Author: Joe Miller, Founder of 1st Optimal
Medically reviewed by: Franchell Hamilton, MD, FACS, FASMBS, DABOM
Quick Answer:
A 2026 systematic review found that testosterone therapy was associated with improvements in sexual desire, libido, sexual satisfaction, and satisfactory sexual experiences in women.
The strongest evidence came from randomized clinical trials involving postmenopausal women. Results in premenopausal women were promising, but the studies were fewer and generally smaller.
Important questions remain about long-term safety, ideal dosing, treatment duration, and which women are most likely to benefit.
Key point: Testosterone therapy is not a universal treatment for fatigue, weight gain, brain fog, or every case of low libido. Current clinical guidance supports its clearest evidence-based use in appropriately evaluated postmenopausal women with hypoactive sexual desire disorder.
Key Findings at a Glance
The researchers:
- Identified 782 records across Scopus, PubMed, and CINAHL
- Removed 230 duplicate records
- Screened 552 records
- Included 32 studies in the final review
- Identified four randomized controlled trials involving premenopausal women
- Found the strongest and most consistent evidence in postmenopausal women
- Reported improvements in sexual desire, satisfaction, and satisfactory sexual experiences
- Noted limited long-term safety data and inconsistent androgen measurements
The findings support individualized evaluation rather than prescribing testosterone based only on symptoms or one laboratory result.
Why This Research Matters
Low sexual desire in women is often dismissed as an unavoidable result of aging, stress, menopause, or relationship changes.
Those factors can influence libido, but they do not make a woman’s symptoms imaginary or unimportant.
Sexual health is connected to:
- Quality of life
- Emotional wellbeing
- Physical comfort
- Relationships
- Sleep
- Medication use
- Nervous system health
- Menopause and hormone changes
When sexual desire declines and causes meaningful distress, it deserves a careful clinical evaluation.
Testosterone is often described as a male hormone, but women also produce testosterone through the ovaries, adrenal glands, and hormone conversion within tissues.
Its relationship with sexual desire is complicated. A single testosterone result cannot determine whether a woman has a sexual desire disorder or predict whether she will respond to treatment.
The 2026 systematic review matters because it evaluated whether testosterone treatment improved actual sexual outcomes rather than assuming symptoms could be explained by a low laboratory value.
What Study Was Reviewed?
The article was titled:
“Testosterone Therapy for Female Sexual Dysfunction: A Systematic Review of the Literature Demonstrating Outcomes in Premenopausal and Postmenopausal Women.”
It was published in The Journal of Sexual Medicine in 2026.
The authors included Vada A. Furlan, Muhammad A. Hammad, Sophia Quesada, Sabrina Nguyen, Jessica Yih, and colleagues from the University of California, Irvine and UCI Health.
The researchers followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses, commonly called PRISMA, to identify and evaluate relevant studies.
Study Selection
| Review stage | Number |
|---|---|
| Scopus records | 565 |
| PubMed records | 186 |
| CINAHL records | 31 |
| Total records | 782 |
| Duplicates removed | 230 |
| Records screened | 552 |
| Studies included | 32 |
Eligible studies evaluated testosterone therapy in premenopausal or postmenopausal cisgender women with female sexual dysfunction.
The studies reported outcomes related to:
- Sexual desire
- Libido
- Sexual satisfaction
- Satisfactory sexual experiences
- Overall sexual function
What Did the Review Find in Premenopausal Women?
Four randomized controlled trials included premenopausal women.
Individual study sizes ranged from 10 to 261 participants.
Transdermal or vaginal testosterone was associated with improvements in:
- Sexual desire
- Libido
- Frequency of satisfactory sexual events
- Overall sexual satisfaction
These results suggest that testosterone may help some premenopausal women with carefully evaluated sexual dysfunction.
They do not establish that testosterone should routinely be prescribed to every younger woman reporting low libido.
The evidence remains less certain because:
- Only four randomized trials were identified
- Some trials included very few participants
- Testosterone formulations differed
- Routes of administration differed
- Hormone measurements were not consistently reported
- Long-term safety was not established
- Criteria for identifying likely responders remain unclear
A 2024 review of systemic testosterone therapy also concluded that treatment may be worth considering in selected premenopausal patients with hypoactive sexual desire disorder.
However, the supporting evidence remains much smaller than the evidence in postmenopausal women.
What Did the Review Find in Postmenopausal Women?
The evidence in postmenopausal women was stronger and included larger randomized controlled trials.
One trial included more than 800 participants.
