Testosterone and Low Libido: What Actually Works for Women

Your sex drive has disappeared. Your energy feels flat. You love your partner, but your body won't cooperate. You've probably heard about testosterone (that hormone that's been declining since your twenties) and you're wondering if it's worth trying testosterone replacement therapy

What You'll Learn in This Article

Can testosterone actually help my low sex drive? Yes. Research backs it for improving sexual desire, arousal, and satisfaction in postmenopausal women. It's the one thing testosterone reliably helps with. (5)

Will it give me more energy or help with weight loss? The research says no. Some women report feeling more energetic, but the evidence so far doesn't support testosterone for fatigue, mood, weight loss, or anti-aging. Unfortunately, there are very few rigorous studies on testosterone use in women.

Is it safe? Yes, At physiologic doses (normal female levels) with proper monitoring,. Side effects are typically mild: acne, slightly oily skin, minimal head hair growth.

How long before I notice changes? Most women see improvements between 4 and 12 weeks.

What if I don't notice anything? That happens. Testosterone replacement therapy (TRT) doesn't work for everyone. That’s why it’s important to work with a clinician who takes a holistic and hands-on approach. 

The Testosterone You've Always Had

Testosterone is something your body has been making since birth, and plays an important role even at low levels. (3) Your ovaries and adrenal glands produce it throughout your life, with peak levels hitting in your late teens and early twenties. By the time you reach menopause, those levels have dropped to about half of what they used to be.

Testosterone supports sexual interest and arousal, energy and motivation, muscle strength and bone health, mental clarity, and general vitality. Not everyone with declining testosterone has symptoms. But plenty of women notice their sexual desire going quiet, their body not responding during sex, or their energy feeling flat in a way that's hard to pin down.

The decline happens gradually. In your thirties, testosterone production starts slowing down. By perimenopause, the drop accelerates. After menopause, when your ovaries essentially stop producing estrogen, they still make small amounts of testosterone but it's nowhere near what it used to be. This hormonal shift affects women differently. Some barely notice. Others feel like they've lost a fundamental part of themselves.

What the Research Actually Shows

Testosterone has one proven medical use in postmenopausal women: Hypoactive Sexual Desire Disorder (HSDD), a persistent drop in sexual desire that bothers you and affects your life or relationships.

Major medical groups agree testosterone can help. Research shows it increases spontaneous sexual desire, improves arousal, leads to more frequent orgasms, boosts sexual satisfaction, and restores confidence about sexual response. Changes typically show up between 4 and 12 weeks. Not dramatic overnight shifts but more like a gradual return.

Women on aromatase inhibitors for breast cancer who were experiencing sexual dysfunction reported meaningful improvements with intravaginal testosterone: they felt a difference in their daily lives, not just on paper. (4)

What testosterone hasn’t been proven yet to reliably help: depression, chronic fatigue, weight loss, cognitive problems, or motivation. Some women report feeling more energetic or clear-headed. Others notice nothing. Testosterone helps specific symptoms, and sexual desire is the strongest one.

The research on energy and mood is mixed at best. While testosterone does play a role in overall vitality, studies haven't found consistent evidence that supplementing it helps with fatigue or depression in postmenopausal women without sexual dysfunction. If you're exhausted or struggling with mood, testosterone probably isn't the answer.

How Treatment Works

No FDA-approved testosterone products specifically for women; clinicians use off-label low-dose transdermal therapy.(1) The goal is restoring testosterone to normal female levels, what you'd have had in your thirties. This is called physiologic dosing.

In our opinion, clinicians should use gels or creams that absorb through the skin. They avoid pellets, injections, or oral testosterone because those create unpredictable hormone swings and, in the case of pellets inserted under the skin, are very hard to adjust. Women like creams or gels that they apply to their skin because they're easy to use and highly adjustable. If it feels too strong, you can change the dose the next day.

The typical approach involves applying a small amount of gel ( a fraction of the male dose) to either one of your extremities or your trunk daily. The testosterone absorbs through the skin and enters the bloodstream gradually, mimicking how your body would naturally produce it. This method avoids the spikes and crashes you'd get with injections or pellets, which can create levels way outside the normal female range.

