Sex is one of the big, beautiful benefits of being a human. But when our bodies refuse to cooperate the way they once did, it can be heartbreaking. So naturally you might want to do whatever you can to get things, well, up and running again. And for a surprisingly high number of women, that means trying testosterone therapy. After all, the hormone testosterone (called “T” for short in medical circles) can work wonders for men, so why not women?
But before you run to your doctor to ask for a prescription, you should know that testosterone therapy is a controversial approach that is not FDA-regulated for women at this time. Despite its mythical reputation, this hormone isn’t a cure-all for sexual dysfunction, and it could even be dangerous for your health if not taken carefully. Let us explain.
How Does Testosterone Work in Women?
Testosterone may be known as a male hormone, but women’s bodies naturally produce it, too. It’s one of many hormones that work together to control our mood, metabolism, sexual desire, bone and muscle growth, and reproductive system. As you age, your hormone levels change, with one of the biggest shifts occurring during menopause when your menstrual cycle stops for good. Menopause causes your estrogen and progesterone levels to decrease, but interestingly, it is not associated with a sudden decrease in testosterone, according to the North American Menopause Society.
That said, there is evidence that testosterone decreases throughout your life. “Testosterone drops with age more than with menopause,” says Margaret Wierman, M.D., professor at the University of Colorado Anschutz Medical Campus in Aurora, CO and former Vice President of Clinical Sciences at the Endocrine Society. This may explain why testosterone pills, gels, and patches are sometimes touted by drug marketing campaigns (and celebs) as a sex drive booster for older men and women whose testosterone is naturally lower than it used to be.
The problem with this approach, according to Chrisandra Shufelt, M.D., associate director of the Barbra Streisand Women’s Heart Center at the Cedars-Sinai Smidt Heart Institute in Los Angeles, CA, is that testosterone is not necessarily the miracle drug you may be reading about on the internet. “If you search online, it seems like testosterone could be the panacea of all hormones, relieving everything from fatigue to weight gain to depression,” Dr. Shufelt says. But interestingly, she notes, there is no scientifically proven list of symptoms directly correlated to low T in women. Everyone’s hormone levels are naturally different, and what looks “low” on a testosterone test for one woman may be a perfectly normal T level for another.
Does Testosterone Impact Sex Drive?
To some extent, yes—but it’s not the end all, be all. Dr. Wierman explains that there are many different causes of sexual dysfunction (the term for when you’re no longer craving or enjoying sex). “There are mechanical hardware causes, there are relationship causes, there are mood causes,” she says. “There are rarely hormonal causes, and [in those cases] it's usually estrogen deficiency that is causing abnormalities.”
What Is Testosterone Therapy?
Testosterone products are supplemental versions of the hormone that people take to increase their existing T levels. They come as a patch, gel, pill, tablet, or injection. Prescription testosterone products are FDA-approved for men whose bodies cannot produce adequate testosterone, due to genetic conditions like Klinefelter syndrome or damage from infection or chemotherapy. Testosterone products are not–we repeat, not!–approved for people whose testosterone is decreasing with age.
Nevertheless, this hasn’t stopped people from taking T (and doctors from prescribing T) for reasons other than it is officially intended. This practice has become so widespread, in fact, that the FDA issued a safety announcement in March 2015 urging doctors not to prescribe testosterone to anyone other than men with testosterone-lowering medical conditions. The statement noted that testosterone therapy could possibly increase your risk of cardiovascular problems or stroke.
For women, the risks of testosterone therapy are even less clear. “What we know about safety and what has been studied in women is the short-term effects, up to two years,” Dr. Shufelt says. “Longer effects are not known, and we do not know the effects in women who have risk factors for heart disease and breast cancer.” She stresses that longer-term studies will be necessary to determine whether low-dose testosterone therapy has detrimental effects on a woman’s body.
When testosterone is taken in excess quantities, Dr. Shufelt explains, it can lead to some pretty severe medical issues for women. “Too much testosterone in women can result in deepening of voice, hair loss, acne, anger, and negative changes to the cholesterol panel,” she says. Dr. Wierman remembers seeing a perimenopausal patient who had been given testosterone pellets at an anti-aging clinic. The high levels of T caused an increase in bad cholesterol, increase in blood pressure, excessive body hair growth, and loss of scalp hair.
Yikes! Are There Any Medical Guidelines for Women and T?
In September 2019, the Endocrine Society, International Menopause Society, European Menopause and Andropause Society, and others got together to publish a global consensus statement on the safety and efficacy of testosterone therapy for women. Dr. Wierman, one of the principal authors, explains the major takeaway: testosterone therapy has only proven to be useful for one specific subset of women–post-menopausal women with hypoactive sexual desire disorder.
Hypoactive sexual desire disorder (HSDD) is characterized by an absence of sexual desire, to an extent that it causes emotional distress and relationship problems for a couple. HSDD can be caused by a variety of factors, from medication use and chronic health conditions, to chemical imbalances and hormone deficiencies. It is diagnosed by a healthcare provider using a questionnaire and treated with anything from counseling to hormone replacement therapy, depending on the situation.
Dr. Wierman says that for post-menopausal women with HSDD, “controlled studies showed that getting high physiologic doses [of testosterone] increased satisfying sexual relations by one per month, with some other potentially good effects on sexual function,” such as arousal and ability to orgasm. The consensus statement specified that these doses should mimic – not exceed – natural levels of testosterone in premenopausal women. The statement authors urged that more research be done on testosterone therapy for women, and that testosterone products for HSDD should be created specifically with women in mind.
So, What Does This Mean for Me?
If you’re curious about testosterone therapy and wondering if you fit into the subset of women who may benefit, Dr. Wierman suggests talking to your regular women’s healthcare provider. “I think that most providers, whether they’re gynecologists or endocrinologists or primary care doctors who specialize in menopausal women, can discuss the issues related to testosterone pros and cons,” she says.
But before you walk away with a prescription, keep in mind that your low sex drive may not have to do with your hormones. “The first thing when someone has abnormalities in their sexual function is to discuss all the different other causes of it, and try to be a detective,” Dr. Wierman says. “If she is having painful intercourse, maybe it's local vaginal estrogen she needs. If there’s stress in the relationship, maybe therapy is what they need.” Testosterone therapy is one option to increase libido, but it’s certainly not a foolproof key to amazing sex. And unless you’re a postmenopausal woman with HSDD, you probably want to steer clear.