The People's Perspective on Medicine

Testosterone Enhances Libido and Improves Female Sexuality

The FDA has approved two drugs to improve women's sexual desire. Trouble is, they have unpleasant side effects. Research shows testosterone enhances libido.

How well does testosterone work to increase women’s sex drive? Many people assume that androgens like testosterone are purely male hormones. Wrong! Women actually make more androgen than estrogen (Fertility and Sterility, April, 2002). Studies have shown that testosterone enhances libido in men who suffer from low levels of this hormone (Sexual Medicine Reviews, July 24, 2019). 

Testosterone Enhances Libido in Women Too

A new meta-analysis of 36 randomized controlled trials involving more than 8,000 postmenopausal women reports that testosterone treatment led to better sexual relations (Lancet Diabetes & Endocrinology, July 25, 2019). Women who took testosterone instead of placebo or estrogen and or progestogen reported improved:

  • Sexual desire
  • Arousal
  • Orgasm
  • Satisfactory sexual event frequency
  • Responsiveness
  • Pleasure
  • Self Image

The authors conclude:

“Testosterone is effective for postmenopausal women with low sexual desire causing distress, with administration via non-oral routes (eg, transdermal application) preferred because of a neutral lipid profile.”

Why Transdermal Testosterone Is Preferred:

Oral testosterone formulations increased LDL cholesterol and lowered beneficial HDL. Topical testosterone in the form of transdermal patches, gels or creams did not have this effect. Some women did complain about acne and modest weight gain.

How Dangerous Is Testosterone?

The authors of the most recent research report:

“No serious adverse event was more frequent with testosterone compared with placebo or a comparator. Specifically, testosterone was not associated with more frequent reporting of cardiovascular events (eg, acute myocardial infarction, stroke, deep vein thrombosis, or cardiovascular deaths.”

“Our systematic review and meta-analysis indicates that current testosterone use was not associated with an increase in serious adverse events, including adverse endometrial and breast effects.”

Reviewing the Evidence that Testosterone Enhances Libido

An accompanying editorial in Lancet Diabetes & Endocrinology (July 25, 2019) concludes that topical testosterone is a reasonable treatment for postmenopausal women with low libido.

The author points out that:

“These findings confirm those of a previous systematic review and meta-analysis which showed short-term efficacy—in terms of improvement of sexual function and the safety of transdermal testosterone—in naturally and surgically menopausal women affected by hypoactive sexual desire disorder and taking or not taking oestrogen–progestin hormone therapy.”

“Finally, short-term use of testosterone does not modify either the breast or the endometrium, but data are insufficient to assess long-term oncological risks.”

The editorial calls for the development of formulations specifically designed for women and long-term studies on safety.

People’s Pharmacy Perspective:

The Food and Drug Administration has approved two drugs for treating low libido. One is flibanserin (Addyi). It’s not all that effective. According to our calculations, this drug led to one more “sexually satisfying event” each month compared to placebo. Side effects include nausea, drowsiness, dizziness, low blood pressure and fainting. Not surprisingly, Addyi has not been a big blockbuster success.

The second drug was just approved by the FDA. It is bremelanotide (Vyleesi). It is administered with an auto-injector. Nausea is a serious complication. As many as 405 of patients reported this side effects. You can read more about the adverse reactions associated with Vyleesi at this link.

Testosterone and other androgens impact the body in numerous ways. These natural hormones have a substantial impact on sexual desire and satisfaction. The problem is that there are currently no female formulations of testosterone on the market. There are male formulations, but they generally have a much higher dose than is recommended for women. And the FDA has not approved testosterone in any dose for women.

We agree with the woman who wrote the editorial in Lancet Diabetes & Endocrinology (July 25, 2019). There is a desperate need for well-controlled, long-term clinical trials using topical testosterone in safe doses. Physicians who currently prescribe topical testosterone off label must rely on compounding pharmacies to create such products.

For example, a decade ago Dr. Rosemary Basson, MD, at the Centre for Sexual Medicine in Vancouver, British Columbia offered this observation (Therapeutic Advances in Endocrinology and Metabolism, Aug. 2010):

“Although clinicians sometimes prescribe topical testosterone to be used sparingly on the vulva in an attempt to restore lost sexual sensitivity of tissues comprising and overlying the clitoris, this practice has not been scientifically studied.”

As far as we can tell, there is still a paucity of research on topical application of testosterone to the outer genital area. What is the lowest effective dose? That will no doubt vary from individual to individual. If topical testosterone enhances libido, can it be used intermittently to lower total systemic absorption and reduce the risk of side effects? It would be nice if researchers made an attempt to answer these questions.

Reports from Readers:

Jayel shared this story:

“I found a wonderful physician who put me on a low-dose testosterone (in addition to balancing out my estrogen and progesterone) to treat the absolutely crippling post-menopausal depression I was experiencing. I went through eight doctors, all of whom just wanted to put me on antidepressants, before I found a bioidentical hormone specialist.

“After he’d gotten all of my other hormones balanced, he added a tiny dose of time-release testosterone that shut off the depression like a light switch. And yes, in addition, it has helped stimulate a buoyant sex drive.”

Nancy reported that testosterone enhances libido:

“Taking bio-identical testosterone has increased my joy in sex exponentially and is good for me in many other ways. Whoopie!”