Proper monitoring means a baseline testosterone test, a follow-up at 3-6 weeks, periodic lab tests to make sure you're in the normal female range, and honest conversations about how things are actually going. Total testosterone levels in women are measured in nanograms per deciliter (ng/dL), and the normal range for premenopausal women is roughly 15-70 ng/dL. The goal of treatment is to get you back into that range, not higher.  

Side effects at physiologic doses are usually mild: acne, slightly oily skin, minimal hair growth, occasionally a mild voice change, small cholesterol shifts. Most women in the normal range don't have major issues. The key is staying in that range. When levels get too high (which can happen with poorly monitored treatment or aggressive dosing) masculinizing effects become more likely.

The Interplay Between Estrogen and Testosterone

Here’s something that doesn’t get enough attention: testosterone often works best when estrogen is already well supported.

Many women who struggle with low desire are also dealing with vaginal dryness, burning, pain during sex, or urinary discomfort. These symptoms fall under something called genitourinary syndrome of menopause, a long name for a very common problem. When intimacy hurts or feels uncomfortable, desire naturally fades. No amount of testosterone can override pain.

This is where vaginal estrogen therapy plays a powerful role. Used locally, vaginal estrogen helps restore vaginal tissue health, improve lubrication, increase elasticity, and reduce discomfort with sex. Once comfort improves, testosterone has room to work on desire and arousal.

You can think of it this way:
First remove the barriers. Then support desire.

This is why thoughtful hormone care starts with a full assessment, not a single prescription. A menopause-trained clinician will ask about vaginal symptoms, painful sex, urinary changes, and overall comfort before jumping straight to testosterone. Many women are surprised to learn that treating estrogen deficiency first makes a bigger difference than they expected. Some even find that once vaginal estrogen is optimized, they don’t need testosterone at all.

Clinical guidelines consistently show that vaginal estrogen is safe and effective for genitourinary symptoms. (7) Because it works locally, it has very low absorption into the bloodstream and has not been shown to increase the risk of breast cancer or heart disease. This matters, because many women still carry fear about hormone therapy based on outdated information from the Women’s Health Initiative study published in 2002: research that did not evaluate modern dosing, delivery methods, or vaginal estrogen use.

A Note on Hormone Testing (What’s Helpful to Know)

While lab numbers never tell the whole story, careful testing can help guide treatment. When testosterone is being considered, clinicians often look at total testosterone, sex hormone–binding globulin (SHBG), and sometimes calculate a free androgen index to better understand how much testosterone is actually available to your tissues.

For patients, a few practical points are helpful to know:

• Testosterone levels are most accurate first thing in the morning, when natural levels are highest (2)
• If you’re already using testosterone, your provider may ask you to hold your dose for at least 12 hours before labs so results aren’t falsely elevated
• Blood should not be drawn from an arm where testosterone gel is applied, as this can distort results

Your provider should explain why labs are being checked and how results guide decisions, always alongside how you actually feel. Lab numbers never tell the whole story; symptoms + context matter more than a single test value (7).

What About DHEA and Testosterone?

You may also hear about DHEA (dehydroepiandrosterone) when exploring options for sexual health. (6) DHEA is a hormone your body naturally makes and can be converted into both estrogen and testosterone at the tissue level.

Some companies position DHEA as a form of “testosterone replacement,” but that’s not quite accurate. DHEA is not testosterone, and its effects are more subtle and localized. However, in the right context, it can be a helpful part of care.

In clinical practice, many menopause specialists find that a combination approach works well for certain women with low desire, especially those with vaginal symptoms. This may include:

• Vaginal estrogen to restore tissue health and comfort
• Vaginal DHEA to support local androgen and estrogen activity in vaginal tissues
• Low-dose testosterone to support sexual desire and arousal

This layered approach recognizes that sexual desire is not driven by a single hormone. Comfort, tissue health, blood flow, and brain signaling all matter. Supporting multiple pathways often leads to better, more sustainable results.

Current research shows that while DHEA is not interchangeable with testosterone, it may provide benefits for specific symptoms such as vaginal discomfort or localized androgen deficiency, particularly when used alongside estrogen therapy. Evidence for whole-body effects like mood or energy is limited (8).

Why Timing and Expectations Matter

One of the biggest challenges women face with hormone therapy is expecting results too quickly. Hormones work on different timelines, and when those timelines aren’t explained clearly, it’s easy to feel disappointed or give up too soon.