Transdermal testosterone at a studied dose of approximately 300 micrograms per day produced significant improvements in sexual desire and symptoms associated with hypoactive sexual desire disorder.
The benefits appeared reasonably consistent across the higher-quality postmenopausal studies.
These results align with earlier systematic reviews and international clinical guidance.
Previous research found that nonoral testosterone therapy may improve several areas of sexual function in postmenopausal women with low desire that causes distress, including:
- Sexual desire
- Arousal
- Pleasure
- Orgasmic function
- Sexual responsiveness
- Sexual distress
The 300-microgram daily dose used in some studies refers to a specific research patch.
It should not be interpreted as a universal dosing recommendation.
Available testosterone products differ in concentration, absorption, formulation, and delivery method. Women should not self-dose testosterone based on a study abstract or online dosing chart.
Premenopausal Versus Postmenopausal Evidence
| Question | Premenopausal women | Postmenopausal women |
| Does research suggest a benefit? | Possibly | Yes, in appropriately selected patients |
| Strength of evidence | Preliminary and limited | Stronger and more consistent |
| Randomized trials in the review | Four | Several, including large trials |
| Outcomes improved | Desire, satisfaction, satisfactory sexual events | Desire, distress, and broader sexual-function measures |
| Guideline support | Limited and cautious | Supported for diagnosed HSDD |
| Long-term safety established? | No | No |
| Routine treatment recommended? | No | Only after individualized evaluation |
What Is Hypoactive Sexual Desire Disorder?
Hypoactive sexual desire disorder, or HSDD, refers to persistently or recurrently reduced sexual desire that causes meaningful personal distress.
Low desire alone does not automatically equal HSDD.
A woman may naturally have less interest in sex than another person and feel completely comfortable with it. In that situation, there may be no disorder to treat.
Clinical evaluation considers:
- Whether desire has changed from the woman’s previous baseline
- Whether the change is generalized or situation-specific
- Whether the change causes distress
- Pain, dryness, or discomfort during sexual activity
- Medication side effects
- Depression or anxiety
- Trauma or chronic stress
- Sleep deprivation
- Relationship conflict
- Body-image concerns
- Menopause symptoms
- Thyroid, metabolic, or other health conditions
International guidance recommends diagnosing HSDD through a comprehensive biopsychosocial assessment, not through a testosterone result alone.
Does a Low Testosterone Result Diagnose Low Libido?
No.
There is no established testosterone cutoff that reliably separates women with normal sexual function from women with sexual dysfunction.
A total testosterone test can provide useful baseline information before treatment. It may also help a clinician monitor for excessive testosterone exposure.
It should not be used alone to diagnose HSDD or prove that a woman’s symptoms come from testosterone deficiency.
Sexual desire is influenced by far more than one hormone.
A woman with a lower testosterone result may have no sexual symptoms. Another woman with a testosterone result inside the laboratory reference range may experience distressing low desire.
The result must be interpreted alongside:
- Symptoms
- Medical history
- Medication use
- Menopause stage
- Relationship context
- Physical comfort
- Personal treatment goals
How Might Testosterone Affect Female Sexual Function?
Testosterone can act directly through androgen receptors.
It can also act indirectly after being converted within tissues into other active hormones.
Potential effects related to sexual function include:
- Increased sexual motivation
- Greater interest in sexual activity
- Improved responsiveness to sexual cues
- Increased arousal
- Changes in genital blood flow
- Improved pleasure
- Improved orgasmic response
- Reduced sexual distress
The response varies substantially between individuals.
Hormones are only one part of a larger network involving:
- The brain
- The nervous system
- Genital tissues
- Emotional wellbeing
- Health conditions
- Medication use
- Sleep
- Relationship context
A strong clinical evaluation does not ask only, “What is the testosterone level?”
It also asks, “What changed, what is causing distress, and what other barriers may be affecting sexual function?”
What the New Study Does Not Prove
The review provides meaningful support for testosterone therapy, but it should not be stretched into claims the evidence cannot support.
It Does Not Prove Every Woman With Low Libido Needs Testosterone
Low desire can be caused or worsened by:
- Stress
- Medications
- Depression
- Anxiety
- Sexual pain
- Vaginal dryness
- Sleep disruption
- Chronic illness
- Relationship factors
- Other hormone changes
It Does Not Establish a Female Testosterone-Deficiency Syndrome
Major guidelines state that there is no reliable symptom pattern or testosterone threshold that establishes a generalized androgen-deficiency diagnosis in otherwise healthy women.
