Testosterone for low libido in women: what the evidence says

Testosterone can improve sexual desire in some women, but the evidence supports only one use: postmenopausal women with hypoactive sexual desire disorder (HSDD), meaning low desire that causes real distress, after other causes have been addressed. The benefit is moderate, long-term safety is not established, and no testosterone product is FDA-approved for women in the US, so any prescription is off-label.

Why testosterone matters for women

Women make testosterone in the ovaries and adrenal glands. Levels decline gradually with age; the FDA notes that levels in a woman’s late 40s are roughly half those in her early 20s. Removal of both ovaries causes a more abrupt fall, which is one reason sexual symptoms can be more severe after surgical menopause.

Blood levels do not explain low desire on their own. The 2019 Global Consensus Position Statement found that no cutoff level of any androgen distinguishes women with sexual dysfunction from those without it, and that a testosterone level should not be used to diagnose HSDD.

Where things stand in the US

The FDA has not approved any testosterone product for women. In an August 2026 Federal Register notice, the agency wrote that, unlike estrogen products, there are no FDA-approved indications for testosterone therapy in menopausal women, even though off-label use has increased over the past decade. The same notice says testosterone is approved for HSDD in women in Australia, New Zealand, the UK, and South Africa, and that long-term safety data beyond 24 months are limited, particularly for cardiovascular disease and breast cancer.

On September 17, 2026, the FDA held a public workshop on testosterone in menopausal women to review the evidence and what would be needed to support an approved product. Public comments are open until October 19, 2026.

Because there is no women’s product, women in the US who use testosterone generally receive a product approved for men at a much lower dose, or a compounded preparation.

What the 2019 Global Consensus says

The Global Consensus Position Statement was written by an international task force after a systematic review of randomized trials. It was endorsed by 11 organizations, including The North American Menopause Society (now The Menopause Society), the Endocrine Society, and the International Society for the Study of Women’s Sexual Health. Its key points:

• One indication. The only evidence-based use is for postmenopausal women (natural or surgical) diagnosed with HSDD after a full biopsychosocial assessment.
• Moderate benefit. At doses that approximate premenopausal levels, testosterone increased satisfying sexual events by an average of one per month over placebo, with improvements in desire, arousal, orgasm, pleasure, and responsiveness, and less sexual distress.
• No other proven uses. Evidence does not support testosterone for well-being, mood, cognition, bone, muscle, or disease prevention, or for premenopausal women.
• Route matters. Oral testosterone worsens cholesterol and is not recommended. Transdermal products had no significant effect on lipids in short-term studies.
• Avoid high doses. Pellets, injections, and any product causing levels above the normal female range are not recommended. Compounded testosterone cannot be recommended unless no approved equivalent is available.
• Monitor and reassess. Measure total testosterone before starting and 3 to 6 weeks later, check every 6 months for overuse, and stop if there is no benefit by 6 months.

What The Menopause Society says

The Menopause Society, as NAMS, endorsed the Global Consensus. A 2023 Practice Pearl published in its journal, Menopause, calls testosterone an important evidence-based therapy for HSDD in postmenopausal women and repeats that this is the sole evidence-based indication. A 2021 guideline from the International Society for the Study of Women’s Sexual Health adds practical steps: informed consent that covers off-label use, transdermal dosing appropriate for women, and monitoring to keep levels in the premenopausal range.

How big is the benefit?

A 2019 meta-analysis pooled 36 randomized trials with 8,480 participants. Compared with placebo or a comparator, testosterone significantly improved satisfying sexual event frequency, desire, pleasure, arousal, orgasm, responsiveness, and self-image, and reduced sexual concerns and distress. The authors concluded it is effective for postmenopausal women with distressing low desire, with non-oral routes preferred.

In everyday terms, one extra satisfying sexual event a month is meaningful for some women and underwhelming for others. A trial period with a clear stop date helps you decide.

The evidence gaps

Question	What the evidence shows
Desire and sexual function in postmenopausal HSDD	Benefit (high-quality evidence)
Mood and general well-being	No effect shown
Bone density, muscle mass, strength	No effect shown at the doses studied
Memory and thinking	Not enough evidence
Breast cancer	No short-term effect with transdermal use; long-term risk unknown
Heart attack and death	Not enough data; trials excluded high-risk women
Safety beyond 24 months	No trial data

Most trial participants were also taking estrogen, and women at high cardiometabolic risk were excluded, so results may not apply to everyone. Women with a history of hormone-sensitive breast cancer were excluded from HSDD trials, and caution is advised.

Safety notes

• The main side effects at physiologic doses are mild increases in acne and body or facial hair.
• The evidence does not support testosterone for fatigue, weight loss, or brain fog.
• Avoid pellets and injections, which can produce levels well above the female range.
• Tell your clinician if you have had breast cancer, blood clots, or heart disease.

How to bring it up

Testosterone is usually not the first step. A clinician should first look at pain with sex, sleep, hot flashes, mood, medications, and relationship factors; see low sex drive in perimenopause. If those are addressed and low desire still distresses you, ask: “Do I meet criteria for HSDD, and would a trial of transdermal testosterone at a female dose make sense? How will we monitor it, and when will we decide whether it is working?” A menopause specialist or an OB-GYN with menopause experience can assess whether it fits your situation.