Each hormone has its own pace:

• Progesterone often has noticeable effects within days, especially on sleep or calming the nervous system.
• Estradiol works more gradually, with improvements in vaginal comfort, hot flashes, and overall stability building over several weeks.
• Testosterone is the slowest. For most women, meaningful changes in desire or sexual response take months, not days.

When women expect an immediate boost in energy or mood from testosterone, the wait can feel discouraging. Research shows that many women begin to notice sexual changes around 4 to 12 weeks, and some need longer. That slower timeline doesn’t mean it isn’t working, it means your body is adjusting.

Another challenge is that sexual desire rarely has a single cause. Hormones matter, but so do stress, relationship dynamics, vaginal comfort, sleep, and emotional safety. If sex has been painful or uncomfortable, desire often stays quiet no matter what hormone you add. This is why experienced clinicians take time to understand the full picture rather than focusing on testosterone alone.

Good care also means setting realistic expectations from the start. When your provider explains what each hormone does and how long it takes to feel changes, you’re far less likely to feel frustrated or abandon treatment before it has a fair chance to help.

Practical wisdom based on expertise and experience: 

• Testosterone often works better when estrogen is balanced first. 
• Creams and gels applied daily to the skin to allow fine-tuning. 
• Changes take weeks, not days. 
• Regular monitoring of symptoms and testosterone levels required matter.
• Keep dose levels low and in the range generally considered to be normal for women.

These aren't just anecdotes, they reflect clinical best practices that research supports.

The Bigger Picture: Menopause and Sexual Health

Sexual dysfunction during menopause isn't just about hormones. It's about a complex interplay of physical changes, relationship dynamics, mental health, stress, sleep quality, medications, and life circumstances. Testosterone can help with desire and arousal, but it's not a magic solution for everything.

Research consistently shows that women experiencing menopause symptoms report decreased work productivity, increased healthcare utilization, and significantly more physician visits compared to women without symptoms. (8)

Some women benefit most from pelvic floor physical therapy to address pain during sex. Others need couples counseling to work through relationship issues that have nothing to do with hormones. Still others discover that treating depression, anxiety, or sleep problems makes a bigger difference than hormones.

This is why comprehensive menopause care matters. A good provider doesn't just prescribe testosterone and sends you on your way. They ask about your whole life: your relationship, your stress levels, your sleep, your mental health, your overall satisfaction. They help you figure out which problems might respond to hormones and which need different approaches.

What Good Care Looks Like

Good care includes: a real conversation about your goals, discussion about estrogen first (since it often addresses vaginal issues that make testosterone more effective), physiologic testosterone dosing aimed at normal female levels, lab checks with clear explanations, and follow-up visits to discuss desire, comfort, mood, and side effects.

You should never feel rushed. You should never feel dismissed. You should understand why your provider is recommending what they're recommending, what to expect, what risks exist, and what alternatives are available. Informed consent isn't just signing a form, it's actually understanding your options.

Telehealth has made this more accessible: privacy for vulnerable conversations, flexible scheduling, access to specialists even in underserved areas, and consistent follow-up. Many women say it was the first time they felt heard. Being able to discuss sexual health from home, without the awkwardness of a waiting room or the pressure of a 15-minute appointment slot, makes a real difference.

The Safety Question

One of the biggest concerns women have is safety. Is testosterone safe? The answer depends on dose, monitoring, and individual risk factors.

At physiologic doses with proper monitoring, testosterone appears safe for most postmenopausal women without contraindications. The key phrase is "physiologic doses". These are levels that mimic what your body would naturally produce, not the much higher levels used in male hormone therapy.

The concerns about masculinization, cardiovascular risk, or liver damage typically arise from much higher doses or from oral testosterone formulations that aren't appropriate for women. When testosterone is delivered transdermally at carefully titrated doses, with regular monitoring to ensure levels stay in the female range, serious adverse effects are rare.

That said, testosterone isn't appropriate for everyone. Women who are pregnant, trying to conceive, or breastfeeding shouldn't use it. Women with certain hormone-sensitive cancers need individualized assessment. Women with significant cardiovascular disease, liver disease, or other serious health conditions need careful evaluation.

This is why working with a knowledgeable provider matters. They can assess your individual risk profile and help you make an informed decision.

Moving Forward

When testosterone is used properly and monitored, it can make a real difference in sexual desire and comfort. It's not magic, it won't work for everyone, but it can be meaningful if it's the right fit.

