Testosterone therapy (TT) is usually prescribed to men who are testosterone deficient. It is used to bring testosterone levels back to a normal range. Women may be prescribed TT more often these days. Usually, this is to treat hypoactive sexual desire disorder (HSDD) in postmenopausal women. In this case, they may be experiencing long periods of low libido (sexual desire)including:

• Little to no interest in sexual activity
• Infrequent or few sexual thoughts or fantasies
• Lack of response to a partner’s sexual desire

How is Testosterone Used in Women?

TT has increasingly been used off label to treat other types of female sexual dysfunction (FSD). This includes painful sex (dyspareunia), low desire or arousal, and difficulty orgasming (anorgasmia). Women experiencing menopause symptoms may be prescribed TT off label. However, this depends on their specific symptoms.

Testosterone is produced naturally in women and declines with age – just like in men. This similarity means that providers can prescribe TT to women as a part of hormone therapy in perimenopause and post menopause. However, it is hard to know how effective TT is for women with FSD.

Researchers reviewed 33 studies on TT and FSD in pre- and postmenopausal women. It was found that testosterone appears to improve libido in women.

Testosterone Therapy Before and After Menopause

The research included in this review appeared to support the International Society for the Study of Women’s Sexual Health's (ISSWSH) clinical guidelines for HSDD. The guidelines cite several trials of postmenopausal women that have shown improved sexual satisfaction, arousal, and orgasm frequency, as well as pleasure, desire, and self-image. They recommend:

• Transdermal (through the skin) testosterone, in an appropriate female formulation.
  • If no female formulation is approved, then an off-label male formulation at about one-tenth of the dose is recommended.
  • Transdermal testosterone should be applied carefully, to avoid affecting children or pets.
• ISSWSH does not generally recommend TT for premenopausal women, as there is not enough evidence supporting its use.
  • Those who are premenopausal and approaching perimenopause may also be considered.
• Patients should not take TT without close monitoring for symptoms such as heart or liver problems.

In addition to the central nervous system arousal pathways, TT may help improve vaginal lubrication. This could help especially with dryness-related dyspareunia in postmenopausal women. Many of the women who saw improvement were also using hormone replacement therapy (HRT) with estrogen. However, benefits were also seen without it.

For premenopausal women, the results were less consistent. TT was associated with improvements in libido and sexual satisfaction. There is not enough evidence to know how well it works before menopause.

TT could benefit both premenopausal and postmenopausal women. However, there is stronger research supporting TT in postmenopausal women. More research is needed at all ages. Clinicians need to examine dosing (outside HSDD) and long-term safety data more closely. They also need to look into TT’s effectiveness in younger women.

Key Takeaways

• Testosterone therapy may be effective at treating sexual dysfunction in women, especially desire.
• There is more research on TT in postmenopausal women than in premenopausal women.
  • More research is needed to confirm TT is effective for early-stage premenopausal women.
• Postmenopausal women may benefit from testosterone – with or without HRT.
• More research is needed on dosing, long-term safety, and TT for treatment of younger (premenopausal) women.
• TT should always be taken with the recommendation of a medical professional. Always speak with your provider if you believe TT is not working, or if you are experiencing symptoms associated with too much testosterone, like acne, voice deepening, etc.
• If sexual dysfunction symptoms are causing distress, it may be beneficial to speak with a sexual health professional.

Resources:

• Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Islam, R. M., Kaunitz, A. M., Kingsberg, S. A., Lambrinoudaki, I., Liu, J., Parish, S. J., Pinkerton, J., Rymer, J., Simon, J. A., Vignozzi, L., & Wierman, M. E. (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women. The Journal of Sexual Medicine, 16(9), 1331–1337. https://doi.org/10.1016/j.jsxm.2019.07.012
• ‌Furlan, V. A., Hammad, M. A., Quesada, S., Nguyen, S., & Yih, J. (2026). Testosterone therapy for female sexual dysfunction: A systematic review of the literature demonstrating outcomes in premenopausal and postmenopausal women. The Journal of Sexual Medicine, 23(8). https://doi.org/10.1093/jsxmed/qdag206
• Parish, S. J., Simon, J. A., Davis, S. R., Giraldi, A., Goldstein, I., Goldstein, S. W., Kim, N. N., Kingsberg, S. A., Morgentaler, A., Nappi, R. E., Park, K., Stuenkel, C. A., Traish, A. M., & Vignozzi, L. (2021). International Society for the Study of Women’s Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. The Journal of Sexual Medicine, 18(5), 849–867. https://doi.org/10.1016/j.jsxm.2020.10.009