Attention women: Low sex drive? Testosterone won’t help

Abey Eapen, M.D., Ph.D.
Obstetrics and Gynecology

For women seeking treatment for low sex drive, the idea of a “quick fix” probably sounds appealing. Testosterone therapy and boosting supplements are among those widely marketed options that might seem too good to be true – because for most women, they are.

Low testosterone (low-T) products for women such as pills, injections, or supplements like dehydroepiandrosterone (DHEA) claim to boost energy, mood, and sexual desire. However, low-T as the root cause for low sex drive is rare in women, especially before menopause.

The Endocrine Society stated in 2019 that while trying testosterone therapy is generally safe for post-menopausal women with hypoactive sexual desire disorder (HSDD) – not wanting sex and not being OK with feeling that way – they do not support low-T therapy for other female health conditions. Side effects from testosterone therapy in women can include:

• Deepening of voice
• Enlargement of clitoris
• Excessive body hair
• Increased acne
• Abnormal fetal development during pregnancy

One in three women struggle with low sexual desire, and most patients start noticing libido changes after menopause. However, low libido can occur at any age and is often caused by problems that aren’t directly linked with the bedroom, such as anxiety, stress, medications, or undiagnosed chronic conditions.

While low-T treatments aren’t the cure-all they claim to be, there are effective treatments to restore sexual desire and improve your quality of life. UT Southwestern’s Reproductive Endocrinology and Infertility specialists follow a three-step process to identify and address the root cause of low libido.

The first step is to pinpoint the source – or sources – of sexual frustration. From there we can design a personalized treatment plan that can help improve overall health along with libido.

3 steps to diagnose low libido in women

For treatment to be effective, we must first try to understand what is affecting your sex drive. There is no cookie-cutter approach – in our three-step program, every patient gets a personalized assessment and treatment plan tailored to her specific needs.

1. General mental and physical health assessment

Working with a team of specialists, your reproductive health doctor will help identify or rule out underlying conditions and medical treatments that are known to decrease libido.

For example, anxiety can significantly affect the desire for sex – women are approximately twice as likely as men to suffer from anxiety before age 50. And women are more likely to report physical symptoms of stress that can interfere with sex drive, such as headache or upset stomach.

Physical health conditions can intertwine with mental health symptoms to double down on your sex drive:

• Heart problems: Along with reduced stamina, having heart problems can induce anxiety about getting your heart rate up during intimacy.
• Incontinence: Leakage can make you feel insecure about your appearance or odor, causing sexual avoidance.
• Diabetes: Blood sugar highs and lows can diminish energy you might have reserved for intimacy.
• Cancer: Systemic treatments for cancer can cause fatigue, nausea, and other symptoms that don’t put you in the mood.
• HSDD: This multifactorial condition is typically diagnosed in women after menopause. It can be caused by a combination of emotional and physical health concerns and is characterized by feeling poorly about not desiring sex.
• Multiple sclerosis: Arousal starts in the nervous system, which is the primary target of this disease. Medications to treat it can also diminish desire.
• Pelvic floor disorder: This condition causes weak muscles in the pelvic area, which can cause uncomfortable or painful sex.
• Thyroid disease: Hormones made by the thyroid help manage many of our body processes, including some aspects of libido, such as energy and stamina.

Common medications such as antidepressants, blood pressure medication, and estrogen therapy also can reduce libido. Your reproductive health doctor can order specific tests and exams to start unraveling the root causes of your symptoms.

Often, patients with physical or medication-related concerns begin feeling desire again after starting or modifying their care plan. Post-menopausal patients may particularly benefit from specialized care for hormone- and aging-related changes that interfere with intimacy, such as vaginal dryness, changes in appearance, or emotional challenges.

Mental health concerns sometimes require a little more time and patience to start feeling results. Seeing a therapist who specializes in sexuality can help women discover underlying barriers and gain more control over their libido.

Related reading: What women need to know about thyroid disorders

2. Visits with a sex specialist

Personal experiences can stack up over time, leading to diminished sex drive and discomfort with intimacy. Talking with a sex therapist gives patients a safe space to discuss past trauma, current difficulties, and relationship issues without judgment. A therapist can help you understand why these situations are decreasing your libido and help you find healthy pathways to start feeling better.

Psychosexual counseling is another avenue that can help women and their partners understand how the mind and body interplay with regards to intimacy. In these sessions, the therapist works with the patient or couple to express their feelings, discuss medical concerns that are interfering with sex, and find workable solutions to satisfy their personal and relationship goals.

3. Discussing treatment options

Your treatment plan will be based on your needs and the results of your assessments. Most patients will see positive results from getting treatment for the specific condition causing their symptoms. Some need a more tailored approach, such as adjusting mental health medications or participating in longer-term counseling sessions before desire returns.

For most women, testosterone therapy will not be a recommended treatment option. Testosterone has not been widely approved by the U.S. Food and Drug Administration for premenopausal low libido, and no large clinical studies have included younger women.

Though some post-menopausal patients with HSDD may experience slight benefits from testosterone therapy, particularly if they still have reduced sex drive after taking estrogen, the benefits probably won’t outweigh the risks. There is very little long-term safety data on testosterone therapy in women.

Patients who want to try off-label testosterone therapy should do their research and consider the potential risks related to appearance and long-term health, including:

• Pregnancy risks: Avoid testosterone if you are or want to become pregnant. Testosterone can cross the placenta and cause abnormal fetal development.
• Increased risk of Type 2 diabetes: A study of more than 8,800 women showed that those who took testosterone and testosterone-associated supplements were at increased risk of developing the disease. Weight changes and fat redistribution during menopause can increase insulin resistance, which is a factor in Type 2 diabetes – adding testosterone therapy might further increase the risk.
• Missed diagnosis of underlying conditions: Symptoms that go along with low libido crossover with many serious health problems, such as thyroid disease or diabetes. Without proper diagnosis and treatment, these conditions can cause life-threatening heart complications.

Getting effective treatment for a decreased sex drive before or after menopause can improve your mental and physical health. While testosterone might not be the answer, help is available.

Don’t be afraid to talk with a doctor about the symptoms of decreased sex drive. We’ll address the problem at its source and start you on the path to feeling better.