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
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.
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.
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)
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 fatigue or mood changes are your main concern, testosterone may not be the first thing to try and should only be considered after other common causes are checked.
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.
When testosterone is used at low, physiologic doses appropriate for women, side effects are typically mild and dose-related. The most common changes are acne or slightly oily skin, and in some cases, mild increases in facial or body hair. These effects usually happen when the dose is higher than your body needs, and they are generally reversible by lowering the dose or pausing treatment. This is why careful dosing and follow-up matter: the goal is to restore testosterone to a normal female range, not to push levels higher. Staying within that range minimizes side effects while preserving benefit.
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.
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:
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).
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:
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).
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:
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.
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.
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.
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.
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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.
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.
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.
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.
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.
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.
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.