Testosterone is often called the male hormone, but women produce it naturally — and levels fall with age and the menopause transition. Bottom line: for postmenopausal women whose low sexual desire is affecting their quality of life, testosterone therapy can help, but it is not FDA-approved for women in the US and is prescribed off-label, at low doses, under careful medical monitoring. The strongest evidence is for libido, not for energy or mood.

What testosterone is and why it falls in women:

Women produce testosterone in the ovaries and adrenal glands, and alongside estrogen it supports part of sexual desire, energy and well-being. Although public discussion often reduces it to a male hormone, it acts in the female body too, and the balance between estrogen and androgens matters for health. Levels peak in a woman's 20s and decline by about 50% by age 50. Surgical removal of the ovaries (oophorectomy) causes an immediate drop of around 50%. In natural menopause the decline is gentler, but it adds to the other hormonal shifts of the transition.

How testosterone acts — and what that means for desire:

Testosterone is a hormone, not a fuel. It works by attaching to receptors in cells, and those receptors are found in the brain as well as in the ovaries, bone and muscle. In the brain, the regions involved in interest and reward respond to androgens alongside oestrogen. That is one reason desire is not a single switch. It is the output of a system that also includes sleep, mood and the relationship you are in.

This explains why testosterone is studied for more than libido. Bone and muscle cells carry androgen receptors too, so a hormone that acts on them could plausibly do more than raise desire. Plausible is not the same as proven. The evidence for desire is clear. For other outcomes the honest position is that the picture is still forming.

One more thing is worth knowing. In women, testosterone is not made only in the ovaries. The adrenal glands produce it as well, so removing the ovaries lowers production sharply without switching it off. Natural menopause is different again: the ovaries stop cycling, yet they continue to release androgens. This is why two women of the same age and stage can differ. It is also why low desire that troubles you is judged on your symptoms, not on a comparison with anyone else.

When low desire becomes a problem:

Low sexual desire is common at menopause and almost always has several causes: broken sleep, fatigue, vaginal dryness, stress, low mood or relationship difficulties. An important point: a diagnosis of hypoactive sexual desire disorder (HSDD) requires not just low interest but distress about it; without distress, a quieter libido may simply be a normal variation that needs no treatment. When the drop is persistent and is not explained by another condition, testosterone is not the first step — it becomes relevant only after other causes, such as mood, relationship or medical issues, have been ruled out and low desire remains the main problem.

What else can lower desire:

Desire is not a purely hormonal event, and a careful assessment treats it as a whole-body question. The usual contributors are ordinary, and most are treatable.

  • Broken sleep and fatigue: desire depends on energy, and sleep is one of the first things the transition disturbs
  • Vaginal dryness and discomfort: if sex is painful, not wanting it is a reasonable response rather than a hormonal failure
  • Low mood and depression: these can flatten interest as directly as any hormonal change
  • Relationship strain and mental load: the brain does not prioritise desire while it is busy monitoring demands
  • Medicines: some prescription medicines dampen desire or arousal as a side effect
  • Thyroid problems: an underactive or overactive thyroid can show up first as a loss of interest

Several of these are usually present at once, and they reinforce one another. Treating only the hormone while a woman is sleeping badly, feeling low and in pain is unlikely to work. That is not a reason to dismiss the hormonal part. It is a reason to look at the whole picture first.

Why low desire is often missed:

Two things get in the way of a useful conversation about desire. The first is that nobody asks. Routine appointments rarely include a question about sex, and many women wait to be invited to raise it. The second is that when it is raised, it is often put down to the relationship or to age, and the conversation stops there.

That is a loss, because low desire at menopause is usually the sum of several things that can each be looked at. Sleep can be treated. Dryness can be treated. Mood can be treated. Medicines can sometimes be changed. Only once those have been considered does the question of a hormone become the interesting one.

It also helps to separate two feelings that sound similar. Low desire is what you notice. Distress is what makes it a medical problem — the sense that something which mattered to you has gone. Women with low desire and no distress usually need reassurance. Women with distress need a proper assessment. Being able to say which one you are brings you closer to the right answer.

What the evidence shows:

  • Davis et al. (Lancet, 2025): a comprehensive review confirmed that testosterone therapy improves sexual desire, arousal and satisfaction in postmenopausal women with HSDD
  • Evidence for effects on energy and mood is less robust but suggestive
  • Bone density benefits are promising but need more research

Overall, this gives testosterone a defined place in the treatment of female sexual dysfunction at menopause, but it is not a universal remedy for fatigue or low mood. Each potential benefit has to be weighed against your own symptoms and the existing clinical evidence.

What is established, what is uncertain, what is unknown:

It is worth sorting the evidence into three piles, because much of the discussion around testosterone blurs them.

