Testosterone is a hormone naturally produced in women by the ovaries and adrenal glands. Although often considered a “male hormone,” testosterone also plays a role in female sexual desire and arousal. Testosterone levels generally decline with age, but a low testosterone level does not necessarily mean that treatment is needed. Sexual desire is influenced by many factors, and there is no specific testosterone level that reliably diagnoses low libido.
For selected women experiencing persistent, distressing low sexual desire (HSDD), particularly after menopause, testosterone therapy may help improve sexual desire and satisfaction.
Although testosterone therapy is not FDA-approved for use in women in the United States, professional medical societies support its use in appropriately selected patients after discussing the potential benefits, risks, and need for ongoing monitoring.
Testosterone therapy may be considered for women experiencing hypoactive sexual desire disorder (HSDD), a condition characterized by persistently low sexual desire that causes significant personal distress. Research supporting testosterone therapy is strongest in postmenopausal women with HSDD, although treatment may occasionally be considered in other circumstances after individualized counseling.
You may be a candidate for testosterone therapy if:
You have experienced a persistent decrease in sexual desire that is bothersome to you.
Low libido is affecting your sexual satisfaction, emotional well-being, or quality of life.
Other contributing factors, such as stress, relationship concerns, medications, vaginal discomfort, or other medical conditions, have been considered or addressed.
What Testosterone Therapy Does Not Treat
Testosterone is not routinely recommended for:
General fatigue or low energy
Weight loss or muscle building
Mood changes or difficulty concentrating
General anti-aging or wellness purposes
Do I Need a Low Testosterone Level to Qualify?
No. There is no specific testosterone level that diagnoses HSDD or determines whether treatment will be beneficial. Bloodwork is obtained before starting therapy to establish a baseline and help guide safe dosing and monitoring. The decision to start testosterone therapy is based primarily on your symptoms, medical history, and treatment goals, rather than a laboratory result alone.
Testosterone therapy may improve sexual desire and satisfaction in appropriately selected women with hypoactive sexual desire disorder (HSDD). As with any hormone treatment, it is important to understand the potential benefits, side effects, and limitations.
For women who respond to treatment, testosterone therapy may help:
Increase sexual desire and interest in intimacy
Improve sexual arousal and pleasure
Increase the frequency of satisfying sexual experiences
Reduce distress related to low sexual desire
Results vary from person to person. Some women experience meaningful improvement, while others notice little or no benefit. Changes may begin within several weeks, but it can take 2–3 months to appreciate the full effect.
When testosterone is used at doses that maintain levels within the normal female range, side effects are generally mild but may include:
Acne or oily skin
Increased facial or body hair growth
Scalp hair thinning
Skin irritation at the application site
Excessively high testosterone levels can increase the risk of more significant side effects, including voice deepening and clitoral enlargement. Some of these changes may be irreversible.
Studies of appropriately dosed testosterone therapy have generally been reassuring in the short term. However, long-term safety data remain limited, particularly regarding cardiovascular health and breast cancer risk. Testosterone therapy is not recommended during pregnancy or breastfeeding and may not be appropriate for women with certain medical conditions, including hormone-sensitive cancers.
The goal of treatment is to improve symptoms while keeping testosterone levels within the normal physiologic range for premenopausal women. Using higher doses does not necessarily provide greater benefit and increases the risk of side effects. Regular follow-up and bloodwork help ensure that treatment remains both safe and effective.
There are several ways testosterone can be administered, but transdermal testosterone (applied to the skin) is generally the preferred approach for women.
Testosterone gel is applied to the skin, typically once daily. It is absorbed through the skin and provides a relatively consistent amount of testosterone.
There are currently no FDA-approved testosterone products specifically for women in the United States.
Products originally designed for men, such as Testim gel, may be prescribed at much lower doses appropriate for women.
Because these products are more concentrated than women need, careful measurement and dosing instructions are essential.
Testosterone levels are monitored periodically to ensure they remain within the normal female range.
Testosterone pellets are inserted beneath the skin and release testosterone over several months. Injections deliver testosterone directly into the body. These formulations are generally not recommended for women because they can produce excessively high or fluctuating testosterone levels, increasing the risk of side effects. Pellets are particularly difficult to adjust or discontinue once inserted, since their effects may persist for several months.
Compounded testosterone preparations are custom-made by specialized pharmacies. However, they are not FDA-approved, and their consistency, potency, and absorption may vary. When an appropriate commercially manufactured product is available, professional medical societies generally recommend using it rather than compounded testosterone.
Our Approach: When testosterone therapy is appropriate, we generally recommend carefully dosed transdermal testosterone gel, with individualized dosing instructions and periodic bloodwork to monitor treatment.
Testim is a testosterone gel originally manufactured for men. Women use a much smaller dose, so it is important to follow your prescribed instructions carefully.
Each Testim tube contains 50 mg of testosterone.
The typical starting dose for women is approximately 1/10 of a tube daily, equivalent to about 3 pea-sized drops of gel.
Apply the medication once daily, unless otherwise instructed. Many women prefer applying the medication at bedtime.
Do not increase your dose without discussing it with our office.
Apply the gel to one of the following areas:
Back of the calf
Upper outer thigh
Buttock
Choose an area of clean, dry, intact skin. Avoid applying the medication to your breasts, genital area, or irritated skin.
Measure the prescribed amount of gel.
Apply a thin layer to your chosen application site.
Allow the gel to dry completely before covering the area with clothing.
Wash your hands thoroughly with soap and water after application.
Testosterone gel can transfer to other people or pets through direct contact with the application site.
To reduce this risk:
Keep the application area covered with clothing once the gel has dried.
Avoid direct skin-to-skin contact with the application site, particularly with children and pregnant individuals.
Prevent pets from licking or rubbing against the application area.
Wash the application site with soap and water before anticipated direct skin contact.
Follow the product instructions regarding bathing or swimming after application.
Use your medication consistently for the best results.
If you miss a dose, do not double your next dose.
Store testosterone securely, away from children and pets.
Contact our office if you have questions about your dose or develop concerning side effects.
Regular follow-up and bloodwork are important to ensure that testosterone therapy is both safe and effective.
Before starting treatment: We typically obtain a baseline testosterone level.
6–8 weeks after starting: We repeat your testosterone level to assess your response and ensure that your levels remain within an appropriate range.
After dose adjustments: Additional bloodwork may be recommended approximately 6–8 weeks after changing your dose.
Long-term monitoring: Once you are stable and doing well, testosterone levels are typically checked every 4–12 months, depending on your dose, symptoms, and prior laboratory results. Repeat testing is often coordinated with prescription renewals.
Some patients may require more frequent testing while we determine the most appropriate dose.
Our goal is to maintain testosterone levels within the normal physiologic range for premenopausal women while improving your symptoms. There is no single ideal testosterone level for every woman. Higher levels do not necessarily lead to better results and may increase the risk of side effects.
Improvement in sexual desire is often gradual. Some women notice changes within 4–8 weeks, with the greatest benefit typically developing around 12 weeks. We will consider both your symptoms and laboratory results when deciding whether to continue or adjust treatment. If you have not experienced meaningful improvement after approximately 6 months, we generally recommend discontinuing testosterone therapy.
Please contact us if you:
Develop significant acne, unwanted facial or body hair growth, scalp hair loss, or voice changes.
Have questions about your dose or feel that treatment is not helping.
Are considering increasing or changing your dose.
Please do not adjust your testosterone dose without discussing it with our office.
If you're unsure whether something you're experiencing is normal, please don't hesitate to reach out. For severe or urgent symptoms, please seek prompt medical evaluation rather than waiting for a MyChart response.
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