Medically reviewed by Michelle Forcier, MD, MPH — Licensed in Massachusetts | Last reviewed: June 2026
Low libido is one of the most common reasons people seek hormone care — and one of the most undertreated. For cis men, testosterone replacement therapy (TRT) has been available for decades, but the medical establishment is only now catching up to the evidence on its specific role in treating low sexual desire. For cis women or gender queer people assigned female at birth, testosterone for libido remains entirely off-label in the United States, despite strong international clinical consensus that it can help.
And for anyone who is LGBTQIA+, the conversation around libido, hormones, and sexual health is often filtered through assumptions about who you are, who you sleep with, and what your sex life is supposed to look like. That makes it harder to get care that actually fits.
This article covers what the current evidence says about testosterone for low libido in both cis men and cis women, who it may be appropriate for, what the risks are, what FOLX can prescribe, and what else is worth knowing. For specific information on testosterone for nonbinary and gender diverse people, check out those sections of our library.
Testosterone and libido: what actually matters
Testosterone is often framed as a "male hormone," but that is misleading. All bodies produce testosterone. In cis men, it is made primarily by the testes. In cis women, it is produced in smaller amounts by the ovaries and adrenal glands. In both cases, testosterone influences sexual desire through its effects on the central nervous system — specifically, brain regions involved in sexual motivation, arousal, and drive.
But low libido is almost never caused by a single hormone. Relationship dynamics, stress, mental health, medications (SSRIs are a common culprit), sleep quality, body image, pain during sex, life transitions, grief, burnout, and age all play a role. Hormones are one piece. Sometimes they are the most important piece. Sometimes they are not.
What testosterone therapy can do is address the hormonal component — when it is genuinely contributing. It is not a desire switch. It does not fix relationship problems. And it does not work for everyone. But when the hormonal picture is real, it can be a meaningful part of a broader plan.
Testosterone for low libido in cis men
What we know
For cis men with clinically low testosterone — a condition called hypogonadism — reduced libido is one of the most consistently reported symptoms and one of the most responsive to treatment. The Endocrine Society guidelines recommend testosterone therapy for men with symptoms of deficiency and consistently low morning testosterone levels confirmed on at least two separate blood draws.
In April 2026, the FDA took a notable step, encouraging manufacturers of approved TRT products to pursue a potential new indication specifically for low libido in men with idiopathic hypogonadism — low testosterone without a known structural cause. This followed a December 2025 expert panel review and reflects growing recognition that low sexual desire is a clinically meaningful indication in its own right, not just a secondary symptom to be managed alongside other complaints.
This matters because many men with low libido and confirmed low testosterone have been told their labs are "borderline" or that low desire is "normal aging." For some, it may be. For others, treatment makes a real difference in quality of life, relationships, and well-being.
Who it may be appropriate for
TRT for low libido in cis men is generally appropriate when low testosterone has been confirmed by blood tests — typically total testosterone below 300 ng/dL on two separate morning draws — symptoms are present and affecting quality of life, and other causes of low libido have been considered. Those other causes include depression, medication side effects, thyroid dysfunction, sleep apnea, relationship factors, and stress.
TRT is not appropriate as a performance enhancer or libido booster for men with normal testosterone levels. The goal is restoring physiological levels, not exceeding them.
Treatment options
- Injections (testosterone cypionate or enanthate): The most common form. Administered weekly or biweekly, either by a clinician or self-administered at home.
- Topical gel or cream: Applied daily. Provides more stable testosterone levels than injections but requires consistent daily use and care to avoid skin-to-skin transfer to partners or children.
- Patches: Applied daily. Less commonly used due to skin irritation in some people.
Your FOLX clinician will help you choose the delivery method that fits your preferences, your lifestyle, and your clinical picture.
Risks and monitoring
TRT in cis men requires ongoing monitoring. Key considerations include:
- Polycythemia: Elevated red blood cell count, which can increase clot risk. Monitored with regular blood tests.
- Fertility effects: TRT suppresses sperm production. If fertility preservation matters to you, discuss this before starting. Alternatives like clomiphene or hCG may be considered.
- Cardiovascular health: Current evidence suggests TRT at physiological doses does not increase cardiovascular risk in appropriately selected patients, but this remains an area of active monitoring.
- Prostate health: TRT does not cause prostate cancer. However, men with active prostate cancer should not use it. PSA monitoring is part of standard care.
- Sleep apnea: TRT may worsen existing sleep apnea in some cases. Worth discussing if you have symptoms.
Testosterone for low libido in cis women
The gap between evidence and access
No testosterone formulation is FDA-approved for women in the United States. This is not because the evidence is weak. It is because pharmaceutical companies have not pursued FDA approval for a women-specific product, largely for commercial and regulatory reasons.
The clinical evidence, however, is substantial. The International Society for the Study of Women's Sexual Health published clinical practice guidelines in 2021 recommending transdermal testosterone for postmenopausal women with hypoactive sexual desire disorder, or HSDD — defined as persistently low sexual desire that causes personal distress. The British Menopause Society updated its guidance in May 2026 with similar recommendations. Multiple systematic reviews and meta-analyses support that low-dose transdermal testosterone can improve sexual desire, arousal, and satisfaction in postmenopausal women.
