Will testosterone supplements increase woman’s libido?
Executive summary
Testosterone supplementation can increase sexual desire for some women—most consistently for postmenopausal patients diagnosed with hypoactive sexual desire disorder (HSDD)—but benefits are modest, not universal, and long‑term safety remains unclear [1] [2] [3]. For premenopausal women or those without a clearly defined disorder, routine use is not supported and regulatory approval and large safety trials are lacking [4] [5].
1. What the clinical evidence actually shows: modest gains, focused population
Randomized trials and meta‑analyses report that transdermal or other testosterone regimens produce modest but measurable improvements in desire, frequency of satisfying sexual encounters and sexual pleasure—effects most reproducible in postmenopausal women with HSDD or surgically induced menopause—yet these gains are neither universal nor large in every study [1] [2] [6]. A large pooled review of dozens of studies found positive effects on desire and reduced sexual anxiety, but investigators and guideline panels emphasize that benefits are primarily demonstrated in women meeting clinical criteria for distressing low desire rather than the broader population [2] [7].
2. Why results vary: biology and the many drivers of libido
Sexual desire in women is driven by complex neuroendocrine, psychological and social factors, so serum testosterone is only one piece of a multifactorial puzzle; large studies often fail to show a clear correlation between total circulating testosterone and desire across all women, and measurement limitations (including intracrine and central nervous system androgen activity) mean “low T” is an imperfect marker for who will benefit [8] [1] [5]. Clinical guidance therefore recommends careful diagnosis—ruling out thyroid disease, depression, medication effects, relationship stress and other contributors—before attributing low libido to androgen deficiency [4] [9].
3. Safety, side effects and the unanswered long‑term question
Short‑term trials report side effects such as acne, increased facial/body hair, voice changes and mild weight changes, and some observational data link androgen supplements with metabolic concerns; long‑term risks—particularly effects on breast tissue, cardiovascular outcomes and diabetes risk—remain insufficiently defined, which is why many authorities caution against broad prescribing beyond well‑selected cases [1] [4] [5]. Regulatory and specialty groups explicitly note that no widely approved female testosterone formulation exists in many countries and advise caution because the long‑term safety profile has not been established [7] [5].
4. What guidelines and experts recommend in practice
Clinical position statements and organizations such as the International Menopause Society and NICE suggest testosterone may be considered for postmenopausal women with HSDD who have not improved with estrogen or other measures, using the lowest effective dose and with specialist oversight and monitoring [3] [10]. Many clinicians treat women off‑label or with compounded preparations when they judge potential benefit outweighs risk, but they do so with informed consent and follow‑up because standard approved products and long‑term data are limited [10] [5].
5. Bottom line: who should expect benefit, and how to approach treatment
For a woman with clinically diagnosed HSDD after menopause, a monitored short course of appropriately dosed testosterone can reasonably be expected to improve desire for some—but not all—patients, and should be part of a comprehensive assessment that explores nonhormonal causes and therapies first; for premenopausal women or those without a clear disorder, the evidence does not support routine use and the risk–benefit calculus is unresolved [6] [4] [9]. Any decision should involve specialist consultation, clear diagnostic criteria, careful dosing, attention to side effects and a plan for regular reassessment given persistent uncertainty about long‑term harms [3] [1].