Over the past several weeks, I have written about why a woman’s sexual desire cannot be predicted by her hormone levels, and what placebo responses in clinical trials may teach us about the complexity of sexual desire.
Since then, new research has added to the conversation.
A recent article in JAMA examined the evidence following the U.S. Food and Drug Administration’s workshop on testosterone use in menopausal women. It highlighted research showing that testosterone prescribing to U.S. women increased 2.6-fold from 2016 to 2025. Women aged 45 to 64 accounted for nearly two-thirds of prescriptions.
Although no testosterone product is approved specifically for women in Canada or the United States, women with distressingly low desire are accessing it now, typically through male formulations prescribed off-label, or through compounded products that can vary in dose and absorption.
That makes practical guidance increasingly important: Who might benefit? What should be assessed first? How should treatment be monitored? And how can a woman tell whether it is actually helping?
What testosterone has—and has not—been shown to do
Testosterone has a legitimate role in treating appropriately selected postmenopausal women with hypoactive sexual desire disorder, or HSDD—a persistent loss of sexual desire associated with personal distress. Randomized trials have found that doses which raise testosterone to physiological levels can produce statistically significant improvements in desire and other aspects of sexual function, although these improvements are modest on average.
Where the evidence is thin is in the domain of many other aspects of quality of life. Despite many anecdotal claims about improvements in mood, cognition, muscle strength, and other aspects of health following the use of testosterone, large and well-conducted trials have not yet supported these claims.
This does not mean that testosterone will never be shown to have benefits beyond sexual function. It means those benefits have not yet been established.
Prescribing is growing before the evidence gaps have been resolved
The demand for testosterone reflects a real and understandable frustration. Women have spent decades being told that changes in their sexual wellbeing are simply part of aging or not important enough to treat. Or, they may have been dismissed altogether. The renewed attention that the testosterone conversation has brought validates that their concerns matter. But that validation should not depend on presenting testosterone as a solution for every midlife concern.
Important safety questions remain. Most testosterone trials involving women have lasted two years or less and have generally excluded women at elevated cardiovascular risk or with a history of breast cancer. Shorter-term studies using physiologic doses have not identified an increase in serious adverse events, which is reassuring. But they cannot tell us whether risks might emerge with longer use, higher doses, or among women who were not represented in those trials.
What an approved product would—and wouldn’t—solve
There is currently no testosterone product approved specifically for women in the United States or Canada. Women may instead be prescribed a small fraction of a product formulated for men or a compounded preparation.
A properly studied product developed for women could improve dosing consistency, provide clearer prescribing information, and support the longer-term safety research that is still needed. But an approved product would not tell us which woman is most likely to benefit. HSDD cannot be diagnosed with a testosterone blood test, and there is no threshold that predicts how a woman experiences her desire.
“The cause matters,” as Dr. Stephanie Faubion, medical director of The Menopause Society, told JAMA. Desire can be affected by pain, medication side effects, chronic illness, sleep, mood, stress, body image, relationship dynamics, past experiences, or several factors at once.
A female-specific product would be progress. It would still need to be accompanied by careful assessment, shared decision-making, appropriate monitoring, and clear guidance about when treatment should be stopped. It also requires that healthcare providers are trained in sexual health assessment (diagnosis and treatment).
Five questions to ask before starting testosterone
If you are considering testosterone for low desire, these are the questions I would encourage you to discuss with your healthcare provider.
Why has my desire changed?
A good assessment considers pain, medications, health conditions, sleep, mood, stress, and relationship factors.Is my low desire causing me distress?
Desire naturally varies. Treatment for HSDD is intended for women who are personally bothered by a persistent change. Distress by a partner only is not a reason to consider testosterone treatment and this may be a situation where further support of the relationship is warranted.Will the dose keep me within the normal female range?
Ask how the dose was selected, what type of product is being prescribed, and how your testosterone levels will be monitored.How will we know whether it is helping?
Agree on what meaningful improvement would look like and when you will review it. Guidelines recommend stopping if there is no benefit after approximately six months.What else might help, on its own or alongside testosterone?
Options might include treating pain, changing another medication, pelvic floor physiotherapy, couples therapy, or psychological approaches such as cognitive behavioral therapy or mindfulness, which are both evidence-based in the treatment of distressing low sexual desire.
These questions are not meant to talk anyone out of testosterone. They are meant to ensure that treatment is being considered for the right reasons—and that other potentially helpful options are not overlooked.
When one treatment is easier to access
The rise in prescribing also tells us something about healthcare access. A prescription is easy to write, it fits into a short appointment, and can be delivered to your door.
Specialized psychological care for sexual concerns can be much harder to obtain. Few clinicians specialize in women’s sexual health, referral pathways are inconsistent, waitlists can be long, and many women do not know that evidence-based psychological treatments exist.
When one option is easier to access than others, it can become the default—even when it may not address the primary reasons desire has changed.
This access gap is one reason we created eSense™, a private, self-guided online program built on more than two decades of research into cognitive behavioral therapy and mindfulness for women’s sexual desire, arousal, and distress. It can be used on its own or alongside testosterone, hormone therapy, pelvic health care, or other treatments.
Women deserve access and accuracy
The renewed attention to testosterone represents progress. Women’s sexual health is finally receiving scientific, public, and regulatory attention that is long overdue.
We know testosterone can benefit some postmenopausal women with HSDD. We do not have evidence yet that it is a general treatment for cognition, mood, muscle strength, cardiovascular health, or midlife wellbeing. We also lack the long-term safety evidence women deserve. Importantly, it can be challenging to predict who might benefit from testosterone and who might not, based on the research done to date.
The answer is neither to dismiss testosterone nor to overstate it. It is to develop a well-studied female-specific product, define clearly who it is intended to help, educate clinicians in its appropriate use, improve access to the full range of evidence-based treatments, and continue studying the questions that remain.
Women deserve access, but they also deserve accuracy.
Sources for reference (but not typically cited in a blog)
Schweitzer K. Testosterone use rises among women, but does the evidence support it? JAMA. Published online October 23, 2026.
Avivi I, Stuenkel CA, Sampath-Kumar R, Ben-Yehuda O. Accelerating testosterone prescribing for U.S. women: implications for cardiovascular safety. JACC: Advances. 2026;5(6):102724.
Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. 2019.
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 Sexual Medicine. 2021;18(5):849–867.