When It Helps, When It Doesn’t, and What You Should Know
If you’ve been dealing with low libido, someone has probably mentioned testosterone to you. Maybe your doctor suggested it. Maybe you saw an ad for it. Maybe your friend swears by it.
And now you’re wondering: Should I try testosterone therapy?
Here’s the honest answer: Maybe. But probably not for the reasons you think.
As someone who actually prescribes testosterone for select patients, I’m going to give you the nuanced truth that you’re not getting from wellness clinics promising to “restore your vitality” or from doctors who dismiss it entirely as dangerous snake oil.
The reality is somewhere in the middle, and understanding where testosterone actually helps (and where it doesn’t) could save you time, money, and frustration.
What Testosterone Actually Does (And Doesn’t Do) for Women
Let’s start with what we know from the research.
Testosterone can help some postmenopausal women with HSDD (Hypoactive Sexual Desire Disorder). In clinical trials, women on testosterone reported increased desire and increased sexual frequency. There is enough evidence for this benefit that multiple national organizations have written guidelines recommending its use for low desire in women, including The Endocrine Society.
Testosterone does NOT:
- Cure relationship problems
- Make you suddenly crave sex out of nowhere
- Compensate for terrible sex
- Fix desire issues caused by stress, resentment, or disconnection
- Improve bone density, mood, or energy (despite what wellness clinics claim)
- Work for premenopausal women (we don’t have evidence for this)
Here’s what frustrates me about how testosterone is marketed: it’s sold as a magic bullet when the evidence shows it’s a very specific tool for a very specific problem.
The Problem with “Low Testosterone = Low Libido”
The most interesting finding from the research? There’s no correlation between testosterone levels and sexual desire in women.
You can have low testosterone and high desire. You can have normal testosterone and no desire. Measuring your testosterone levels doesn’t tell us whether testosterone therapy will help you.
So why does testosterone work for some women?
The current thinking is that it’s not about the level in your blood—it’s about how testosterone is produced in the brain, how sensitive your androgen receptors are, and a bunch of other factors we don’t fully understand.
This is why I don’t just run labs and prescribe testosterone. That’s not good medicine.
Who Might Actually Benefit from Testosterone
Based on the evidence and my clinical experience, testosterone therapy might be worth considering if:
1. You’re postmenopausal (naturally or surgically)
This is where we have the strongest evidence. The drop in ovarian function changes hormone production in ways that can genuinely impact desire for some women.
2. You have true HSDD
This isn’t just “I don’t think about sex as much as I used to.” This is: “I have little to no sexual thoughts or desire, this bothers me significantly, and it’s not explained by relationship problems, medical conditions, or medications.”
3. You’re already on estrogen therapy (if needed) and it hasn’t helped your desire
The research shows testosterone works better when estrogen levels are adequate. Jumping straight to testosterone without addressing other hormonal factors usually doesn’t work.
4. You’ve ruled out other causes
This is crucial. If you’re exhausted because you’re managing the entire household, or if you don’t want sex because the sex you’re having isn’t good, or if you’re anxious or depressed or in a relationship that feels unsafe—testosterone isn’t going to fix those things.
5. You understand this is a trial, not a guarantee
About 50% of women who try testosterone notice meaningful improvement. That means 50% don’t. A trial is a great way to determine if it will work for you.
Who Should NOT Take Testosterone
Don’t take testosterone if:
- You’re pregnant or trying to conceive (it can cause fetal abnormalities)
- You’re premenopausal and can get pregnant (we don’t have safety data)
- You haven’t addressed obvious relationship or contextual factors
- You’re expecting it to fix your energy, mood, or bone density (that’s not what it does)
- You’re getting it from a wellness clinic promising “bioidentical hormones” without proper medical oversight
The Real Risks Nobody Talks About Honestly
Let’s be straight about the side effects, because the wellness industry downplays them and some doctors catastrophize them.
Common, manageable side effects:
- Mild acne
- Facial hair growth (usually minimal if dosed correctly)
- Oily skin
The honest truth: The safety data that we do have for testosterone supplementation in women is great. However, we don’t fully know the long-term risks. In lieu of further data and pending FDA approval, testosterone is prescribed based on available evidence, known pharmacotherapy and expert guidelines from multiple national organizations.
Why Most Testosterone Prescribing Is Problematic
Here’s where I’m going to be blunt about my own field:
A lot of testosterone prescribing for women is garbage.
Wellness clinics are using it as a profit center, prescribing testosterone pellets or injections that create supraphysiologic (higher than normal) levels and increase the risk of side effects. They’re marketing it for everything from “brain fog” to “lack of motivation” despite zero evidence.
On the other end, some doctors refuse to prescribe it at all, even for appropriate candidates, because they’re uncomfortable with off-label use or they’ve bought into the idea that low libido is always psychological.
Good testosterone prescribing looks like:
- Transdermal cream or gel (not pellets or injections)
- Low, physiologic doses (aiming for normal female range, not male range)
- Trial period with assessment of benefit
- Regular monitoring for side effects
- Integrated with attention to relationship dynamics, context, and sexual satisfaction
What Should You Do Instead? (Or First?)
Before you pursue testosterone therapy, ask yourself:
About your relationship:
- Do I feel emotionally connected to my partner?
- Is there unresolved resentment or conflict?
- Do I feel safe saying no to sex?
- Does my partner pursue me, or do they just wait for me to want it?
About the sex itself:
- Is the sex I’m having actually pleasurable?
- Do I orgasm? Does it matter to me if I don’t?
- Is there pain or discomfort that I’m minimizing?
- Would I want more sex if the sex was different?
About your life:
- Am I chronically stressed or exhausted?
- Do I have space for pleasure in my life, or am I always in task-mode?
- Am I on medications (antidepressants, blood pressure meds) that affect libido?
- Do I have untreated anxiety, depression, or trauma?
If the answers to these questions reveal obvious problems, fix those first. Testosterone won’t make you want sex with someone you resent. It won’t make bad sex good. It won’t create desire in a life that has no room for pleasure.
The Bottom Line
Testosterone therapy can be a useful tool for some postmenopausal women with genuine desire disorders.
But it’s not a cure-all. It’s not risk-free. And it’s not a substitute for addressing the relational, contextual, and psychological factors that affect desire.
If you’re considering testosterone:
- Work with a provider who actually understands female sexuality (not just hormone replacement)
- Rule out other causes first
- Monitor for side effects
- Be willing to stop if it’s not helping
And if someone is selling you testosterone as the solution to all your problems, run.
Your desire is more complex than a hormone level. You deserve care that treats you as a whole person, not a prescription pad.
Wondering if testosterone therapy might be right for you?
Sex counseling can help you understand whether hormones are part of your desire picture—or if other factors are at play. For couples navigating desire differences, couples counseling addresses the relational dynamics that affect intimacy, with or without hormonal support. Learn more about sex counseling here.
Dr. Lori Davis is a Doctor of Nursing Practice, board-certified Family Nurse Practitioner, and AASECT Certified Sex Counselor. She prescribes testosterone therapy when clinically appropriate as part of comprehensive sex counseling and medical care.