Mary is also enthusiastic:

“I am 67 years old. Several years ago I began a relationship with a kind and loving man. He is six years younger than I am.

“I had a very low sex drive. I do not have a uterus. My Doctor put me on bio-identical hormone pellets which contain animal estrogen and some testosterone, and voila! Sex drive back full force. I have more energy, better sleep and no beard (LOL). Now everybody’s happy. I also take micro-ionized progesterone in a pill.”

Paul offers this perspective:

“Susan Rako, MD, wrote a book several years ago called the “Hormone of Desire.” It addressed the use of testosterone in low dose as a treatment for lost libido in older women. It received quite a bit of publicity at the time. Since the FDA doesn’t approve of testosterone to enhance libido for men or women, it never caught on. But it is very interesting reading. She recommended compounding pharmacies as a source for testosterone and also addresses the safety issues.”

What do you think? Have you ever used topical testosterone. How well did it work? Did you experience any side effects? Millions of women would like to know.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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  • Islam, R. M., et al, "Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data," The Lancet Diabetes and Endocrinology, July 25, 2019, DOI:
  • Nappi, R.E. "Testosterone for women: green light for sex, amber light for health?" Lancet Diabetes & Endocrinology, July 25, 2019, DOI: 10.1016/S2213-8587(19)30251-7
  • Basson, R. "Testosterone therapy for reduced libido in women," Therapeutic Advances in Endocrinology and Metabolism, Aug. 2010, doi: 10.1177/2042018810379588
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One misconception is that testosterone is a male-only hormone. “Although men have a higher circulating level of testosterone than women, from a biological perspective, men and women are genetically similar. Both sexes include functional estrogen and androgen (testosterone) receptors. And while estrogen is popularly considered the primary female hormone, throughout a woman’s lifespan, testosterone is actually the most abundant, biologically active hormone with significantly higher levels than estradiol. And as early as 1937, testosterone therapy was reported to effectively treat symptoms of the menopause.”

I was prescribed topical testosterone for “energy” and increased metabolism, was told it was the “happy” hormone (by a male doctor). Stopped taking it — tired of hair growth (not on my head), and it did not seem to have the positive impacts that were projected. It was a compounded cream, very low dose. Not worth the trouble or the cost (expensive). I am a 67 year old female.

I am 70 years old and had a total hysterectomy 21 years ago. Needess to say, my libido was adversely affected. In the winter of 2018 I found a wonderful doctor who prescribed estrogen, progesterone and transdermal testosterone. What remarkable difference!! Yes, my desire returned in a big way! The downside is that my husband isn’t as supercharged as I am so I have had to cut back on the number of times per week that I apply the testosterone cream. I have not noticed any serious side effects from using testosterone. If I use too much I might get a small pimple on my face. And in spite of what a previous commenter had to say, the reality is that I now have much LESS facial hair since starting testosterone therapy!!

I started topical testosterone several months ago, and couldn’t be happier. I’m 53 years old. My libido and sexual response had been poor for some years because of peri menopause. Testosterone has improved my sex life dramatically with no facial hair or acne. I am also on topical estrogen and take progesterone.

I have been working with a compounding pharmacist and my physician. I haven’t felt this good in years. My energy is greatly improved, I sleep better and my frequent headaches are a thing of the past. Using estrogen and testosterone topically does not have the negative side effects associated with traditional oral preparations. I am simply using what my body has always made; why would that suddenly be so ‘harmful’ and ‘dangerous?’ I plan to take hormones indefinitely. They will help protect my cognition, my bones and my heart. I can’t prevent aging, but I don’t have to become a dried up, angry, old woman who doesn’t enjoy sex anymore either.

I tried testosterone cream in perimenopause and I feel like someone else had taken over my body. I didn’t feel the desire mentally, just in my body.

I took estratest for about11 years. It caused acne, for which no treatment really helped, and my hair got a lot thinner, particularly in the male pattern baldness area of my scalp. I stopped the drug, but my hair never grew back. The acne cleared up right away though. It did stop my hot flashes, and now I take estradiol instead, which also helps. I don’t mind a reduced libido that much v the side effects. I was afraid I’d end up totally bald. The doctor never warned my about losing my hair.

I was given .5ml of testosterone cream by my bariatric doc. It did increase my libido as well as increase my metabolism. It did NOT make me grow a beard, chest hair or any other manly things. It did give me some acne and made my face and hair a little greasy.

Every time I tried it my face broke out and at the time I was in my late 50’s.

Strange thing about “evidence” — later findings can totally contradict “safety”. For years doctors prescribed supplemental hormones for menopausal women, which is now associated with increase in heart attacks, strokes, blood clots..cancer. If exogenous testosterone is so “safe” — why is it men have shorter lifespans than women. PS: Enjoy shaving your face, hair loss, hairy chest, and other manly attributes. If an increased sex drive is worth these things…go ahead. Unless the woman has money, most men do not go for older women when so many young ones are around.

I had a total hysterectomy in 2008 and was put on synthetic estrogen for a couple of years. Thankfully, i found a holistic doctor after i got extremely ill from Levaquin in 2012. He put me on bioidentical estrogen and progesterone. A few years ago, due to having almost zero sex drive (I am 59 now) he added bioidentical testosterone to the estrogen cream. It has been amazing

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