Testosterone is usually thought of as a male hormone.

But women produce testosterone too—and it plays a role in sexual function.

That raises an increasingly common question:

Can testosterone help women who have lost interest in sex?

For some women, the answer may be yes.

But the evidence is much more specific than many broad claims about “hormone optimization” suggest.

Current expert guidance supports testosterone most strongly for appropriately selected postmenopausal women with hypoactive sexual desire disorder, or HSDD. Evidence before menopause exists, but it is more limited. And in the United States, testosterone treatment for women remains off-label because FDA-approved testosterone products are approved for men, not women.

One point is especially important:

A low testosterone blood level does not diagnose low libido or HSDD in women.

Current ISSWSH guidance specifically states that there is no testosterone level that can diagnose HSDD or serve as a treatment target. Testosterone testing is used primarily as part of baseline assessment and monitoring.

So the more useful question is not simply:

“Is my testosterone low?”

It is:

“What is causing my change in sexual desire—and would testosterone actually address that problem?”

The Short Answer

Testosterone can improve sexual desire in some women with HSDD, particularly after menopause.

Randomized trials and major clinical guidelines support physiologic transdermal testosterone for appropriately selected postmenopausal women with HSDD. The evidence is strongest when treatment follows a broader biopsychosocial assessment rather than being prescribed solely because of a testosterone laboratory result.

But testosterone is not appropriate for every woman with low libido.

Reduced sexual desire can also be related to:

• stress
• depression or anxiety
• medications
• relationship factors
• vaginal dryness
• pain during sex
• genitourinary syndrome of menopause
• sleep problems
• other health conditions
• changes in arousal or orgasm rather than desire itself

That is why identifying what changed is often more important than starting with a hormone level.

Related reading: Low Libido in Women: Causes, HSDD and Treatment Options in 2026

What Does Testosterone Do in Women?

Testosterone is an androgen hormone present in women as well as men.

In women, androgens interact with receptors throughout the body, including tissues and neural pathways involved in sexual function.

But the relationship between circulating testosterone levels and sexual desire is complex.

Studies have produced inconsistent associations between a single testosterone measurement and sexual function. Some studies have found correlations between androgen levels and aspects of sexual function, while others have not.

That means this simple equation does not work:

Low libido → low testosterone → testosterone treatment

Female sexual desire is influenced by biological, psychological and interpersonal factors.

What Is HSDD?

Hypoactive sexual desire disorder, or HSDD, refers to persistent low sexual desire that is personally distressing and is not better explained by another medical or psychiatric condition, medication effect, relationship problem or other identifiable factor.

Low desire alone does not automatically mean someone has HSDD.

A woman may naturally have less interest in sex than her partner.

She may temporarily lose interest during an exhausting or stressful period.

Or she may avoid sexual activity because it has become uncomfortable or painful.

Those situations are different from persistent, generalized low desire that causes meaningful distress.

Current sexual-medicine guidance therefore recommends examining desire alongside factors such as arousal, orgasm, pain, medications, health conditions, mental health, life events and relationship context.

Does Low Testosterone Cause Low Libido in Women?

Not necessarily.

This is one of the most important distinctions in female testosterone treatment.

Unlike testosterone deficiency in men, there is no established testosterone threshold that diagnoses HSDD in women.

ISSWSH states that total testosterone should not be used to diagnose HSDD and that there is no blood level that serves as a treatment goal.

Blood testing can still be useful.

Before treatment, clinicians may measure:

• total testosterone
• sex hormone-binding globulin, or SHBG

But those measurements are used primarily to establish baseline status, assess whether treatment is appropriate and help prevent excessive testosterone exposure during therapy.

So a laboratory result near the lower end of a reference range does not, by itself, establish:

“This is why my libido is low.”

Does Testosterone Improve Libido in Women?

For appropriately selected women, it can.

The evidence is strongest in postmenopausal women with HSDD.

Randomized trials have found that physiologic transdermal testosterone can improve sexual desire and other sexual-function outcomes in this population.

The Global Consensus Position Statement and ISSWSH guideline therefore support its use for appropriately evaluated postmenopausal women with HSDD.

