger falls:
- Removal of both ovaries (surgical menopause) causes an abrupt drop, and some of the earliest testosterone trials were in this group (Shifren 2000).
- Oral estrogen, including combined birth control pills and oral menopausal hormone therapy, raises sex hormone-binding globulin (SHBG), a protein that binds testosterone and leaves less of it free.
- Some medical conditions and medicines, such as adrenal or pituitary disorders, long-term steroids and opioids, can lower androgen levels.
Can a blood test show whether low testosterone is causing low libido?
Testing still has a role. Guidelines recommend checking a baseline level before starting testosterone, then rechecking after a few weeks to make sure the dose keeps levels within the normal range for premenopausal women, not higher (Parish 2021). The point of testing is safety, not diagnosis.
Symptoms such as fatigue, low mood, brain fog or trouble building muscle are often blamed on "low T," but they overlap with thyroid disease, iron deficiency, depression, sleep problems and perimenopause. These are worth evaluating properly, but testosterone therapy is not recommended to treat them. Our guide to low testosterone in women covers symptoms and testing in more detail.
Does testosterone therapy improve libido in women?
For one group, yes, modestly. A 2019 meta-analysis pooled 36 randomized trials with 8,480 women (Islam 2019). In postmenopausal women, compared with placebo or a comparison treatment, testosterone:
- added about 0.85 satisfying sexual events per month
- improved desire, arousal, orgasm, pleasure and sexual self-image
- reduced sexual concerns and distress
By the numbers
Testosterone trials, pooled
The same review found too little data to recommend testosterone for premenopausal women, and no evidence that it improves body composition, muscle strength, bone or cognition. Long-term safety beyond about two years is unknown.
How is testosterone prescribed for women?
| Form | What guidelines say |
|---|---|
| Transdermal gel or cream, approved product at a female dose | Preferred route; aim for blood levels within the normal premenopausal female range |
| Oral testosterone | Not recommended; it worsened cholesterol (higher LDL, lower HDL) in trials |
| Compounded creams | Not recommended where an approved product can be dosed for women, because strength can vary |
| Pellets and injections | Not recommended; they can push levels well above the female range for long periods |
In the US, no testosterone product is FDA-approved for women, so all prescribing is off-label. Clinicians who follow the guidelines commonly use a small fraction of a dose of a product approved for men, with regular blood tests. If you're weighing pellet therapy, our hormone pellet side effects guide explains why dose control matters.
What are the risks of testosterone for women?
When levels stay in the normal female range, the main side effects in trials were acne and increased hair growth (Islam 2019). No serious adverse events were linked to testosterone in the pooled trials, but most lasted less than two years.
Higher-than-physiologic levels can cause:
- scalp hair thinning
- voice deepening
- clitoral enlargement
- unfavorable cholesterol changes, especially with oral forms
How does estrogen therapy fit in?
For many women in perimenopause and after menopause, the first sexual changes are physical: vaginal dryness, pain with sex, night sweats that wreck sleep. Those problems understandably drain desire, and testosterone doesn't treat them. Menopausal hormone therapy with estrogen, or low-dose vaginal estrogen for dryness and pain, often helps more with those symptoms.
The type of estrogen matters for testosterone. Oral estrogen raises SHBG and lowers free testosterone, while estrogen through the skin has much less effect. Some clinicians switch a woman with low desire from oral to transdermal estrogen before considering testosterone. In the trials, testosterone added benefit for women whether or not they were also taking estrogen. Our guide to painful sex after menopause covers the vaginal side.
What about DHEA?
DHEA is a precursor the body converts into testosterone and estrogen, and it's sold over the counter in the US. Oral DHEA has not shown a consistent benefit for libido in women with normal adrenal function, and supplement doses are not standardized. A low-dose vaginal DHEA insert is FDA-approved for painful sex after menopause, which is a different problem. See DHEA for women for the full evidence.
Non-hormonal prescription options for low desire
Testosterone isn't the only route, and it isn't an option for everyone. Two FDA-approved medicines act on brain signaling instead: Addyi (flibanserin), approved for women under 65 with HSDD, and Vyleesi (bremelanotide, or PT-141), approved for premenopausal women with HSDD. Our guide to PT-141 for women covers how bremelanotide works and its risks.
Amie offers Blys™, a compounded rapid-dissolve tablet that combines PT-141 with oxytocin and tadalafil, taken 30 to 60 minutes before intimacy for low desire and arousal, and made with women on antidepressants in mind. It contains no testosterone. Blys is not FDA-approved and its use is off-label. A licensed clinician reviews your history to decide whether it's appropriate, and because it contains tadalafil, it must never be used with nitrate medicines. Anyone with heart disease or blood pressure concerns needs careful review.
Questions to ask your clinician
- Do my symptoms fit HSDD, or could pain, sleep, mood, medications or relationship stress explain them?
- Am I postmenopausal, and if not, what are my options instead of testosterone?
- If we try testosterone, which product and dose will you use, and how will we monitor my levels?
- How long will we try it before deciding whether it's working?
- Does my personal or family history (breast cancer, heart disease) change the risks?
Common questions
Does low testosterone cause low libido in women?
It can contribute, but the link is loose. Studies don't show a testosterone level that separates women with and without low desire, which is why guidelines say not to diagnose low libido from a blood test.
Does testosterone therapy increase libido in women?
In postmenopausal women with hypoactive sexual desire disorder (HSDD), trials show a modest improvement in desire, arousal, orgasm and satisfying sexual events. There isn't enough evidence to recommend it for premenopausal women or for energy, mood or memory.
Is there an FDA-approved testosterone for women?
No. In the US, testosterone is not FDA-approved for women, so any prescription is off-label. Guidelines suggest using a carefully measured dose of an approved product rather than compounded creams or pellets, with blood levels checked to stay in the normal female range.
What are the side effects of testosterone in women?
The most common are acne and unwanted hair growth. At higher-than-physiologic doses, voice deepening, hair loss and clitoral enlargement can occur, and some changes may not reverse. Long-term safety beyond about two years hasn't been established.
Sources
- Davis SR et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab 2019
- Islam RM et al. Safety and efficacy of testosterone for women: systematic review and meta-analysis. Lancet Diabetes Endocrinol 2019
- Parish SJ et al. ISSWSH clinical practice guideline for systemic testosterone for HSDD in women. J Sex Med 2021
- Shifren JL et al. Transdermal testosterone in women with impaired sexual function after oophorectomy. N Engl J Med 2000
- Clayton AH et al. ISSWSH Process of Care for HSDD in women. Mayo Clin Proc 2018
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