Testosterone and Low Libido in Women
Testosterone plays a major role in a woman's sex drive. But if that sex drive fizzles, replacing the hormone with a supplement isn't as simple as it sounds.
Testosterone may be known as a male sex hormone, but women need it, too. Testosterone is part of what drives female desire, fantasy, and thoughts about sex. It also plays a role in ovarian function, bone strength, and the overall well-being of women, says Kelli Burroughs, MD, an obstetrician-gynecologist at Memorial Hermann in Houston. Yet while your testosterone level plays a key role in your sex drive, taking it in supplement form to treat low libido remains controversial.
Here’s what doctors know about testosterone’s role in low libido in women and how the hormone might be used as a treatment.
Women’s testosterone levels gradually go down as they age, and lower amounts of the hormone can also reduce muscle mass, affect skeletal health, impact mood, cause fatigue, and decrease sensitivity in the vagina and clitoris, which affects libido, Dr. Burroughs says.
A drop in testosterone levels is believed to be the reason sex drive goes down after menopause, according to the North American Menopause Society.
Although it’s common for men to take testosterone to treat low libido, the U.S. Food and Drug Administration (FDA) hasn’t approved testosterone replacement therapy for women. Some doctors do prescribe it for women as an off-label use, notes Jenna M. Turocy, MD, an ob-gyn at NewYork-Presbyterian Columbia University Irving Medical Center in New York City. “These products include testosterone skin patches, gels, creams or ointments, pills, implants, and injections, often designed and government-approved for men,” Dr. Turocy says.
Testosterone doses provided by these formulations generally are much too high for females, so women are given a fraction (usually one-tenth) of the dose that men are prescribed, notes Barbara Schroeder, MD, an assistant professor and ob-gyn with UTHealth Houston.
“There is no dose that we can say is absolutely safe for women,” she explains. “There are no large randomized trials that have looked at this.” That’s why Dr. Schroeder says to check baseline testosterone levels and re-check them every three to six months to make sure they’re not too high. “The goal is to aim for testosterone levels that are in the normal premenopausal range,” she adds.
Still, testosterone supplementation for women with low sex drive is rarely recommended in the United States, especially for premenopausal females, given the limited data on safety and efficacy, Turocy explains.
One of the main issues is that testosterone has side effects. Acne and hair growth at the application site are the most common, Schroeder says. Changes in your voice, weight gain, hair loss, oily skin, mood changes, and an enlarged clitoris, may also occur, Turocy adds.
But the biggest concern involves testosterone’s long-term safety in women, as no robust scientific studies have looked at potential lasting effects.
In a review of 36 randomized controlled trials published in the Lancet Diabetes & Endocrinology in October 2019, researchers determined that testosterone therapy is effective at increasing sexual function in post-menopausal women. They noted that when taken orally, testosterone was linked to significant increases in LDL, or “bad” cholesterol, and reductions in total cholesterol, HDL, or “good” cholesterol, and triglycerides. These effects were not seen with testosterone patches or creams. More importantly, the researchers concluded that “data are insufficient to draw conclusions about the effects of testosterone on musculoskeletal, cognitive, and mental health and long-term safety and use in premenopausal women.”
If you have low libido, testosterone may help, but it’s important to weigh the benefits with the risks. Know that there are other options that may be beneficial.
“If concerned about low sex drive, women should consult a knowledgeable healthcare provider who can evaluate their individual medical history, symptoms, and hormone levels,” Turocy says. “It's essential to take a comprehensive look at their sexual health, considering not only hormonal factors but also psychological, emotional, and relational aspects.”
Other potential causes of low sex drive, such as stress, relationship problems, medication side effects, or underlying medical conditions, like nerve issues or endometriosis, should be explored and addressed before considering hormone supplementation, she says.
Finally, don’t ignore the power of healthy lifestyle modifications. “Implementing healthy lifestyle changes such as diet and exercise can also boost energy levels and self-image perception resulting in increased libido,” Burroughs says. According to a study published in July 2021 in the Journal of Sexual Medicine, regular exercise one to six hours per week was associated with benefits in desire, arousal, lubrication and sex-related distress in women experiencing sexual dysfunction.
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