ISSWSH also recognizes limited evidence supporting treatment in some women in the late reproductive years, but the evidence base is substantially smaller.

What Did the New 2026 Review Find?

This is one of the most important recent developments in the evidence base.

A systematic review published in The Journal of Sexual Medicine in July 2026 evaluated testosterone therapy for female sexual dysfunction across both premenopausal and postmenopausal women.

The researchers reviewed 33 studies.

Among them were:

• 2 randomized controlled trials involving premenopausal women
• 7 randomized controlled trials involving postmenopausal women

The premenopausal trials reported improvements in outcomes including libido, satisfying sexual events and sexual satisfaction, but involved relatively small study populations.

In postmenopausal women, larger randomized trials showed more consistent improvements in sexual desire and HSDD-related symptoms with testosterone treatment.

The researchers concluded that:

The strongest evidence currently exists for postmenopausal women.

For premenopausal women, the results were encouraging but the evidence remains more limited because there are fewer randomized trials and smaller study populations.

More research is needed to clarify appropriate indications, dosing and long-term safety in younger women.

That makes the current evidence hierarchy relatively clear:

Postmenopausal women with HSDD → strongest evidence

Premenopausal women → promising but more limited evidence

Is Testosterone FDA-Approved for Women?

No.

As of August 2026, there is no FDA-approved testosterone product specifically indicated for women in the United States.

FDA's current testosterone information states that approved testosterone products are approved for use in men.

That means testosterone prescribed to a woman for HSDD is an off-label use.

Off-label means that an approved drug is being prescribed for a population, condition, dose or use that is not included in its FDA-approved indication.

ISSWSH recommends that clinicians explain the off-label nature of testosterone treatment for women and discuss potential benefits, risks and uncertainties as part of informed decision-making.

A Note About Recent FDA Testosterone Label Changes

There have been several recent FDA actions involving testosterone, but they should not be confused with an approval for women.

On February 28, 2025, FDA announced class-wide testosterone labeling changes after reviewing the TRAVERSE cardiovascular trial and ambulatory blood-pressure studies.

FDA recommended removing boxed-warning language about increased cardiovascular risk while also requiring or adding information about increased blood pressure.

Then, in June 2026, FDA separately requested additional testosterone-label updates concerning men, including removal of previous limitation-of-use language related to age-associated hypogonadism and revisions to prostate and BPH safety information.

These were separate regulatory actions for different reasons.

Neither created an FDA-approved testosterone indication for women.

FDA continues to state that currently approved testosterone products are approved for men.

Is Testosterone Only for Women After Menopause?

That is where the strongest evidence exists.

The Global Consensus Position Statement supports testosterone therapy for postmenopausal women with HSDD following appropriate assessment.

ISSWSH guidance goes somewhat further, noting limited evidence that testosterone may also be considered in appropriately selected women in the late reproductive years.

The new 2026 systematic review reached a similar overall conclusion: randomized evidence in premenopausal women is promising, but there are far fewer trials and substantially fewer participants than in the postmenopausal evidence base.

So it would be inaccurate to say:

“Testosterone never helps before menopause.”

But it would also be inaccurate to suggest that the evidence is equally strong across all ages.

Testosterone vs. Estrogen: Are They Treating the Same Problem?

No.

Estrogen and testosterone may address different aspects of sexual health.

Declining estrogen around menopause can contribute to vaginal dryness, tissue changes and pain with sex. If sexual activity becomes uncomfortable, treating those genitourinary symptoms may improve the overall sexual experience.

That is different from directly treating persistent low sexual desire.

A woman may therefore have:

Pain or dryness without HSDD

HSDD without significant dryness or pain

or

Both at the same time

This is another reason sexual symptoms need to be separated rather than treated as one generic “hormone problem.”

Testosterone vs. Addyi vs. Vyleesi: What's the Difference?

These are very different treatments.

Testosterone

Testosterone is a hormone.

Evidence is strongest for physiologic systemic transdermal testosterone in appropriately selected postmenopausal women with HSDD.

In the United States, this treatment is off-label because there is no female-specific FDA-approved testosterone product.

Addyi® — Flibanserin

Addyi is FDA-approved for women under age 65 with acquired, generalized HSDD when low desire causes significant distress or interpersonal difficulty and is not better explained by another medical or psychiatric condition, relationship problems or a medication or drug.

