Testosterone for Midlife Women: the Hormone of Desire?

Jan L. Shifren, MD, NCMP


Menopause. 2015;22(10):1147-1149. 

In This Article

Abstract and Introduction


Testosterone declines with aging, so most midlife women have "low" testosterone levels. Because libido also declines with aging, and distressing sexual problems peak at midlife, should midlife women with low libido and associated distress be treated with testosterone? This Practice Pearl reports clinical trial evidence, reviews the risks, and explains how testosterone might be used in a clinical setting. For women who may be considering a trial of testosterone therapy, limitations and adverse effects should be disclosed and appropriate monitoring instituted once treatment has begun.


Sexual problems are highly prevalent, reported in approximately 40% of US women, with 12% reporting a sexual problem associated with personal distress.[1] Although sexual problems generally increase with aging, distressing sexual problems peak in midlife women (aged 45-64 y) and are lowest in women aged 65 years or older. Hypoactive sexual desire disorder (HSDD), low desire with associated distress, is the most common sexual problem for women.

The etiology of sexual dysfunction is generally multifactorial, including psychological and social factors such as depression or anxiety, fatigue, stress, lack of privacy, conflict within the relationship, partner performance, relationship duration, and prior physical or sexual abuse. Medical and gynecologic problems also play a role, including medications, especially antidepressants, and conditions that make sexual activity uncomfortable, such as endometriosis or arthritis. For perimenopausal and postmenopausal women, genitourinary syndrome of menopause (GSM), encompassing symptomatic vulvovaginal atrophy, and night sweats with associated sleep disruption and fatigue contribute to sexual problems at this stage of life.

Low androgen states occur in the settings of oophorectomy, hypopituitarism, adrenal insufficiency, oral estrogen therapy, and aging. Although decreased testosterone concentrations may contribute to sexual dysfunction in midlife women, results from large observational studies generally have found no association between androgen levels and female sexual function. Rather than androgen levels, physical and psychological well-being and the partner relationship appear to be significant predictors of a distressing sexual problem for women.