Intimate health | 6 min read
Testosterone for Women: Who It Helps, What the Evidence Says, and the Risks
Editorial draft — clinical review pending.
Short answer: Testosterone has one well-supported use in women: treating hypoactive sexual desire disorder (HSDD), meaning low sexual desire that causes distress, in postmenopausal women after other causes have been looked at. In that group, it modestly improves desire and satisfaction. There isn't good evidence that it improves energy, mood, memory, weight or bone health in women. [1,2]
Key takeaways
- A global consensus of medical societies concluded HSDD in postmenopausal women is the only evidence-based reason for women to use testosterone. [1]
- In trials, testosterone added on average about one more satisfying sexual event per month compared with placebo, along with improved desire and less distress. [1]
- There is no FDA-approved testosterone product for women in the US, so prescribing is off label. The consensus recommends against compounded testosterone. [1]
What HSDD is
HSDD is persistent low interest in sex that bothers you. Low desire that doesn't bother you is not a disorder. Diagnosis is based on a clinical conversation, not a blood test. There is no testosterone level that separates women with and without low desire. [1,3]
A good assessment looks at everything that can affect desire:
- Pain during sex or vaginal dryness (often from menopause).
- Medicines, especially some antidepressants.
- Depression, anxiety and stress.
- Relationship issues.
- Poor sleep, fatigue and other health conditions.
Treating one of these may help more than testosterone would. [2]
What testosterone can do
In postmenopausal women with HSDD, testosterone at doses that keep blood levels in the normal premenopausal range improved desire, arousal, orgasm and pleasure, and reduced distress about sex. [1] The effect is real but moderate. It isn't a dramatic change for most women.
What it can't do
The consensus found insufficient evidence to use testosterone for any other symptom or condition in women, including cognition, mood, energy and disease prevention. [1] Marketing that promises confidence, fat loss and youthfulness all at once goes beyond the evidence. The Endocrine Society also advises against diagnosing "androgen deficiency" in otherwise healthy women. [3]
Risks and monitoring
At appropriate doses, short-term studies show mainly mild side effects such as acne and increased hair growth. Long-term safety hasn't been established. [1] Higher doses, which can occur with pellets, injections or compounded products, can cause voice deepening, hair loss and other lasting changes.
If you start testosterone, expect:
- A baseline blood test to check your level isn't already high.
- A repeat test after a few weeks to make sure levels stay in the female range.
- A review at around 3 to 6 months. If there's no meaningful benefit by then, stopping is usually advised. [2]
Frequently asked questions
Can testosterone help with fatigue or brain fog?
The evidence doesn't support it for those symptoms. [1]
Do I need a blood test to qualify?
A blood test doesn't diagnose HSDD, but it's used to check your baseline and monitor treatment safely. [2]
Can premenopausal women use testosterone?
There's not enough evidence to recommend it for premenopausal women. [1]
Next step
Low desire is common, and you deserve a conversation that looks at the whole picture. HerScripts clinicians can help work out what's driving it and which options fit. Learn about low libido in women.
Sources
[1] Global Consensus Position Statement on the Use of Testosterone Therapy for Women, 2019
[2] ISSWSH clinical practice guideline on systemic testosterone for HSDD
[3] Endocrine Society, Androgen Therapy in Women guideline
Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.