It Does Not Prove Benefits for Weight Loss, Cognition, Fatigue, or Longevity
The clearest evidence-based indication remains HSDD in postmenopausal women.
Evidence remains insufficient to recommend testosterone solely for:
- Weight loss
- Cognitive enhancement
- Brain fog
- Disease prevention
- General wellbeing
- Metabolic health
- Anti-aging
- Longevity
It Does Not Establish Long-Term Safety
Most clinical trials were too short to define long-term:
- Breast health outcomes
- Cardiovascular outcomes
- Metabolic outcomes
- Cancer risk
Controlled safety data beyond approximately 24 months remain inadequate.
It Does Not Make Every Delivery Method Equivalent
The strongest evidence involves nonoral testosterone used at doses intended to maintain normal female physiological levels.
Results should not automatically be applied to:
- High-dose injections
- Oral testosterone
- Implanted pellets
- Formulations that produce supraphysiological testosterone levels
Who May Be an Appropriate Candidate?
Based on current evidence and international guidance, the clearest potential candidate is a postmenopausal woman who:
- Has persistently reduced sexual desire
- Experiences meaningful distress
- Has completed an appropriate biopsychosocial evaluation
- Has addressed other contributing conditions
- Understands that treatment may be off-label in the United States
- Has no clear contraindication
- Is willing to complete follow-up and laboratory monitoring
- Understands the limitations of long-term safety data
Some premenopausal or late-reproductive-age women may also be considered by an experienced clinician after careful evaluation.
The evidence in these groups remains less established, so treatment decisions require greater caution and informed consent.
What Should Be Evaluated Before Testosterone Therapy?
A thorough evaluation begins with the symptom, not the prescription.
1. Clarify the Sexual-Health Concern
A clinician should determine whether the primary concern involves:
- Desire
- Arousal
- Orgasm
- Sexual pain
- Vaginal dryness
- Relationship context
- More than one of these concerns
Testosterone will not correct every form of female sexual dysfunction.
2. Review Medications
Medications that may affect sexual function include:
- Selective serotonin reuptake inhibitors
- Certain blood pressure medications
- Opioids
- Some hormonal contraceptives
- Antiandrogen medications
- Sedating medications
Medication changes should only be made with the prescribing clinician.
3. Assess Vaginal and Pelvic Symptoms
Pain, dryness, bleeding, vulvar conditions, genitourinary syndrome of menopause, and pelvic floor dysfunction can significantly reduce sexual desire and satisfaction.
Treating discomfort may be more important than adding testosterone.
4. Review Sleep, Stress, and Mental Health
Chronic stress and poor sleep can suppress sexual interest even when hormone results appear acceptable.
Anxiety, depression, trauma, and relationship strain may also require targeted support.
5. Consider Appropriate Laboratory Testing
Testing varies according to the patient’s symptoms and medical history.
A clinician may consider:
- Total testosterone
- Sex hormone-binding globulin
- Estradiol
- Thyroid markers
- Complete blood count
- Comprehensive metabolic panel
- Lipid panel
- Hemoglobin A1c
- Iron and ferritin
- Prolactin when clinically indicated
Total testosterone is measured primarily to establish a baseline and help prevent excessive treatment.
It is not used alone to diagnose HSDD.
How Is Testosterone Therapy Monitored in Women?
International recommendations support a structured monitoring process.
A clinician may:
- Measure total testosterone before treatment.
- Repeat testing approximately three to six weeks after treatment begins.
- Assess symptom response.
- Look for signs of excessive androgen exposure.
- Keep testosterone concentrations within the normal physiological range for premenopausal women.
- Recheck testosterone periodically during ongoing treatment.
- Stop treatment when no meaningful benefit occurs within approximately six months.
Follow-up may also include a review of:
- Acne
- Facial or body-hair growth
- Scalp-hair changes
- Voice changes
- Clitoral changes
- Skin reactions
- Lipid levels
- Metabolic markers
- Treatment adherence
- Sexual desire
- Sexual distress
- Overall quality of life
Monitoring should focus on both clinical benefit and safe exposure.
The goal is not to chase the highest possible testosterone result.
What Are the Possible Side Effects?
When testosterone is used at doses that maintain normal female physiological concentrations, studies have reported mild increases in:
- Acne
- Facial hair
- Body hair
Short-term randomized trials have not consistently shown increased rates of:
- Voice deepening
- Clitoral enlargement
- Scalp-hair loss
These effects become more concerning when doses are excessive or produce supraphysiological testosterone concentrations.
