Most women are never told they produce testosterone at all. They do, the ovaries keep producing it after estrogen production has largely stopped, and the fall is gradual rather than abrupt.
The 2025 European Society of Endocrinology guideline is explicit about where the evidence is solid, and it is narrower than the internet claims: persistent low sexual desire that is causing distress, in a postmenopausal woman already on adequate estrogen.
This is the hormone that gets either dismissed entirely or sold as the answer to everything, and neither is right.
Where the evidence is genuinely strong
For low sexual desire that is persistent and distressing, in a postmenopausal woman whose estrogen is already adequately handled, testosterone has real trial support. That is the indication the guideline endorses, and for practical detail on dosing and monitoring it refers clinicians to the Global Consensus Position Statement on testosterone therapy for women.
Three principles come out of that literature and they are not negotiable:
- Physiological doses only. The aim is to restore the concentrations of a healthy premenopausal woman, not to exceed them. Above that range you are not treating anything, you are causing side effects.
- Through the skin, not swallowed. The route matters here as it does with estrogen.
- Measured, not guessed. Levels are checked before and during, precisely because the difference between a physiological dose and an excessive one is not something you can feel your way to.
What women actually report
A study published in Archives of Women's Mental Health in 2025 looked at the wider question. Researchers at a specialist menopause clinic in the United Kingdom followed 510 women who were already taking hormone therapy and who still had persistent low libido together with cognitive symptoms and low mood.
After four months of transdermal testosterone added on top of their existing treatment, the proportions reporting improvement were 52 percent for libido, 47 percent for mood and 39 percent for cognition. Mean symptom scores fell by 33, 34 and 22 percent respectively.
Read that carefully, because how you read it is the whole point. Those are meaningful numbers and they describe real women. They are also uncontrolled, meaning there was no placebo group, and in a field where the placebo response runs from 20 to 50 percent that limitation is not a technicality.
So the honest summary is this: the libido evidence is strong enough to act on. The mood and cognition signals are interesting, consistent with what women report, and not yet proven. Anyone selling you testosterone for brain fog as though it were settled is ahead of the evidence.
What it is not for
The guideline says plainly that the use of testosterone for effects other than on libido needs to be studied. That is a research gap, not an endorsement.
It is not established for bone. It is not established for muscle in women. It is not established for energy as a standalone complaint. And it is emphatically not a substitute for looking at whether your thyroid, your iron, your sleep or your estrogen is the actual problem, which in a great many women it is.
The practical problem, and it is a real one
In most countries there is no product licensed specifically for women, so what exists is designed for men at male doses. Getting a physiological female dose out of that requires knowing exactly what you are doing, and it is precisely where inexpert handling causes acne, hair changes and voice changes that are not always reversible.
This is the strongest argument in the whole piece for who you take it to. Not because the hormone is dangerous, but because the margin between a correct dose and a harmful one is narrow and invisible from the inside.
If your drive has gone and it bothers you, that is a legitimate medical complaint and there is evidence behind treating it. What it is not is a decision to make from a forum, at a dose someone guessed, without measuring anything.
Before anyone thinks about testosterone
A proper sequence looks like this. Is the estrogen side handled adequately, because low desire on inadequate estrogen is usually an estrogen problem. Is there dryness or pain, because desire rarely survives discomfort and that is treated locally and separately. Is the sleep destroyed. Is the mood the primary issue. Are there relationship or medication factors, since several common medicines suppress desire directly.
Only when those have been worked through does the testosterone question become answerable. Skipping to it is how women end up on a hormone they did not need for a problem it was never going to fix.
That sequence is what a specialist consultation is. If low drive is the symptom you have never said out loud to a doctor, say it in writing instead, in English or Dutch, and have the whole picture worked through properly.