By Dr. Lilian Massihi, MD, Board-Certified Family Medicine, Advanced BHRT Certification
It did not happen overnight. Desire faded slowly, and one day you noticed it was simply gone. Not strained, not complicated, just absent. You mentioned it at an appointment, maybe more than once, and you were told it was stress, or age, or a natural part of being a woman. Your labs came back, and someone said they were normal.
So you stopped bringing it up. You decided it was your fault, or your relationship, or one more thing to accept quietly. What almost no one told you is that there is a hormone directly responsible for sexual desire in women, and that in most exam rooms it is never discussed and never measured.
The short answer: Yes, women have testosterone, and low testosterone in women is a real, common, and well-documented cause of fading sexual desire. It is also one of the least investigated, because there is no FDA-approved testosterone product for women and no agreed-upon “normal” female value, so most clinics simply skip it. A loss of desire that distresses you deserves a full evaluation, not a shrug.
Yes, Women Have Testosterone, and It Does More Than You Were Told
Testosterone is usually filed under “male hormone,” which is exactly why it gets overlooked in women. Your ovaries and adrenal glands produce it your entire adult life, and it is part of the same hormonal system that includes estrogen and progesterone. According to the Cleveland Clinic, testosterone in women plays a role in sex drive, bone and muscle health, mood, and energy.
Levels begin a slow decline in your thirties. By the time you reach menopause, your testosterone may be roughly half of what it once was, and if your ovaries were surgically removed, that drop is steeper and more sudden. This is biology, not a character flaw, and it is not something you were supposed to push through on willpower.
The symptoms of low testosterone in women are easy to mistake for everything else: low desire, persistent fatigue, loss of muscle tone and strength, low mood, and a general sense of feeling flat. Those same symptoms overlap with thyroid issues, perimenopause, anemia, and depression, which is one reason they get attributed to anything except the hormone that may actually be involved.
The Symptom Most Clinics Never Investigate
The symptom is distressing low sexual desire, and it is far more common than the silence around it suggests. The international expert panel behind the first Global Position Statement on testosterone therapy for women noted that hypoactive sexual desire disorder, the clinical term for desire loss that causes genuine distress, affects roughly 32 percent of women at midlife.
Nearly a third of women, and the reasons it goes unexamined are structural, not personal. Most clinicians were trained to think of testosterone as a men’s hormone, and there is no testosterone product the FDA has approved specifically for women, so there is no tidy prescription waiting at the end of the conversation. Being told your experience is normal is not the same as being heard.
The Lab Test Was Built Around Men, Not You
Even when a provider is willing to look, the testing works against you. As the Cleveland Clinic puts it plainly, healthcare providers do not have a standard value for “normal” testosterone in women. The reference ranges most labs use were built around men, whose levels run roughly ten times higher, and standard assays are not precise at the much lower concentrations found in women.
So a number comes back, it falls inside a range that was never designed around how you feel, and you are told everything looks fine. The reference range did its job. It just was not built to answer your question. Reference-range medicine asks whether your number is technically acceptable. Precision medicine asks whether your physiology and your symptoms line up, and what would change if they did. A single testosterone value never tells the whole story in a woman, which is exactly why it has to be read alongside your symptoms, your history, and the rest of your hormones, not in isolation.
Testosterone Is Never the Whole Answer
This is the part the franchise clinics leave out, and it is the most important thing on this page: for a perimenopausal or postmenopausal woman, testosterone is rarely the first hormone to address, and it is never the only one. Female hormone care is built primarily on estradiol and progesterone. Testosterone is added to that foundation when your symptoms and the evidence point there, not handed out on its own as a desire shortcut.
There is a clinical reason the order matters. Much of what gets labeled low libido in menopause is actually driven by declining estrogen: vaginal dryness, discomfort with sex, broken sleep, and mood changes that pull desire down on their own. The same international panel that endorsed testosterone for desire was explicit that inadequate estrogen and these genitourinary changes should be evaluated and addressed first. Layer testosterone onto an estrogen and progesterone base that has been ignored, and you are adjusting one instrument while the rest of the orchestra stays out of tune.
So the honest framing is not “you need testosterone.” It is “you deserve a complete hormonal evaluation, and testosterone is one piece of it.” Progesterone protects sleep, mood, and, for women with a uterus, the uterine lining. Estradiol addresses the hot flashes, genitourinary changes, and bone loss of menopause. Testosterone supports desire. They were designed to work as a system, because that is how your body ran them before they declined.
What the Evidence Actually Says, Without the Overselling
Here is where honesty matters, because you have likely been oversold before. The strongest, most agreed-upon evidence for testosterone in women is for sexual desire. The 2019 Global Position Statement, endorsed by the Endocrine Society and ten other international medical societies, concluded that testosterone can meaningfully improve sexual wellbeing in postmenopausal women, including desire, arousal, orgasm, and the distress that comes with their loss.
