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Testosterone is almost universally described as a male hormone. The label is so embedded in popular usage that many women who learn they have low testosterone are surprised to discover they have any at all. But testosterone is produced by every female body, plays essential roles in female health across a lifetime, and when levels fall significantly, particularly around menopause, the consequences can include a real and measurable decline in sexual desire. This article explains what testosterone actually does in women, how levels change over time, and what the research says about the relationship between testosterone and libido.
Testosterone is an androgen, a class of hormones associated with masculine development and physiology. Men produce it in larger quantities than women, primarily in the testes, and it drives puberty, muscle development, facial hair, and various other aspects of male biology. This association has led to testosterone being described as a male hormone in popular culture and even in some medical contexts.
The description is misleading. Women produce testosterone in two main locations: the ovaries and the adrenal glands (the small glands that sit on top of the kidneys). A portion is also produced through the conversion of other hormones in peripheral tissues. Women's testosterone levels are typically 10 to 15 times lower than men's, but the hormone is biologically active and important at those lower concentrations.
All sex hormones, including testosterone, oestrogen, and progesterone, are present in both sexes. They differ in quantity and ratio, not in which sex possesses them. Understanding this is essential context for understanding why a decline in testosterone in women can have real physiological consequences, including effects on desire.
Testosterone contributes to several aspects of female physiology and wellbeing. Its role in sexual desire is the most discussed, but the hormone's effects extend well beyond libido.
Bone density: testosterone contributes to bone maintenance and strength in women, as does oestrogen. The combination of declining oestrogen and testosterone at and after menopause accelerates bone density loss, increasing fracture risk over time.
Muscle mass and physical strength: testosterone supports the maintenance of lean muscle tissue. Women with very low testosterone may notice reduced physical endurance and difficulty maintaining muscle, though these effects are subtler than the more dramatic changes seen with testosterone variation in men.
Mood and energy: testosterone has documented effects on mood, motivation, and energy. Low levels are associated with fatigue, low mood, and reduced motivation in women, though these are non-specific symptoms with many possible causes. Margaret Wierman and colleagues have reviewed this evidence in detail, noting the difficulty of distinguishing testosterone-specific effects from the broader hormonal and life-context changes that occur around menopause.
Sexual desire: this is where the evidence is strongest and most clinically relevant. Testosterone is involved in the brain's processing of sexual stimuli and the neurochemical pathways associated with arousal and wanting. It acts on androgen receptors in the brain, including areas involved in motivation and reward, and on receptors in genital tissue, contributing to sensitivity and arousal response.
Testosterone levels in women peak in the early to mid-twenties and then decline gradually with age. This decline is gradual and relatively steady through the thirties and forties. It is not as steep or sudden as the oestrogen decline that occurs at menopause, but it is real and cumulative.
Menopause, which typically occurs in the late forties or early fifties, marks a more significant hormonal transition. Oestrogen falls sharply; testosterone also declines as ovarian function reduces. The overall effect is a substantial reduction in total androgen activity in the body.
Surgical menopause, which results from removal of the ovaries (oophorectomy), produces a much more abrupt hormonal change than natural menopause. Because the ovaries are a primary source of testosterone production, their removal can cause a sudden and significant drop in testosterone levels. Women who experience surgical menopause often report more sudden and severe symptoms, including rapid decline in libido, compared to those going through natural menopause over several years.
Hypoactive sexual desire disorder (HSDD) is a clinical diagnosis characterised by persistently low sexual desire that causes personal distress. It is one of the most common sexual concerns reported by women, particularly in midlife and beyond. Research has examined the role of testosterone in HSDD extensively.
Jan Shifren and colleagues published research examining testosterone levels and sexual function in women who had undergone surgical menopause and were on oestrogen therapy. They found that women who received testosterone supplementation in addition to oestrogen reported significantly greater sexual desire, arousal, and frequency of satisfying sexual activity compared to those on oestrogen alone. The effect size was clinically meaningful, not trivial.
A comprehensive 2019 review by Susan Davis and colleagues, published in The Lancet Diabetes and Endocrinology, reviewed the available evidence on testosterone therapy for women across a range of outcomes. The review found consistent evidence that testosterone therapy improves sexual function and desire in post-menopausal women with HSDD. It also found that at physiological doses, testosterone therapy in women appeared safe over the periods studied, with no significant increase in adverse cardiovascular events or breast cancer risk in trials of up to two years.
Davis noted, however, that the evidence base remains thinner than for other hormonal therapies, partly because pharmaceutical industry interest in developing approved products for this indication has been limited. This has left many clinicians working with off-label formulations and without the long-term safety data that would come from dedicated regulatory trials.
Testosterone therapy for women is available in some countries in approved formulations. In many countries, including India, it is not formally approved for female use, meaning that when it is prescribed it is done so off-label, using formulations developed for men at adjusted doses. The clinical landscape is therefore variable, and access depends significantly on the knowledge and willingness of individual endocrinologists or gynaecologists.
It is important to note that low testosterone is not the only possible cause of reduced desire, and not all cases of low desire involve testosterone. Psychological factors (stress, anxiety, relationship dynamics, past experience), other hormonal changes (oestrogen, progesterone, thyroid function), medication effects (some antidepressants and hormonal contraceptives are associated with reduced desire), and relationship context all contribute. A good clinical assessment considers all of these, not just androgen levels.
Testing for testosterone in women is also more complex than it might appear. Standard testosterone assays were developed and validated for male ranges, and their accuracy at the lower concentrations typical of women is variable. More sensitive assays (LC-MS/MS methods) are more reliable but not universally available. A result showing low-normal or low testosterone in a woman with reduced desire is worth discussing with a doctor, but the context and clinical picture matter as much as the number.
If sexual desire has declined significantly, particularly if the change was noticeable around a specific hormonal transition (menopause, surgical menopause, stopping hormonal contraception), and if psychological and relationship factors have been reasonably considered, a conversation with an endocrinologist or gynaecologist about hormone levels is a worthwhile step. The research base for testosterone therapy in this context, while not as extensive as for some other interventions, is real and growing.