Long-term uncertainties remain regarding:
- Cardiovascular outcomes
- Breast cancer risk
- Treatment in women with high cardiometabolic risk
- Treatment beyond two years
- Safety in women with hormone-sensitive cancers
Most major trials excluded women with substantial cardiovascular risk and women with a history of breast cancer.
The results cannot automatically be applied to those populations.
Are Testosterone Pellets, Injections, and Oral Products Supported?
The evidence is not equal across delivery methods.
International consensus guidance recommends against preparations that produce testosterone concentrations above the normal female physiological range.
Testosterone Injections
Some injections may produce high peaks in testosterone exposure, depending on the product and dose.
They require careful dosing and monitoring.
Testosterone Pellets
Pellets may be difficult to adjust or discontinue after insertion.
Some formulations can produce testosterone levels above the normal female physiological range.
Oral Testosterone
Oral testosterone is generally not recommended because it may negatively affect cholesterol levels.
Transdermal Testosterone
Transdermal therapy has the strongest research support.
It may be easier to adjust and monitor than longer-lasting preparations.
The specific formulation and dose still require careful clinical management.
Is Testosterone Approved for Women in the United States?
As of July 2026, there is no testosterone product specifically approved by the U.S. Food and Drug Administration for treating women with HSDD.
Clinicians may prescribe certain testosterone products off-label in carefully adjusted female doses.
Off-label treatment is legal and common in medicine, but it requires:
- Clear documentation
- Informed consent
- Accurate dosing
- Appropriate monitoring
- Ongoing clinical follow-up
FDA-approved testosterone products in the United States are primarily labeled for men with specific medical causes of testosterone deficiency.
A standard male testosterone dose can be several times greater than the amount generally considered for women.
Experienced clinical oversight is essential.
What Does This Mean for Women in Perimenopause?
The review’s premenopausal findings may be relevant to women in perimenopause because many women experience changes in sexual desire before their final menstrual period.
The new data suggest that testosterone may provide benefits for selected premenopausal women.
However, the evidence does not carry the same certainty as the evidence in postmenopausal women.
Perimenopausal libido changes may also involve:
- Fluctuating estrogen
- Lower or inconsistent progesterone
- Sleep disruption
- Heavy or unpredictable periods
- Vaginal discomfort
- Mood changes
- Stress
- Medication effects
- Thyroid problems
- Iron deficiency
A complete assessment is more useful than assuming every perimenopausal symptom comes from low testosterone.
Learn more in our https://1stoptimal.com/perimenopause-survival-guide/ Perimenopause Survival Guide.
The Clinical Takeaway From the 2026 Review
The new systematic review strengthens the evidence that testosterone can improve important areas of sexual function in women.
Its most defensible conclusions are:
- Testosterone therapy may improve sexual desire and related outcomes in appropriately selected women
- The evidence is strongest in postmenopausal women with HSDD
- Premenopausal findings are promising, but more high-quality trials are needed
- A testosterone level should not be used alone to diagnose sexual dysfunction
- Treatment should aim for normal female physiological exposure
- Long-term safety remains incompletely defined
- Sexual health requires a whole-person assessment
That assessment should include:
- Hormones
- Physical comfort
- Medications
- Mental health
- Sleep
- Stress
- Relationships
- Personal goals
The research is encouraging.
It is not permission for careless hormone prescribing.
How 1st Optimal Approaches Women’s Hormone Health
At 1st Optimal, women’s hormone care begins with a review of:
- Symptoms
- Medical history
- Current medications
- Menopause stage
- Laboratory data
- Health risks
- Personal treatment goals
Depending on the patient, the evaluation may consider:
- Estrogen and progesterone changes
- Testosterone and sex hormone-binding globulin
- Thyroid function
- Iron status
- Blood sugar and metabolic health
- Sleep quality
- Stress and recovery
- Vaginal and sexual health
- Nutrition
- Exercise and strength training
- Medication-related symptoms
Treatment is personalized.
Testosterone may be one part of a treatment plan when clinically appropriate, but it should not be treated as a universal solution for every midlife symptom.
The goal is not to push hormones as high as possible.
The goal is to understand what is driving the symptoms and use the lowest appropriate intervention that produces meaningful improvement.
Learn more about https://1stoptimal.com/testosterone-dosage-for-women/ testosterone dosing and monitoring for women.
You can also read our https://1stoptimal.com/womens-trt-hrt-peptides-perimenopause/ women’s testosterone and hormone therapy guide.