It is taken once daily at bedtime.

Its current indication includes eligible premenopausal and postmenopausal women under age 65.

Vyleesi® — Bremelanotide

Vyleesi is FDA-approved for premenopausal women with acquired, generalized HSDD.

It is an as-needed subcutaneous injection administered at least 45 minutes before anticipated sexual activity.

Its label states that it is not indicated for postmenopausal women or men and is not intended to enhance sexual performance.

So these treatments differ in:

• patient population
• mechanism
• dosing schedule
• FDA approval status
• safety considerations
• route of administration

They should not be treated as interchangeable versions of a single “female libido drug.”

Related reading: Low Libido in Women: Causes, HSDD and Treatment Options in 2026

Related reading: PT-141 vs. Sildenafil vs. Tadalafil: What’s the Difference?

How Is Testosterone Usually Given to Women?

The strongest guideline support is for systemic transdermal testosterone—testosterone absorbed through the skin.

ISSWSH recommends dosing intended to keep testosterone exposure within the physiologic range seen in premenopausal women.

Where a female-specific formulation is unavailable, the guideline discusses cautious off-label use of regulated male transdermal formulations at substantially lower dosing.

This is another reason clinical supervision matters.

The goal is not to raise testosterone as high as possible.

The goal is to determine whether symptoms improve while avoiding excessive exposure.

What About Testosterone Cream for Women?

“Testosterone cream” can refer to different products, and that distinction matters.

Transdermal testosterone can be delivered using formulations such as gels or creams, and transdermal administration is the route with the strongest guideline support for HSDD.

But a commercially manufactured testosterone product being used off-label is not the same thing as a compounded testosterone preparation.

ISSWSH states that compounded testosterone products cannot be recommended for HSDD because of limited efficacy and safety evidence and potential variability in testosterone concentration.

That does not mean every compounded product is identical.

It means the clinical evidence and manufacturing standardization underlying compounded formulations are not equivalent to those supporting the formulations used in the major trials and guidelines.

What About Testosterone Pellets for Women?

Testosterone pellets have become visible in hormone and wellness treatment, but they are not the formulation recommended by current ISSWSH guidance for HSDD.

The guideline notes that testosterone implants may produce supraphysiologic testosterone concentrations, do not allow easy dose titration and can be difficult to manage once implanted.

Intramuscular injections and oral testosterone formulations are also not recommended for this indication.

The key principle is:

More testosterone is not necessarily better.

Increasing testosterone above the normal physiologic female range has not been shown to produce better HSDD outcomes and increases concern for androgen-related effects.

How Long Does Testosterone Take to Improve Libido?

Testosterone is not an immediate or on-demand libido treatment.

According to clinical-trial data summarized by ISSWSH:

• some women may begin noticing improvement around 4 weeks
• average efficacy tends to emerge around 6–8 weeks
• maximal effects on sexual desire and satisfying sexual events are generally seen at about 12 weeks

If there is no clinically meaningful improvement, the guideline recommends that treatment not be continued beyond approximately six months without reconsidering other potential causes of the symptoms.

That distinction is important.

The outcome being treated is not the testosterone number.

The relevant question is whether sexual desire and associated distress actually improve.

Does Testosterone Help Energy, Mood or Brain Fog in Women?

The evidence is much less established for those purposes.

Testosterone is sometimes promoted for broad symptoms such as:

• fatigue
• low energy
• mood changes
• concentration problems
• “brain fog”
• muscle loss
• general wellbeing
• anti-aging

But the evidence supporting testosterone for those goals is not comparable to the evidence supporting it for HSDD.

Major evidence reviews have not demonstrated consistent benefits for outcomes such as body composition, bone density or cognitive measures at physiologic female dosing.

So the more evidence-based position is:

Testosterone has a defined evidence base for sexual desire in selected women. It should not automatically be treated as a general energy, anti-aging or menopause-optimization treatment.

What Are the Side Effects of Testosterone in Women?

At physiologic doses, the most consistently observed androgen-related effects involve skin and hair.