That same statement was careful to say the current evidence does not yet prove testosterone helps with other symptoms like energy, mood, or cognition. Those are roles testosterone plays in the body, but the research has not caught up enough to promise them as outcomes. A practice that tells you testosterone will solve your energy, your mood, and your sleep all at once is getting ahead of the science.
What a careful physician does instead is evaluate your complete hormonal picture, treat the symptom that has the clearest evidence behind it, dose appropriately, and adjust to how you actually respond while monitoring for safety. That is the difference between a protocol sold to you and medicine practiced with you.
What a Real Evaluation Looks Like
If the foundation matters this much, so does the workup behind it. A thorough evaluation through hormone optimization looks at the whole system, not a single hormone:
- Your full symptom history, including when desire changed, what else shifted with it, and what distress it is causing. The diagnosis is clinical first, never a lab number alone.
- Estradiol and progesterone, because low desire frequently travels with the estrogen and progesterone changes of perimenopause and menopause, including vaginal dryness and discomfort that affect desire on their own.
- Testosterone, measured with attention to the limits of the assay and read against your symptoms, not just a male-built range.
- Thyroid and metabolic markers, since an underactive thyroid produces nearly identical fatigue and low mood, and is missed just as often.
- Your personal and family history, including current cancer screenings, so any decision is made with your individual risk in full view.
When testosterone therapy is appropriate, it is bioidentical, molecularly identical to what your body already makes, and titrated to how you feel rather than to where a chart sets the floor, with follow-up labs that keep the focus on your safety. You can read more about that approach on our testosterone therapy for women page.
If your story also includes weight that will not move or a mind that feels foggy, those are not separate problems to file away. They are often the same hormonal shift showing up in different places, which is why we treat the whole picture rather than one symptom at a time. We have written about perimenopause weight gain and menopause brain fog for exactly that reason.
Frequently Asked Questions
Can women have low testosterone?
Yes. Women produce testosterone in the ovaries and adrenal glands, and levels decline with age, beginning in the thirties and dropping further through menopause or after surgical removal of the ovaries. Low testosterone in women is well documented and can affect sexual desire, energy, mood, and muscle tone. It is underdiagnosed mostly because it is rarely investigated, not because it is rare.
What are the symptoms of low testosterone in women?
The most evidence-backed symptom is distressing loss of sexual desire. Others commonly reported include fatigue, reduced muscle strength and tone, low mood, and a flat, joyless feeling. Because these overlap heavily with thyroid problems, perimenopause, anemia, and depression, they are frequently attributed to something else, which is part of why testosterone gets overlooked.
Why didn’t my doctor check my testosterone?
Several reasons, none of them about you. Testosterone is still widely thought of as a male hormone, there is no FDA-approved testosterone product made specifically for women, and labs have no agreed-upon “normal” female range, so the test feels less useful to providers who are not focused on hormone optimization. When there is no simple prescription waiting at the end, the question often is not asked at all.
Does testosterone help low sex drive in women?
For postmenopausal women with genuinely distressing low desire, the evidence is clear enough that eleven international medical societies endorsed it: carefully dosed testosterone can improve desire, arousal, and satisfaction. It is not a guarantee, and it is not a stand-alone answer for energy or mood, where the evidence is weaker. It works best as one part of a physician-directed plan that addresses your full hormonal picture.
Is testosterone therapy for women safe?
When it is bioidentical and carefully monitored, testosterone is generally well tolerated, with acne or increased hair growth being the most common side effects and both manageable by adjusting the dose. Current evidence has not shown that testosterone at the doses used for women raises breast cancer risk, though long-term safety data are still limited, which is why ongoing lab monitoring and individual risk review matter. You can read our broader take on hormone safety in Is HRT Safe? What the Science Actually Says.
AllureMD is a physician-led hormone optimization practice in Madison, Mississippi. Dr. Lilian Massihi, MD evaluates each patient’s complete hormonal picture before making any recommendation. To schedule your consultation, book a complimentary discovery call.
About the Author
Dr. Lilian Massihi, MD is a board-certified family medicine physician and hormone optimization specialist who completed her undergraduate education at UCLA, earned her medical degree at the University of Poznań, and finished her residency at the University of Mississippi Medical Center. For more than five years, she practiced as a hospitalist, treating patients in the late stages of cardiovascular disease, cognitive decline, and severe osteoporosis. She kept asking the same question: what would have been different if someone had intervened sooner? That question led her to bioidentical hormone therapy, where a rigorous review of the evidence changed the direction of her career. She founded AllureMD in Madison, Mississippi to practice the kind of medicine she had come to believe in: treating the entire hormonal system, titrating to how patients actually feel, with a physician leading every decision.