Frequently Asked Questions
Does testosterone improve libido in women?
Research shows that physiologically dosed, nonoral testosterone can improve sexual desire and reduce sexual distress in appropriately evaluated postmenopausal women with HSDD.
Evidence in premenopausal women is promising but less established.
Can premenopausal women use testosterone?
Some premenopausal women may be considered for treatment after a detailed clinical evaluation.
The 2026 review identified improvements in several randomized trials, but optimal dosing, long-term safety, and patient-selection criteria remain uncertain.
Is testosterone therapy only for menopause?
No.
Studies have included both premenopausal and postmenopausal women.
However, current guideline-level support is strongest for postmenopausal women diagnosed with HSDD.
What testosterone level is considered low in a woman?
There is no universal testosterone threshold that diagnoses HSDD or determines whether a woman needs treatment.
Laboratory ranges vary by age, testing method, and laboratory.
Symptoms and clinical context matter more than one isolated result.
How quickly can testosterone improve libido?
Some women may notice changes within several weeks.
A complete response may take several months.
Clinical guidance recommends discontinuing treatment when no meaningful benefit occurs within approximately six months.
Does testosterone help with energy and brain fog?
Some women report improvements, but randomized evidence does not currently support testosterone as a standard treatment for fatigue, general wellbeing, cognitive performance, or brain fog.
Its clearest evidence-based use is sexual desire disorder in selected postmenopausal women.
Will testosterone make a woman masculine?
Physiological female dosing is intended to avoid masculinizing effects.
Mild acne or increased facial and body hair can occur.
Voice deepening, clitoral enlargement, and other virilizing effects become more concerning with excessive dosing or supraphysiological testosterone levels.
Is testosterone safe for women with breast cancer?
Women with a history of breast cancer were generally excluded from the major randomized trials.
Anyone with current or previous hormone-sensitive cancer should discuss treatment with the appropriate oncology and hormone-care specialists.
Are testosterone pellets safe for women?
Consensus guidance does not recommend formulations that produce supraphysiological testosterone concentrations.
Pellets can be difficult to adjust or remove after insertion, so their risks and potential benefits require careful discussion.
Is testosterone the same as estrogen therapy?
No.
Estrogen, progesterone, and testosterone have different functions and clinical uses.
Estrogen therapy is commonly used for hot flashes, night sweats, vaginal symptoms, and other menopause concerns.
Testosterone has its clearest evidence for HSDD in selected postmenopausal women.
When to Seek a Professional Evaluation
Consider speaking with a qualified healthcare provider when low sexual desire:
- Represents a meaningful change from your baseline
- Persists over time
- Causes distress
- Affects your quality of life
- Affects your relationship
- Occurs with pain, dryness, bleeding, or pelvic symptoms
- Begins after a medication change
- Appears alongside major sleep, mood, or menopause symptoms
A thoughtful evaluation should make room for the entire picture.
Sexual health is medical health, not an optional complaint to be dismissed.
Take the Next Step
Low libido does not always mean low testosterone, but persistent changes deserve a real evaluation.
1st Optimal provides personalized women’s hormone care using symptoms, medical history, laboratory testing, and ongoing clinical monitoring to determine which treatment options may be appropriate.
Book a Free Women’s Health Consultation to discuss your hormones, sexual health, energy, sleep, metabolism, and treatment options.
Educational only, not medical advice. Testosterone is a prescription medication and should only be used under the supervision of a qualified healthcare professional.
References:
- Furlan VA, Hammad MA, Quesada S, Nguyen S, Yih J, et al. 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. doi:10.1093/jsxmed/qdag206.
- Furlan V, Hammad M, Quesada S, Nguyen S, Yih J. Conference abstract published in The Journal of Sexual Medicine. Volume 23, Supplement 3. April 2026.
- Furlan V, Hammad M, Nguyen S, Quesada S, Campos LR, Kadakia Y, Yih J. Conference abstract published in The Journal of Sexual Medicine. Volume 23, Supplement 4. June 2026.
- Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Journal of Clinical Endocrinology & Metabolism. 2019;104(10):4660-4666.
- 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. Journal of Women’s Health. 2021.
- Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomized controlled trial data. The Lancet Diabetes & Endocrinology. 2019;7(10):754-766.
- Wierman ME, Arlt W, Basson R, et al. Androgen Therapy in Women: A Reappraisal. Journal of Clinical Endocrinology & Metabolism. 2014;99(10):3489-3510.
- Simon JA. Testosterone for Treating Female Sexual Dysfunction. 2025.
