In the pursuit of better sex, women are turning to this unconventional therapy
Industry Buzz
There’s a growing awareness of hormone therapies available to women that I hope more patients will be motivated [to explore] to improve their lives... for low libido, low energy, and low vitality symptoms.
—Jessica Nazzaro, DO
A social media trend has influencers convincing your female patients to take testosterone to improve libido, energy, and motivation, making it seem like a magical pill that addresses many of the challenges women of menopausal age face.
Related: Docs react to FDA’s removal of HRT black box warning: ‘An incredible mistake was made 25 years ago’—but not all agree
While androgen decline comes with age and can cause problems with sexual desire, arousal, orgasm, and painful sex post-menopause, there are no FDA-approved testosterone products for women due to safety concerns. Still, many women report their doctor wrote them a prescription for testosterone products after blood work.[]
Jessica Nazzaro, DO, an OB/GYN at the Cleveland Clinic and a certified menopause practitioner, believes testosterone products do have a place in women’s healthcare. ‘‘There’s a growing awareness of hormone therapies available to women that I hope more patients will be motivated [to explore] to improve their lives,” she tells MDLinx. “When women are seeking testosterone specifically, it could be for low libido, low energy, and low vitality symptoms.’’
Can it actually help?
Despite safety and efficacy concerns, research shows testosterone has beneficial effects on female sexual dysfunction.[] A meta-analysis of 36 RCTs involving women with hypoactive sexual desire disorder (HSDD) found the following:[]
Testosterone significantly increased sexual desire, arousal, pleasure, orgasm, and reduced sexual concerns and distress in postmenopausal women compared with placebo or estrogen with or without progesterone (comparator group).
Testosterone significantly increased LDL cholesterol when taken orally; there were no significant differences when it was taken through a transdermal patch or cream.
Testosterone therapy increased acne and hair growth compared with placebo or comparator groups. However, there was no significant difference in the frequency of serious adverse events between groups.
Additionally, a March 2025 review in Clinical Obstetrics and Gynecology stated that “testosterone improved the frequency of sexually satisfying events, desire, arousal, and orgasm in several randomized, controlled studies of surgically and naturally postmenopausal women.”[]
The study authors continued: “Available evidence from large cohort and registry studies does not show potentially concerning cardiovascular or breast safety signals with physiological levels of testosterone. Although no female testosterone products are currently approved in most of the world, one-tenth of the male dose can enhance female sexual function.”[]
Despite promising effects, testosterone therapy for women presents several challenges, including determining who is suitable for treatment; the target testosterone levels; the ideal dosage, form and duration; safety; and more.
Clinicians can consult the clinical guidelines of the International Society for the Study of Women’s Sexual Health[] and the Global Consensus Position Statement on the Use of Testosterone Therapy for Women.[] The guideline has been endorsed by more than 10 societies in sexual medicine, obstetrics and gynecology, menopause medicine, and endocrinology, and helps to shed light on these issues.
Currently, there is not enough research to make recommendations for testosterone therapy in premenopausal women. On the other hand, testosterone therapy can be an option for women who have experienced menopause naturally or surgically and who also have female sexual dysfunction, such as HSDD.
‘‘Low libido in women is a very complex issue, the answer to which is not always testosterone,” says Dr. Nazzaro. “Every woman struggling with low libido should be assessed for safety and happiness in her relationship(s), underlying depression and anxiety, underlying substance use, medical conditions, and medications that may be affecting her libido. For low libido specifically, postmenopausal women with HSDD can benefit from testosterone therapy, and this is an evidence-based treatment.’’
"If a patient has true HSDD, and other causes of low libido have been ruled out or eliminated, such as medication side effects, testosterone therapy can be an excellent option."
— Jessica Nazzaro, DO
In the clinic
Many women can see improvements after a month of therapy. The treatment should be discontinued if patients do not experience any benefits within 6 months. However, if HSDD improves with the treatment, guidelines recommend continuing the therapy for 6 to 12 months, then taking a break to see if patients need further treatment. In this case, it's important to note that the long-term safety of testosterone therapy in women is lacking.
But testosterone therapy carries risks, of course. Dr. Nazzaro warns, ‘‘Risks of testosterone are partly unknown, since there is no FDA-approved testosterone therapy for women. This means studies have not been performed to assess risks, particularly long-term. It is unknown whether testosterone therapy is beneficial or harmful to cardiovascular health. Testosterone can cause acne, hirsutism, male pattern hair loss, and voice deepening. These can occur if the testosterone level is too elevated, though not always. These are not likely, although they may be irreversible if they occur.’’
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