Can Testosterone Fix Your Broken Sex Drive & Energy? I Talked to Doctors and Tried It Myself

Suddenly, testosterone for women is a topic that’s everywhere. There are hundreds of thousands of TikTok views on videos of women taking testosterone supplements and major news organizations are all over the hormonal supplement, too. Real Housewives take it. Halle Berry sings its praises. As a wellness writer, not since the great roll-out of Ozempic in the early 2020s have I seen a drug capture the imagination of the public, especially women. Ozempic came to popularity on a wave of unclear intel, scary stories and moral shaming (you’ll have to take the shots forever! You won’t get the nutrition you need! The drug means you are caving to body image oppression!); this reminds me of the current discourse around testosterone for women.

I’ve heard both appealing and concerning anecdotes about women taking the stuff, and I understand there are no female-focused medical studies about testosterone. Mostly, I'm hearing about the hormone’s ability to restore energy, sexual drive, mental clarity and other feel-good elements to a woman’s life, especially after menopause. But I’m also detecting not-so-subtle shade and sexism (ladies, can’t you just try harder? You’ll seem mannish if you take this male hormone). Testosterone for women is a contemporary Snow White fable: A witch is telling us, I’ll give you days of feeling energetic and horny, my pretty, in exchange for chin hairs and an enlarged clitoris.

I wanted to take down the heated temperature of the debate a bit, as a woman who has taken testosterone supplement for years, as prescribed by my gynecologist. Additionally, I spoke to a hormone specialist physician about what doctors know about this drug, how she sees women benefit from it, what its risks are and why this medicine, which has been available as a supplement for men for decades, is just now becoming popular for women to take.

Dr. Cathleen M. Brown is a board-certified OB/GYN with over two decades of experience in women’s health. In addition to seeing patients as part of the labor and delivery team  Philadelphia’s Abington-Jefferson Hospital, Dr. Brown serves as the Medical Director for Winona, a leading national menopause telehealth provider. In that role, Dr. Brown oversees patient education and treatment programs and co-hosts “The Menopause Hour” podcast. She began her medical career in the U.S. Army, completing her OB/GYN residency at Tripler Army Medical Center in Hawaii. Her medical degree is from the Philadelphia College of Osteopathic Medicine after completing her undergraduate studies at Shippensburg University of Pennsylvania.

Testosterone is a hormone produced in the sex organs of both males and females. Males have much higher levels of testosterone than women, but both men and women experience drop-offs in their bodily production of the hormone as they age. In adolescent males, the testosterone levels spike, producing an increase in height, body and pubic hair growth, enlargement of penis, testes and prostate gland and an increased libido. Adolescent females’ levels do not spike, however, and stay at a low but steady rate through adulthood, enhancing libido (and at excess levels converting to an estrogen-like substance).

Okay, Why Are Women Taking Testosterone? And How?

Women, especially perimenopausal and post-menopausal women, desire the libido-enhancing effects of testosterone supplementation, as well as reported side effects such as mental sharpness and energy.  “In general, after menopause, our testosterone levels drop significantly,” says Dr. Brown. “They're like half what they are when you are in your early 20s. Now, there's no optimal testosterone level that equates with an adequate libido or sex drive, and that's what a lot of women are looking for. Like, what does my number need to be for me to get my sex drive back? And nobody's really defined that.”

In my case, my early-50s onset of menopause prompted me to seek hormone replacement therapy from my gynecologist who wrote scripts for not only estrogen patches and progesterone pills, but also a daily dollop of low-dosage testosterone cream that I picked up at a compounding pharmacy. I thought that the cocktail of the three hormones made sense, and was happy to follow her direction in order to reverse the hot flashes, mood swings and overall lack of zest for life I felt. I didn’t detect a sudden spike in sexiness, but I did notice that I had more interest in and enthusiasm toward intimate encounters than lots of my women friends. I just chalked it up to liking my partner and being constitutionally horny, but now that I reflect back, who’s to say that having sex several times a week with or without partners has not been thanks to a hormone supplement? If so, I’ll take it.