Frequently Asked Questions

Can I take testosterone if I'm still having periods (in perimenopause)?

Most research on testosterone therapy focuses on postmenopausal women. Some clinicians do prescribe it during perimenopause for persistent low libido, but there's less data on this.

If you're still having periods, your provider will likely want to address other factors first—like whether you need estrogen or progesterone support, whether vaginal discomfort is getting in the way, and whether stress or sleep issues are playing a role.

Will testosterone make me look or sound masculine?

At physiologic doses (normal female levels), most women don't experience masculinizing effects. The goal is to restore levels to what you had in your thirties, not push them higher. Mild side effects like slightly oily skin or minimal hair growth can happen but are usually reversible if the dose is adjusted. Significant voice changes,facial hair growth, or hair loss from your head typically only occur at much higher doses than what's used in proper menopause care.

What's the difference between compounded testosterone and FDA-approved products?

In the U.S., there are no testosterone products FDA-approved specifically for women. Because of this, clinicians use one of two options.

Some prescribe FDA-approved testosterone gels made for men, used off-label in very small amounts to reach normal female levels. These products have consistent, regulated potency, but require careful measuring because women need much lower doses.

Others use compounded testosterone creams or gels from specialty pharmacies. Compounding allows for easier micro-dosing and customization, but product strength can vary depending on the pharmacy. Compounded products are not FDA-approved, though medical societies support their use when no approved female formulation exists.

In both cases, the goal is the same: relieve symptoms while keeping testosterone in a normal female range, with proper dosing and monitoring.

Do I need to take estrogen along with testosterone?

Not always, but many women find that testosterone works better after estrogen-related issues are addressed first.

Vaginal dryness is a very common cause of discomfort with sex after menopause, and vaginal estrogen can greatly improve lubrication, tissue health, and comfort. When sex feels comfortable again, testosterone has more opportunity to support desire and arousal.

That said, not all pain with sex is caused by dryness. If pain happens with touch or at the vaginal opening, it may involve the vestibule (the area around the vaginal opening) which responds differently to hormones. In some cases, vaginal lubricants alone aren’t enough, and targeted treatments such as vaginal estrogen, vaginal DHEA, or other therapies may be considered.

If pain does not improve with lubricants or vaginal estrogen, an in-person evaluation with a gynecologist or pelvic floor physical therapist is important. Your provider can help determine whether estrogen, testosterone, or a different approach is needed based on your specific symptoms.

What happens if I stop taking testosterone?

If you stop testosterone therapy, your levels will return to what they were before treatment, usually within a few weeks to months. Any benefits you experienced will gradually fade. There's no evidence of lasting harm from stopping, and you won't experience withdrawal symptoms. Some women try it for several months, decide it's not helping enough, and stop without issue.

References

1. Women’s Health Concern; British Menopause Society. Androgen Deficiency. Women’s Health Concern; 2023.
   
   
2. Victoria State Government, Department of Health. Androgen Deficiency in Women. Better Health Channel. Published April 12, 2023.
   
   
3. Society for Endocrinology. Testosterone. YourHormones.info. Accessed April 12, 2023.
   
   
4. Davis SR, Robinson PJ, Jane F, et al. Intravaginal testosterone improves sexual satisfaction and vaginal symptoms associated with aromatase inhibitors. J Clin Endocrinol Metab. 2018;103(11):4146-4154. doi:10.1210/jc.2018-01345
   
   
5. Fernandes T, Costa-Paiva LH, Pinto-Neto AM. Efficacy of vaginally applied estrogen, testosterone, or polyacrylic acid on sexual function in postmenopausal women: a randomized controlled trial. J Sex Med. 2014;11(5):1262-1270. doi:10.1016/j.jsxm.2014.01.011
   
   
6. Smith TB, Batur P. Prescribing testosterone and DHEA: the role of androgens in women. Cleveland Clinic Journal of Medicine. 2021;88(1):35-43.
   
   
7. American Urological Association; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction; American Urogynecologic Society. Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline. American Urological Association; 2025.
   
   
8. Whiteley J, DiBonaventura M, Wagner JS, Alvir J, Shah S. The impact of menopausal symptoms on quality of life, productivity, and economic outcomes. J Womens Health. 2013;22(11):983-990. doi:10.1089/jwh.2012.4102