Testosterone for Women with Low Sexual Desire: When and How Safe?

Many people are surprised to learn that women also have testosterone in their bodies, and that its level falls gradually with age, or suddenly after both ovaries are removed. A question I am often asked is, "If I use a male hormone, will my desire come back the way it was?" The most honest answer is, "For some women, yes, if the right person uses it in the right way."

What testosterone does in a woman's body

In women, testosterone is made by the ovaries and adrenal glands, and it is also a raw material for making oestrogen. It plays a part in sexual desire and sexual response, and may be related to mood and muscle. But women's sexual desire does not depend on a single hormone; the relationship, stress, pain and medicines matter just as much.

For this reason, blood testosterone levels are not used to diagnose a woman as "testosterone deficient", because blood levels are not clearly related to sexual desire.

Who may benefit?

The 2019 Global Consensus Position Statement on testosterone use in women, endorsed jointly by several societies, and the 2021 ISSWSH clinical practice guideline agree that:

• there is only one evidence-based indication: hypoactive sexual desire disorder (HSDD), meaning low desire that causes distress, in postmenopausal women, whether menopause was natural or surgical
• other causes must be assessed first, such as medicines, depression, pain and the relationship; if these have not been addressed, testosterone usually helps little
• in premenopausal women, the data are still limited, and use is considered only case by case

You can read first about diagnosing reduced desire in low sexual desire (HSDD) and FSIAD.

How well does it work?

A meta-analysis of randomised trials (Islam and colleagues, Lancet Diabetes & Endocrinology, 2019) found that in postmenopausal women, testosterone moderately improved desire, arousal, orgasm and sexual satisfaction, and increased the number of satisfying sexual events by about one a month on average. Some women respond very well; others notice almost no difference.

In other words, this is not a "passion pill" but one aid within a bigger care plan.

How it is used (as assessed and prescribed by a doctor)

• Form: a skin (transdermal) preparation is recommended. Products made specifically for women exist only in a few countries, so in many places, including Thailand, doctors use men's gel at a much lower dose, typically about one-tenth of the male dose. This is off-label use and therefore needs close supervision.
• Not recommended: injections, implants or oral tablets, because levels go too high and are hard to control.
• Target: blood levels within the normal range for premenopausal women, not male levels.
• Monitoring: a blood test before starting and about 3–6 weeks after starting, then periodically. Symptoms are assessed at 3–6 months, and if there is no improvement by 6 months, treatment should stop.

If the gel comes into contact with another person's skin, such as a partner's or a child's, they may absorb the hormone too. Wash your hands after applying it and let the area dry before touching others.

Side effects and contraindications

Common when levels are too high

• Acne, oily skin
• Extra hair growth at the application site or on the face

Uncommon but important

• A deeper or hoarse voice, enlargement of the clitoris, male-pattern hair thinning. Some of these may not reverse, so tell your doctor as soon as you notice them.

Should not be used, or needs special caution, in women who are pregnant or breastfeeding, who have or have had a hormone-sensitive cancer, who already have signs of androgen excess such as marked acne or excess hair or uncontrolled PCOS, and who have severe liver disease. Long-term safety data beyond 2 years for the heart and breast are still limited.

A note for trans people and men

This article is about low-dose use in cisgender women. For trans men who want hormones for gender affirmation, the doses and goals are very different; read masculinising hormone therapy (FTM). For the basics of this hormone, read testosterone basics.

When to see a doctor

If you are menopausal or have had your ovaries removed, and reduced sexual desire is causing you distress, see a doctor for a full assessment first, which may include menopausal hormone therapy and vaginal dryness. Do not buy gel or injections to use yourself, because the wrong dose can cause side effects, some of which do not reverse.

At Dr. Kris Clinic, I assess whether testosterone is suitable for you, test your blood before and during treatment, and follow you closely. English-speaking consultations are available at the clinic or online.