Testosterone for Low Libido in Perimenopause and Menopause: What New Research Shows

By Mace Scott, MD, Founder and Medical Director, Chronos Body Health & Wellness

One of the hardest things for a woman to bring up in an exam room is that she has simply lost interest in sex. Not because anything is wrong in her marriage. Not because she's too busy. The desire just isn't there anymore, and she misses it.

Many women I see in their 40s and 50s tell me they assumed this was just part of getting older, and that there was nothing to do about it. Some were told exactly that. A new review of the research, published this summer in The Journal of Sexual Medicine , adds to a growing body of evidence that says otherwise, at least for the right patient.

What the new research looked at

In July 2026, a team from the Department of Urology at the University of California, Irvine published a systematic review on testosterone therapy for female sexual dysfunction. They screened more than 800 published studies and included 33 in their analysis. What made this review different from earlier ones is that the researchers separated the results by menopausal status: premenopausal women, women in the menopausal transition, and postmenopausal women.

Here's what they found:

• Postmenopausal women had the strongest results. Seven randomized controlled trials looked at testosterone in this group, including one with more than 800 women. Transdermal testosterone produced significant improvements in sexual desire and in symptoms of hypoactive sexual desire disorder (HSDD), the medical term for persistently low desire that causes distress.
• The benefit was consistent. Across the studies, the improvements held up, which is why the authors concluded that the evidence supports guideline-based use of testosterone for these women.
• Younger women showed promise, but the evidence is thinner. Two smaller randomized trials in premenopausal women found improvements in libido, satisfying sexual events, and sexual satisfaction. The authors called these results promising but said more research is needed before drawing firm conclusions.
• Long-term safety data is still limited. The researchers noted that androgen levels and long-term safety were inconsistently reported across studies. I think that's an honest and important point, and it shapes how I treat patients.

You can read the full review here: Furlan VA, et al. Testosterone therapy for female sexual dysfunction: a systematic review. The Journal of Sexual Medicine , 2026.

Why this matters in perimenopause and menopause

Most people think of testosterone as a male hormone. But women make it too, in the ovaries and adrenal glands, and it plays a real role in desire, arousal, energy, and a general sense of well-being. Testosterone levels gradually decline through a woman's reproductive years and continue to drop after menopause as ovarian and adrenal production slows.

Low sexual desire is also more common at midlife than at any other stage. One large survey found that HSDD affects about 12% of women between 45 and 64, a higher rate than in younger or older women ( The Pharmaceutical Journal, 2025). That's exactly the window when most of my female patients first come in asking about hormones.

This new review builds on earlier landmark work. A 2008 trial in The New England Journal of Medicine , often called the APHRODITE study, followed 814 postmenopausal women with low desire who were not taking estrogen and found that a testosterone patch improved desire and the number of satisfying sexual episodes ( Davis SR, et al. NEJM, 2008). An international consensus statement from menopause and endocrine societies in 2019 reached the same conclusion: the one well-supported reason to prescribe testosterone to a woman is low sexual desire that causes distress after menopause.

What I've seen in more than 10 years of practice

None of this research surprises me. I've been treating women with testosterone for more than 10 years, and in that time I've cared for hundreds of women on this therapy. The large majority have done very well. Many tell me they feel like themselves again, not just in their sex lives, but in their energy, their mood, and their confidence.

Just as important, I've seen very few problems. When testosterone is dosed carefully and levels are monitored, side effects in my patients have been uncommon and usually mild. That experience is a big part of why I'm comfortable with this treatment, and also why I'm so particular about how it's done. Every woman is different, and results vary, but it's rewarding to see the published research line up with what I've watched happen in my own patients for years.

What I tell my patients

When a woman asks me whether testosterone could help her, I start with a few honest points.

Low desire usually has more than one cause. Poor sleep, hot flashes, vaginal dryness and painful intercourse, depression, certain medications (antidepressants are a common one), thyroid problems, relationship stress, and plain exhaustion can all play a role. Testosterone isn't a fix for every one of those. If intercourse is painful, for example, local estrogen or other treatment for vaginal dryness may matter more. That's why I take a full history before recommending anything.

Estrogen and progesterone often come first. For many women in perimenopause and menopause, treating hot flashes, night sweats, sleep problems, and vaginal changes makes a big difference on its own. Testosterone is often something we consider when desire remains low even after those symptoms are addressed.

The goal is a normal female level, not a male one. The research that shows benefit used doses designed to bring women back into the normal female range. Staying in that range is also what keeps side effects to a minimum. We check blood work before starting and continue to monitor levels during treatment.

There is no FDA-approved testosterone product for women in the United States. Testosterone for women is prescribed off-label, which is legal and common, but it's something every patient should understand before starting. I want my patients to make that decision with full information.

Possible side effects

When testosterone is kept within the female range, side effects are usually mild and uncommon. The most frequent are acne and some increase in facial or body hair. Higher doses can cause more significant changes, such as voice deepening or hair thinning, which is one more reason careful dosing and follow-up lab work matter so much.

Testosterone isn't right for everyone. It shouldn't be used during pregnancy or breastfeeding, and women with a history of hormone-sensitive cancer need a careful individual discussion with their oncologist and me before any hormone therapy is considered.

Who might be a good candidate?

You may want to talk with a physician about testosterone if:

• You're in perimenopause or past menopause
• Your sexual desire has dropped noticeably and it bothers you
• Other causes, such as pain, medication side effects, or depression, have been evaluated
• You're willing to have lab work and regular follow-up

If you're earlier in life and still having regular cycles, testosterone may still be worth discussing, but the evidence is less certain, and I'm more cautious.

The bottom line

Losing interest in sex during perimenopause or menopause is common, but it isn't something you simply have to accept. The newest research reinforces what earlier trials showed, and what I've seen in my own practice for more than a decade: for the right woman, testosterone at the right dose can make a real difference. It's not a cure-all, and it should be part of a complete evaluation, not a quick prescription.

If this sounds familiar, I'd encourage you to have the conversation. It's one of the most common concerns I hear, and one of the most treatable.

Learn more about our women's hormone therapy program, read how to tell if you're in perimenopause, or book a consultation with me at our Metairie office.

Mace Scott, MD is the founder and medical director of Chronos Body Health & Wellness in Metairie, Louisiana. He earned his medical degree and a master's degree from LSU Health Sciences Center and trained in emergency medicine before focusing his practice on hormone therapy, metabolic health, and medical weight loss. He has treated women with testosterone therapy for more than 10 years.

This article is for educational purposes and is not a substitute for individual medical advice. Individual results vary. Treatment decisions are made after a full medical evaluation.