The short answer
For one thing: low sexual desire after menopause that causes distress. Trials found about one more satisfying sexual event a month on average. The evidence does not support it for energy, mood, bone or memory. No testosterone product is FDA-approved for women.
What the trials measured
The best summary is a 2019 meta-analysis of 36 randomized trials with 8,480 women [1]. Its numbers, compared with placebo:
| Outcome | Effect | What it means |
|---|---|---|
| Satisfying sexual events | 0.85 more a month (95% CI 0.52 to 1.18) | About one more a month, on average |
| Desire | Standardized difference 0.36 | A small to moderate rise |
| Arousal, orgasm, pleasure | All improved | Smaller effects than desire |
| Distress about sex | Standardized difference −0.27 | A small drop |
| Acne and hair growth | More likely than on placebo | The main side effects |
| Serious adverse events | None recorded | At doses keeping levels in the female range |
What it does not help
- Energy and wellbeing: the international consensus found no effect on general wellbeing [2].
- Mood: studies do not show an effect on depressed mood [2].
- Bone: no effect on spine or hip bone density at 12 months [2].
- Muscle, body shape and memory: no effect on body composition or muscle measures, and too little evidence on thinking and memory [1] [2].
That is why the consensus statement, endorsed by menopause and endocrine societies worldwide, names one evidence-based use, hypoactive sexual desire disorder after menopause, and says the data are insufficient for any other symptom or for preventing disease [2].
Who is a candidate
Low desire on its own is not a diagnosis. Hypoactive sexual desire disorder means low desire that persists and causes you distress, after other causes have been looked at: relationship strain, depression, medicines that dampen desire, and pain with sex [2]. Pain from vaginal dryness is common after menopause and has its own treatment, vaginal estrogen. If you have had breast cancer, read HRT after breast cancer first.
What else can lower desire after menopause
- Pain with sex. Dryness and thinning of vaginal tissue are common after menopause, and low-dose vaginal estrogen is an effective treatment [3].
- Poor sleep and night sweats. Treating hot flashes treats the tiredness that comes with them [4].
- Mood and medicines. Low mood and some medicines dampen desire, and the consensus asks physicians to look at these first [2].
- The relationship and stress. These count too, which is why the consensus describes a full biopsychosocial assessment before testosterone [2].
Put the trial numbers in that context. One more satisfying sexual event a month is an average across women who all had low desire, some of whom changed a lot and some not at all. The 2021 guideline calls it a moderate benefit [5]. If something else on that list is the main driver, treating it may matter more than testosterone. Many women have more than one, and they can be treated together.
How it is prescribed
- BeforeA total testosterone blood test to know your starting level [2]. At VevaMD, a live video visit with your physician too.
- 3 to 6 weeksA repeat level, to keep it in the normal female range [2].
- By 6 monthsIf there is no benefit, the consensus advises stopping [2].
In most countries testosterone for women is prescribed off-label [2]. The consensus calls an approved men’s product at a woman’s dose reasonable, and says compounded products cannot be recommended; a 2021 guideline from the International Society for the Study of Women’s Sexual Health says the same and adds that long-term safety has not been established [2] [5]. VevaMD’s testosterone cream is compounded and not FDA-approved, offered only as an add-on to an estrogen plan. The details, and the trade-off, are on the testosterone for women page.
If sleep is the other thing wearing you down, see does progesterone help sleep?. Every option is on the menopause care page.
VevaMD is a technology company, not a medical provider. Educational content only, not medical advice. A US-licensed physician decides whether any treatment fits you, and a prescription is not guaranteed. Compounded medications are prepared by state-licensed pharmacies for individual patients. They are not FDA-approved and have not been reviewed by FDA for safety, effectiveness or quality.
Sources
- Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754-766. Checked October 23, 2026.
- Davis SR, Baber R, Panay N, et al. Global consensus position statement on the use of testosterone therapy for women. J Clin Endocrinol Metab. 2019;104(10):4660-4666. Checked October 23, 2026.
- The NAMS 2020 GSM Position Statement Editorial Panel. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976-992. Checked October 23, 2026.
- MacLennan AH, Broadbent JL, Lester S, Moore V. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev. 2004;(4):CD002978. Checked October 23, 2026.
- Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women’s Sexual Health clinical practice guideline for the use of systemic testosterone for hypoactive sexual desire disorder in women. J Sex Med. 2021;18(5):849-867. Checked October 23, 2026.