You used to want to. It was just there, a normal part of your life, something you looked forward to. And then it was not. Not gradually, not in a way you could point to, just gone. You have tried to find it. You have addressed stress and sleep and all the things you read about. You have been romantic, initiating, waiting for the right moment. And there is just nothing there. No interest, no response, no drive. Your partner is patient but you can see the effect it is having. You feel disconnected from a part of yourself that used to feel natural and alive.

Your doctor told you this is just what happens as you get older. They suggested lubricant and perhaps therapy.

Both of those may have a place, but neither one addresses what may actually be driving the change: testosterone levels that have declined so significantly that the biological substrate for sexual desire has simply been removed.

This article explains what testosterone does in women’s bodies, what the evidence says about testosterone therapy for libido, energy, cognition, and muscle preservation, and how to navigate a medical system where, paradoxically, there is no FDA-approved testosterone product specifically designed for women in the United States.

Testosterone is not just a male hormone

Women produce testosterone throughout their lives, primarily in the ovaries and adrenal glands. In a woman’s thirties, testosterone levels are already significantly lower than they were in her twenties, and they continue to decline through perimenopause and menopause. By the time a woman reaches her fifties, her testosterone levels may be a fraction of what they were at their peak.

Testosterone in women contributes to libido, arousal, sexual response, energy levels, mood, cognitive function, muscle protein synthesis, and bone density. It acts partly directly through testosterone receptors in various tissues and partly through conversion to estrogen in peripheral tissues. The ovaries are a major production site for testosterone, which is why surgical menopause (removal of both ovaries) often produces a particularly dramatic and sudden drop in libido and energy compared to natural menopause.

The idea that testosterone is a male hormone with no meaningful role in women is simply incorrect, and the clinical neglect of testosterone in women’s health reflects historical biases in medical research rather than biological reality.

What the evidence says

Dr. Kelly Casperson, a board-certified urologist whose work focuses on women’s sexual and urological health, is one of the most vocal proponents of evidence-based testosterone therapy for women in the US. She consistently highlights the gap between the strength of the research on testosterone for women and the degree to which it is offered and discussed in clinical practice.

The Menopause Society published a comprehensive position statement in 2022 reviewing the evidence for testosterone therapy in postmenopausal women. Its conclusions were clear: testosterone therapy has good evidence supporting its use for hypoactive sexual desire disorder (HSDD), the clinical term for low libido that causes distress to the individual. The evidence supports improvements in desire, arousal, frequency of satisfying sexual events, and sexual pleasure.

Beyond sexual function, the evidence for testosterone’s effects on other domains is accumulating but less definitive. Studies suggest benefits for energy, mood, and cognitive function, particularly in women who have low baseline levels. The evidence for muscle mass preservation is biologically plausible given testosterone’s known anabolic role and is supported by some trial data, though this is a less-studied area in women specifically.

A 2019 systematic review and meta-analysis published in The Lancet Diabetes and Endocrinology, which analyzed data from thirty-six randomized controlled trials involving more than eight thousand women, found that testosterone therapy significantly improved sexual function including desire, arousal, and satisfaction, with an acceptable safety profile at physiological doses.

The FDA gap and what it means practically

There is no FDA-approved testosterone product specifically for women in the United States. This is a significant practical obstacle that reflects historical regulatory prioritization of male health, not a reflection of the evidence on testosterone’s role in women.

The only FDA-approved testosterone products in the US are formulated for men and come in doses designed for male physiology, which is approximately ten times higher than what women require. This means that women who seek testosterone therapy are relying on off-label use of these products at fractions of the labeled dose, or on compounded testosterone products formulated specifically for women’s dose ranges.

This creates real challenges: off-label prescribing requires a clinician willing to navigate outside standard formulary, insurance typically does not cover testosterone therapy for women, and compounded products vary in quality depending on the compounding pharmacy.

In other countries, including the UK and Australia, testosterone products specifically formulated for women exist and are prescribed within licensed guidelines. In the UK, Androfeme, a testosterone cream for women, is available. In Australia, Androfeme is licensed. US women are left to work around a regulatory gap that does not exist elsewhere.

How to get tested and what the numbers mean

If you suspect low testosterone is contributing to your symptoms, asking for a blood test is the right starting point. You will want total testosterone and free testosterone measured, ideally by a lab using an assay validated for female-range levels. Standard male-range testosterone assays are often insufficiently sensitive at the lower concentrations found in women.

What constitutes “low” for women is contested and there are no universally agreed reference ranges, which is itself a reflection of how little investment has gone into this area of research. Generally speaking, most menopause-specialist clinicians consider total testosterone below 20-25 ng/dL in a symptomatic woman as indicating testosterone insufficiency worth addressing.

It is important to note that testosterone therapy should be considered in the context of overall hormone health. Many women benefit from addressing estrogen deficiency first, since low estrogen can impair the tissue-level response to testosterone. Low-dose vaginal estrogen can also restore local tissue sensitivity in ways that improve response to testosterone therapy for sexual function.

Who should consider testosterone therapy

The clearest indication for testosterone therapy in women is HSDD: significantly reduced sexual desire causing personal distress, in the absence of other explanatory causes. If you have addressed relationship factors, treated any depression or anxiety, optimized estrogen status, and still experience no sexual desire, testosterone therapy is an evidence-backed option worth discussing with your clinician.

Women with surgical menopause, where testosterone levels often drop suddenly and severely, are particularly strong candidates for consideration of testosterone therapy given the abruptness of the loss.

Women with fatigue, low energy, and poor motivation in the context of documented low testosterone may also benefit, though the evidence in these domains is less robust than for sexual function specifically.

Finding a provider

Getting testosterone therapy for women in the US requires finding a clinician willing to prescribe off-label or through compounding. Menopause-certified practitioners, listed through the Menopause Society’s provider directory, are the most likely to be knowledgeable about this area and willing to have the conversation. Telehealth platforms specializing in menopause care have also made it easier for women in areas without local specialists to access appropriate care.

You are not asking for something unusual. You are asking for your hormones to be assessed completely, not selectively, and for the treatments that the evidence supports to be made available to you. That is a reasonable expectation of your healthcare.

Medical disclaimer: This article is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider regarding any medical condition or before starting any new treatment.