In order to have a medicine covered by insurance, it has to be FDA approved. And according to Dr. Brown, there’s no financial incentive for pharmaceutical companies to run the necessary tests for prescribing testosterone for women. “What patients need to understand is the FDA is a government regulatory agency whose job is to basically keep the general public safe by putting guidelines out there. But it's not all-encompassing. I mean, there are over-the-counter vitamins and minerals that we know make a difference in health, but they will never be FDA -approved, because no one's ever going to pay the money to do the study to get the FDA approval for it,” she says. Just because something is not approved for a certain use by the FDA, she says, does not mean it’s not a useful and safe medicine to use “off label,” i.e. prescribed by a doctor to treat another illness. She offers, by example, a drug called misoprostol, approved to treat stomach ulcers. “They found out years ago by accident, that by giving it to pregnant women, it was putting them into labor and causing miscarriages. And so now that's the primary use for that medication—to induce labor under a doctor’s supervision. The GI doctors don't even use it for stomach ulcers anymore. But it's such a cheap medication, no big pharma company is ever going to make money on it, so no one will ever do the study to get this FDA approval for use in obstetrics,” Dr Brown says.

• Keep a Libido/Energy/Feelings Diary Dr. Brown recommends keeping a month-long diary of concerning symptoms and issues. “So many patients come to the office and like, they might have a complaint like, well, I don't have a libido. But then when you ask them for more specifics, about how long has this been going on, they don't have that information,” she says.
• Schedule an Appointment for Your Specific Issue “A lot of women will request a specific medication because a friend has mentioned it, or they've seen it in an article, or someone's talked about it in a reel. I think the most important thing is like to really kind of gauge where you're at and what's going on in your life and your health, and to have a conversation with a provider that you trust,” Dr. Brown says.
• Don’t Treat Sexual Wellness as an Afterthought Dr. Brown understands that bringing up a low sex drive or blah feelings in general can be embarrassing, but stresses being upfront and frank with your physician, and prioritizing these concerns. “So often I'd do a well-woman exam for a patient, and we'd spend the entire visit talking about their medical history, doing their breast exam, their pubic exam,” she says. “And it's always like, when I had my hand on the doorknob to leave, that they'd say, Oh, by the way….” 
• Discuss Possible Side Effects Dr. Brown says that prolonged exposure to high-dose therapy give masculinizing side effects such as acne, hair loss, voice deepening and clitoral enlargement. She says that by “prescribing a low dose then monitoring for those side effects every three to six months, it's unlikely that they would get those irreversible changes.”
• Consider Alternative Therapies At Winona, the online bioidentical hormone provider that Dr. Brown is affiliated with, she says that testosterone isn’t on offer “due to state regulations for the prescription of testosterone that vary from state to state. It's considered a controlled substance in some states, requiring a face-to-face visit. They monitor it like they do narcotics,” she says. “We felt like it wasn't good to offer it to some patients in certain states and not some patients in another state. So instead of doing low-dose testosterone, we prescribe DHEA, a precursor hormone, basically that when the body metabolizes it, it gets broken down into low levels of estrogen and testosterone. So it's kind of a gentle way to boost your body's production of testosterone without giving testosterone directly.”

My Takeaway

I feel lucky that my Santa Monica-based gynecologist not only listened to the symptoms I explained having during perimenopause (hot flashes, low energy, little sex drive, among other complaints) and but also treated all the hormones I was given as being equally important. In other words, my sexual wellness including libido (affected by testosterone) was regarded as important as my insomnia, mood swings and hot flashes (affected by estrogen and progesterone). I’m glad I started using testosterone when I did, and that I started on a low dose that could be tweaked, instead of having those pellet implants I’ve read about that can’t be taken out once emplaced subcutaneously. Since researching testosterone and speaking with Dr. Brown, I’ve been evangelizing this medicine to my friends, but not in the “buy it bootleg from a guy out of a trunk on the down low” way that some wellness hackers are. I’m all for women to consider how this medicine might make them feel better; I support pressuring insurance companies to pay for it the way they do estrogen and progesterone—and doctor-prescribed testosterone for men. But I’m giving a big thumbs-down to inflammatory media reports of women turning into sex pests with chin hairs and a bossy demeanor, because that’s not my reality of testosterone therapy. Everybody, just calm down…yikes, that sounds like the joke about what men should never say to a woman. (It must be all the T flowing through my veins that made me say that.)