A large meta-analysis summarized in the ISSWSH guideline found increased rates of:

• acne
• increased facial or body hair

with testosterone compared with control treatment.

When testosterone exposure becomes supraphysiologic, additional androgenic effects may include:

• acne
• hirsutism
• scalp hair thinning
• voice deepening

ISSWSH therefore emphasizes maintaining testosterone within the normal premenopausal physiologic range rather than attempting to maximize the laboratory value.

Is Testosterone Safe for Women Long Term?

The available shorter-term evidence is relatively reassuring when physiologic transdermal dosing is used appropriately.

Clinical trials summarized by ISSWSH did not show clear increases in serious adverse events over the studied periods, and several metabolic and laboratory measures were similar between testosterone and control groups.

But there is an important limitation:

Long-term safety remains incompletely established.

Randomized controlled trial safety data at physiologic dosing do not extend much beyond approximately 24 months, and evidence remains insufficient to definitively establish long-term effects on outcomes such as:

• breast cancer
• cardiovascular events
• endometrial and ovarian effects
• cognitive health
• other long-term outcomes

So testosterone should not be described as risk-free simply because shorter-term studies have been reassuring.

What Monitoring Is Needed With Testosterone Therapy?

Monitoring serves two different purposes:

1. Is treatment actually helping?

and

2. Is testosterone exposure staying within an appropriate physiologic range?

ISSWSH recommends measuring total testosterone and SHBG before treatment.

Testosterone is then reassessed after treatment begins to help identify excessive dosing, and levels are periodically monitored once treatment is stable.

The guideline also recommends monitoring for signs of androgen excess, including acne, increased facial hair and scalp hair thinning.

The important distinction is:

Testing is used to help prevent excessive testosterone exposure—not to chase a high target number.

Frequently Asked Questions

Can Women Take Testosterone?

Yes.

Testosterone is prescribed to some women, particularly appropriately selected women with HSDD.

The strongest evidence exists in postmenopausal women.

ISSWSH also recognizes limited evidence in some late-reproductive-age premenopausal women.

In the United States, testosterone use for women is off-label because no testosterone product is currently FDA-approved specifically for women.

Does Testosterone Increase Sex Drive in Women?

It can.

Randomized studies show that physiologic testosterone treatment can improve sexual desire in appropriately selected women with HSDD, with the strongest evidence in postmenopausal women.

Can I Have Low Libido Even if My Testosterone Is Normal?

Yes.

There is no testosterone blood level that diagnoses HSDD.

Sexual desire can be influenced by multiple biological, psychological, medication-related and relationship factors.

Does a Low Testosterone Blood Test Mean I Need Testosterone?

No.

A testosterone result may be useful during evaluation and treatment monitoring, but current guidelines specifically advise against using it alone to diagnose HSDD or determine whether treatment is needed.

Is Testosterone FDA-Approved for Female Libido?

No.

FDA currently states that approved testosterone products are approved for men.

Testosterone treatment for female HSDD is therefore an off-label use in the United States.

Can Premenopausal Women Use Testosterone for Low Libido?

Research exists, but the evidence is more limited than in postmenopausal women.

The 2026 systematic review identified only two randomized testosterone trials in premenopausal women compared with seven in postmenopausal women.

The authors characterized the premenopausal evidence as promising but limited by fewer studies and smaller sample sizes.

Does Testosterone Help Libido After Menopause?

This is where the evidence is strongest.

Large randomized trials and international sexual-medicine guidance support physiologic testosterone treatment for appropriately selected postmenopausal women with HSDD.

Does Testosterone Help Vaginal Dryness?

Testosterone is not the standard FDA-approved treatment for menopausal vaginal dryness.

Vaginal dryness and pain can reflect genitourinary changes associated with menopause and may require a different treatment approach.

A woman can have both vaginal discomfort and low sexual desire, so the two issues may need to be evaluated separately.

How Quickly Does Testosterone Work for Female Libido?

It does not usually work immediately.

ISSWSH reports that some women notice improvement after about four weeks, average efficacy emerges around six to eight weeks, and maximal effects on sexual desire are generally seen around 12 weeks.

What Happens if Testosterone Doesn't Improve Libido?