Established: for postmenopausal women with low sexual desire that causes distress, testosterone improves desire, arousal and satisfaction. This is the finding the reviews support, and it is the basis on which the treatment is offered.

Uncertain: effects on energy, mood and a general sense of wellbeing. Some studies suggest a benefit. The signal is weaker, and it is hard to separate a real effect from the improvement that follows better sex and better sleep. A result described as suggestive is not a reason to prescribe.

Unknown: what happens over the very long term, and whether any bone benefit is large enough to matter on its own. These are open questions, and they are why testosterone is not offered as a general treatment for ageing.

The practical use of all this is simple. A trial of therapy is reasonable when the goal is desire and the distress is real. It is not reasonable when the goal is vague — more energy, a better mood, a general sense of getting back to yourself.

Who is a candidate — and what the guidelines advise:

The Menopause Society recommends considering testosterone therapy for postmenopausal women with low sexual desire that affects quality of life, after other causes have been ruled out — such as depression, thyroid problems, certain medicines or relationship difficulties. It is not a first-line treatment for energy, fatigue or mood, and a possible bone benefit on its own does not justify prescribing. Your doctor will also take your personal context into account, because sexual desire does not depend on hormones alone. A proper assessment starts with an open conversation.

Talking to your doctor about desire:

Desire is one of the harder subjects to raise in a short appointment. Some preparation makes it easier, and makes the conversation more useful.

  • Say what changed and when: interest you used to have and no longer do, and roughly when you noticed the shift
  • Say what it costs you: whether it causes distress, affects your relationship, or makes you feel unlike yourself. This is the part that decides what is offered
  • Separate desire from comfort: note whether sex is also dry or painful, because that is a different problem with different solutions
  • Bring the whole picture: sleep, mood, stress, medicines and supplements, and any other symptoms of the transition
  • Ask directly what your options are, including what the alternatives to a hormone would be, and what follow-up would look like

It also helps to say what you want from the appointment. Some women want the symptom gone. Some want to understand what is happening. Some want to rule out something else. All three are good reasons to be there.

How it is prescribed and at what doses:

  • No formulation is formally approved for women in the US, and in most countries testosterone is prescribed off-label
  • Doses used in women are roughly one tenth of male doses — usually 1-2 mg a day, applied to the skin (transdermal)
  • Monitoring matters: blood levels should stay within the normal female range
  • Treatment is adjusted individually, based on your symptoms and blood tests, with regular review

What the monitoring is for:

Monitoring is not a formality. It exists because the dose that suits one woman does not suit another, and because the amount absorbed through the skin varies between individuals. Two women using the same prescription can end up with different levels.

The aim is to keep you within the range your body would normally produce, not above it. Symptoms guide the decision as much as the blood test does. A level that looks acceptable on paper, while desire has not changed, is a reason to review the plan rather than to carry on unchanged. A good response alongside early signs of excess is a reason to lower the dose, not to accept the side effects as the price of feeling better.

Reviews are also where the other contributors get revisited. Sleep, mood, the relationship and any new medicines all change over time. A plan that worked last year may need adjusting for reasons that have nothing to do with the hormone itself.

Side effects and signs of excess:

At the correct dose, side effects are rare. Acne, hair growth and voice changes are signs that the dose is too high; report them to your doctor, as they call for a lower dose or stopping the treatment, along with a blood level check. That is why testosterone should never be taken on your own — only with a prescription and follow-up. Effects build gradually, and regular reviews track both the benefits and any early signs of excess.

Common misconceptions about testosterone in women:

Several ideas circulate widely, and each one leads women to the wrong expectation.

'Testosterone is the male hormone.' It is present in both sexes, and women produce it throughout life. The name describes where it was first studied, not who it belongs to.

'It is an energy treatment.' The trials do not support that use, and a prescription written for fatigue is unlikely to deliver what is hoped for.

'More will work better.' Usually the opposite. The doses used in women are kept small on purpose, and pushing them up produces side effects before it produces benefits.

'If my level is low, I need replacement.' Levels fall with age in everyone. A low number on its own is not a diagnosis, and it does not tell you how you feel. Symptoms and distress are what decide.

'It is approved, so it must be standard care.' No formulation is approved for women in the US, and use is off-label in most countries. Off-label does not mean unsafe. It means the evidence and the licensing have not lined up, which is why follow-up matters.

'Once I start, I am on it for life.' Treatment is reviewed, and it can be stopped. If it is not helping, the plan changes.

In short:

Testosterone falls naturally in women with age, and replacing it can improve low sexual desire after menopause — the strongest evidence being the Davis et al. review published in The Lancet in 2025. The treatment is not formally approved for women and is used off-label at low doses with blood monitoring. If low libido is affecting your life, talk to your doctor, who can rule out other causes and decide whether testosterone is right for you.