Testosterone and Menopause: Can It Improve Sexual Desire — or Strain Relationships?
December 12, 2025 2025-12-14 20:40Testosterone and Menopause: Can It Improve Sexual Desire — or Strain Relationships?
Introduction
Many women ask whether testosterone during menopause can really help with low desire and fatigue, or whether the risks outweigh the benefits.
Testosterone plays a subtle but important role in women’s health after menopause. Although it is not licensed for general use, international guidelines recommend testosterone for treating low sexual desire in postmenopausal women who meet criteria for Hypoactive Sexual Desire Disorder (HSDD). This guide clarifies when testosterone may be appropriate, what other effects women often report beyond libido, and how to avoid unnecessary risks that can harm metabolic, cardiovascular or hormonal balance.
Guide overview
This guide covers three key areas:
• When testosterone is medically recommended in postmenopausal women
• Which additional effects some women report, including vitality and mental clarity
• Which risks to avoid, including pellets, gym-supplied hormones and unsafe doses.
PART 1
When testosterone Is medically recommended
The only internationally recommended use of testosterone in women is for Hypoactive Sexual Desire Disorder (HSDD) after menopause.
HSDD is a persistent lack of sexual desire that causes distress and is not explained by pain, dryness, poor relationship satisfaction or external stressors. Women may recognise low sexual thoughts, reduced initiation, limited responsiveness or a sense that desire has disappeared.
When prescribed, testosterone is recommended in low-dose transdermal form, meaning it is applied to the skin and can be adjusted or discontinued if needed.
Before considering testosterone, other causes must be evaluated. Pain or discomfort during sex should be assessed separately, and women can find more information in the guide on vaginal dryness and in the guide on pain during sex.
When prescribed at physiological doses and monitored by an experienced clinician, testosterone can be a safe and effective option for women who meet diagnostic criteria.
Other hormone options are explained in Menopause: The Three Essential Pillars
PART 2
Effects beyond libido: emotion, inhibition, and social behaviour
Although testosterone is not recommended to improve energy or mood, brain imaging studies show that it influences neural circuits involved in emotional regulation, inhibition, and social behaviour in women. This may help explain why many women report feeling “different” — and why interest in testosterone continues to grow
Have you ever wondered why testosterone is banned in professional female athletes? This is because exogenous testosterone can confer several performance-enhancing effects, including increased muscle mass and strength, faster recovery, and improved physical performance, giving athletes a competitive advantage.
However, not all effects are desirable. Recent evidence shows that high-dose testosterone can cause persistent voice changes, including deeper pitch and altered vocal quality.
PART 3
Pellets, desire, and when improving intimacy strains relationships
If testosterone and menopause raise questions about benefits for low desire and fatigue, it is equally important to understand how testosterone should not be used.
Pellets often deliver excessively high doses that cannot be adjusted once inserted. Such doses may lead to acne, hair loss, increased facial hair, subtle deepening of the voice, and unexpected bleeding, as well as adverse changes in cholesterol. In my clinical practice, I have seen that even when voice changes or behavioural shifts are subtle, they can alter a woman’s natural softness, creating a more dominant or forceful tone that may unintentionally change the dynamics within a relationship.
Equally concerning are androgenic pills or injections obtained from gyms or online suppliers. These substances can disrupt metabolic health and mimic the hormonal and metabolic risks seen in women with long-term androgen excess. Safe testosterone treatment must always remain within physiological ranges and under medical supervision.
A private consultation allows women to review symptoms, hormonal context and goals, and to ensure any treatment—if needed—is conducted safely.
References
1.World Anti-Doping Agency (WADA) Prohibited List — anabolic agents (testosterone).
2. ISSWSH Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Sex Med. 2021;18(5):849–867.
.3. North American Menopause Society. Testosterone therapy for HSDD in postmenopausal women.
Menopause. 2023;30(7):781–783. doi:10.1097/GME.0000000000002190
4.. Egen et al. Testosterone and voice changes. Journal of Voice, 2025