If no clinically meaningful benefit occurs, ISSWSH recommends not continuing therapy beyond approximately six months without reconsidering other possible causes of the symptoms.

Are Testosterone Pellets Better Than Cream or Gel?

Current ISSWSH guidance does not recommend testosterone pellets for HSDD because implants can produce supraphysiologic testosterone exposure and do not allow straightforward dose titration.

Transdermal testosterone has the strongest guideline support.

Is Compounded Testosterone Recommended for Women?

ISSWSH does not recommend compounded testosterone for HSDD because of insufficient efficacy and safety evidence and concerns about variability in testosterone concentration.

Can Testosterone Be Used Together With Estrogen?

Testosterone has been studied in postmenopausal women both with and without concurrent estrogen therapy.

Whether a woman needs treatment for low desire, menopausal genitourinary symptoms, both or neither depends on her symptoms and clinical situation.

Is Testosterone the Same as Addyi or Vyleesi?

No.

They are different therapies.

Testosterone is a hormone used off-label for selected women with HSDD.

Addyi is an FDA-approved daily oral treatment for women under 65 with acquired, generalized HSDD.

Vyleesi is an FDA-approved as-needed injection for premenopausal women with acquired, generalized HSDD.

The Most Important Question Isn't Just Your Testosterone Level

A change in sexual desire can be real and important even when hormone levels appear “normal.”

And a low testosterone result does not necessarily explain why desire changed.

Current evidence suggests that testosterone can be a meaningful treatment for some women with HSDD—particularly after menopause—but treatment decisions should be based on symptoms, distress, contributing factors and clinical evaluation rather than a laboratory number alone.

AmalfiDuo Sexual Wellness Programs

If you’re exploring ways to support your sexual wellness, AmalfiDuo offers private, provider-guided care programs for adults.

Explore available programs and complete a private online health evaluation if you find an option that may be right for you. A licensed clinician will review your health information to determine whether treatment is appropriate.

Explore Sexual Wellness Programs

A prescription is never guaranteed.

‍

References

1. Furlan VA, Hammad MAM, Quesada S, Nguyen S, Yih J. Testosterone therapy for female sexual dysfunction: a systematic review of the literature demonstrating outcomes in premenopausal and postmenopausal women. The Journal of Sexual Medicine. 2026;23(8). Published July 2026.
   https://academic.oup.com/jsm/article/23/8/qdag206/8732207
2. Parish SJ, Simon JA, Davis SR, et al. 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. 2021;18(5):849–867.
   https://www.isswsh.org/images/PDF/jsm_18_5_849.pdf
3. Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. The Journal of Sexual Medicine. 2019;16:1331–1337.
4. Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. The Lancet Diabetes & Endocrinology. 2019;7(10):754–766.
5. U.S. Food and Drug Administration. FDA issues class-wide labeling changes for testosterone products. February 28, 2025. This action addressed cardiovascular boxed-warning language and blood-pressure labeling following TRAVERSE and ambulatory blood-pressure studies.
   https://www.fda.gov/drugs/drug-safety-and-availability/fda-issues-class-wide-labeling-changes-testosterone-products
6. U.S. Food and Drug Administration. Testosterone Information. Updated June 23, 2026. Current FDA information also describes the separate June 2026 testosterone-label updates and states that FDA-approved testosterone products are approved for men.
   https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/testosterone-information
7. DailyMed. ADDYI® (flibanserin) U.S. Prescribing Information. Current indication: women under age 65 with acquired, generalized HSDD meeting the labeled criteria.
   https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3819daf3-e935-2c53-c527-e1d57922f394
8. DailyMed. VYLEESI® (bremelanotide) U.S. Prescribing Information. Current indication: premenopausal women with acquired, generalized HSDD meeting the labeled criteria.
   https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=VYLEESI

‍

This article is provided for general educational purposes only and is not a substitute for individualized medical advice, diagnosis or treatment. Prescription treatment should be discussed with a qualified healthcare professional. AmalfiDuo Journal articles are written by AmalfiDuo Editorial and are not medically reviewed — see our Editorial Policy.

Addyi® and Vyleesi® are trademarks of their respective owners. AmalfiDuo is not affiliated with or endorsed by the owners or manufacturers of these brands.