by Dr. Lori Davis, DNP, FNP-C, Clinical Sexologist & Sex Counselor
“I don’t know what happened. I used to be interested in sex, but now… nothing. I never want it like I used to. And weirdly, my orgasm is really hard to get to, and when I do get there it’s just… meh. Could it be my hormones?”
Yes. It could.
But probably not the hormones you’re thinking of.
Most women assume the answer is estrogen or progesterone. Those hormones matter for sexual health in real ways. But they’re not the primary player when it comes to desire and orgasm intensity.
The hormone that matters most here? Testosterone.
Surprised? Most women are. Testosterone gets framed as a male hormone. But women produce it too, at about a tenth of the level men do. And for many women, it’s quietly running a significant part of their sexual experience.
When levels are adequate, most women never think about it. When levels fall, some women feel it immediately.
TL;DR
- Testosterone matters for women too — produced at about a tenth of male levels, it quietly drives a significant part of female sexual experience
- When it drops, some women feel it clearly — reduced desire, harder to reach orgasm, and flatter orgasm intensity are all signs
- Two women with the same level can feel completely different — desire is multifactorial and testosterone is just one factor, which is why how you feel matters as much as the number
- It won’t create desire out of nowhere — but when levels are low it can smooth the pathway into arousal and make the right conditions easier to access
- The safety picture is reassuring — androgenizing side effects require doses ten times higher than what is prescribed for libido support
- This is evidence based medicine — supported by the Endocrine Society and ISSWSH, not fringe or experimental
What Testosterone Does for Women
Testosterone supports libido, genital sensitivity, and the intensity of orgasm. Those are the sexual health effects, and they’re the ones with the strongest evidence.
But testosterone also plays a broader role in women’s health. Research points to its involvement in bone density, muscle mass and strength, mood, cognitive function, and possibly cardiovascular health. These systemic effects are real and worth knowing about.
That said, the evidence for using testosterone specifically to treat those things in women is still limited. It’s not currently prescribed for energy, mood, or bone health, and you should be skeptical of anyone selling it that way. The one area where the evidence is clear and the major medical organizations agree? Libido and sexual function.
Testosterone levels decline gradually over time in women. It’s not specifically a menopause problem. It’s just that by perimenopause and menopause, levels have often fallen enough that the impact on sexual experience becomes noticeable for women for whom testosterone matters most.
And that qualifier is important.
Two Women, Same Level, Completely Different Experience
Two women can have the exact same testosterone level and feel completely different. That’s because desire is multifactorial, and testosterone is just one factor. For some women it’s a primary driver. For others it barely registers.
This is why we don’t just look at a number. We look at your levels, including SHBG (which can bind up testosterone and reduce what’s actually available to your body), and we look at how you actually feel. Both matter.
What Testosterone Can and Cannot Do
It’s not going to make you suddenly crave sex regardless of what else is going on in your life.
It won’t override exhaustion, relationship disconnection, or physical discomfort. What it can do, when levels are genuinely low, is smooth the pathway into arousal. Lower the threshold. Make it easier for the right conditions to work.
Think of it this way: if you’re reasonably comfortable, you feel okay about your partner, you’re not completely running on empty, testosterone can be what tips the scales toward desire rather than away from it. It supports the conditions for arousal. It doesn’t create them on its own.
This is also why hormonal support and relational or psychological work aren’t either/or. They’re most effective together. Addressing relationship dynamics, stress, and sexual satisfaction at the same time as testosterone therapy makes sense because each supports the other.
Is It Safe
People sometimes carry concerns about hormones generally, often shaped by what they’ve heard about estrogen and progesterone. Those are real conversations worth having, and the risks and benefits of estrogen and progesterone are frequently misunderstood in ways that leave women without treatments that could genuinely help them.
Testosterone is a different conversation. The side effects specific to testosterone are androgenizing effects, things like facial hair or voice changes. Here’s the context: those effects require sustained exposure to doses roughly ten times higher than what is used for libido support. The dose for low desire is around 5mg. The dose used in gender transition is around 50mg. At therapeutic doses, with level monitoring along the way, androgenizing side effects are uncommon. In my clinical experience, I rarely see them.
This is not fringe medicine. Testosterone therapy for low libido in women is supported by the Endocrine Society and the International Society for the Study of Women’s Sexual Health. It is evidence based, mainstream, and underutilized.
A Note Before You Go
Testosterone isn’t for everyone, and your individual health history matters. This is a conversation to have with a provider who actually knows your picture, not a prescription to chase on your own. There are situations where it may not be appropriate, and you deserve a real conversation about your specific risks and benefits, not a dismissal.
Which brings me to this: if you raise this with your provider and get brushed off, that’s not the end of the conversation. Push back. Ask questions. Seek a second opinion if you need to. Your sexual health is part of your health, full stop, and you deserve a provider who takes it seriously.
What to Do If This Resonates
Ask your provider to check your testosterone and SHBG levels and have a real conversation about what the results mean in the context of how you actually feel.
If you’re not getting that support, the International Society for the Study of Women’s Sexual Health has a provider directory at isswsh.org. These are clinicians who specialize in exactly this.
Your desire is worth taking seriously. Testosterone is one real, evidence based tool in that conversation. You deserve a provider who treats it that way.
Working With Me
If this resonates and you want to explore whether testosterone might be part of your picture, I work with individuals on exactly this. In person in Ithaca or available for sexual medicine consultations in NY and VT.
Learn more about working together here. Book a free consultation 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.
Further Reading
Why Does Sex Hurt After Menopause?
Why Don’t I Want Sex Anymore? Understanding Responsive Desire