The key phrase is "low-dose transdermal." The evidence supports testosterone delivered through the skin — gel or cream — at doses that keep blood levels within the normal premenopausal female range. That is roughly one-tenth the dose used in cis men or in gender-affirming testosterone therapy. The goals and dosing are entirely different.
It also helps to understand the bigger hormonal picture. Testosterone does decline through menopause, but not as sharply as estrogen — and there is no defined "low testosterone" diagnosis in women, because there is no established threshold for what counts as low. For that reason, treatment is guided by symptoms rather than lab numbers, and optimizing estrogen is usually the first step in menopause before adding testosterone for libido.
Who it may be appropriate for
Testosterone for low libido in cis women is most commonly considered for postmenopausal people (natural or surgical menopause) with HSDD who have already explored other contributing factors — relationship dynamics, medication review, treating depression or anxiety, addressing pain during sex — and who are either already on or have considered menopause hormone therapy. It may also be considered for some premenopausal people with HSDD, though the evidence base is smaller.
An important clinical note: testosterone levels in women do not reliably predict who will respond to therapy. A normal testosterone level does not rule out benefit, and a low level does not guarantee improvement. Treatment decisions are based on symptoms and clinical assessment, not labs alone.
How it is prescribed
Since there is no FDA-approved testosterone product for women, clinicians prescribe either compounded testosterone cream or gel, prepared by a compounding pharmacy at women-specific dosing, or an FDA-approved male product used at a fraction of the labeled dose — typically about one-tenth to one-fifth of a tube or packet daily.
Both approaches are off-label. FOLX clinicians can prescribe transdermal testosterone for low libido when clinically indicated and will monitor your care closely.
Risks and monitoring
At low doses, testosterone in cis women is generally well-tolerated. Potential side effects include acne (the most common, usually mild), unwanted hair growth (typically reversible if the dose is adjusted), and voice changes (rare at these doses, but worth monitoring).
There is no strong evidence that low-dose testosterone increases cardiovascular or breast cancer risk in women, but long-term safety data beyond 24 months is limited. Your clinician will check testosterone levels to ensure they stay within the premenopausal female range and will monitor for side effects at follow-up visits.
What about other options for low libido?
Testosterone is not the only option. And for many people, the most effective approach combines hormonal treatment with other interventions.
- Flibanserin (Addyi): An FDA-approved daily pill for HSDD, recently expanded to include postmenopausal women up to age 65. Works on serotonin pathways rather than hormones. Modest efficacy. Requires avoiding alcohol.
- Bremelanotide (Vyleesi): An FDA-approved injectable for premenopausal women with HSDD. Self-administered before sexual activity. Works on melanocortin receptors. Can cause nausea.
- Addressing contributing factors: Medication review (SSRIs are a major culprit), treating depression or anxiety, relationship therapy or sex therapy, stress management, sleep optimization. Sometimes these interventions resolve the issue. Sometimes they clear the way for hormonal treatment to work.
- Estrogen therapy: For menopausal people, treating the underlying estrogen decline with HRT can improve overall sexual function, including desire. Local vaginal estrogen addresses dryness and discomfort that may be dampening desire. See our article Is HRT Safe? for more.
Why LGBTQIA+ people deserve better libido care
Low libido conversations in mainstream healthcare are deeply heteronormative. Most clinical research on HSDD was conducted on heterosexual cisgender women in opposite-sex relationships. Most low-T screening for cis men assumes a heterosexual context. The questions providers ask, the intake forms they use, the assumptions they make about what "normal" desire looks like — all of it is filtered through a framework that may not fit your life.
If you are a gay, bisexual, or queer man navigating low libido, your experience of desire, your relationship dynamics, and how low T affects your daily life may not match the script your provider expects. If you are a queer cis woman, your provider may not think to discuss testosterone for libido at all — or may not know it is an option. And for anyone managing low libido alongside HIV care, PrEP, mental health medications, or questions about gender identity, having a clinician who can hold the whole picture is not a luxury. It is necessary.
FOLX clinicians understand these contexts. You will not have to explain why inclusive care matters before you can talk about your sex drive.
Frequently Asked Questions
Can FOLX prescribe testosterone for low libido?
Yes. FOLX clinicians can prescribe testosterone replacement therapy for cis men with confirmed low testosterone, and low-dose transdermal testosterone for cis women with HSDD, when clinically indicated. Your clinician will evaluate your symptoms, review any relevant labs, and discuss whether testosterone therapy is appropriate for your situation.
Do I need blood tests before starting testosterone?
For cis men, yes. The standard of care requires at least two morning testosterone levels confirming deficiency before starting TRT. For cis women, blood tests may be ordered but are not required for diagnosis, since testosterone levels do not reliably predict who will benefit. Treatment decisions are based primarily on symptoms and clinical assessment.
Will testosterone therapy make me feel different right away?
Most people notice changes gradually. For cis men, improvements in energy and libido often begin within a few weeks, with full effects developing over several months. For cis women on low-dose testosterone, improvements in sexual desire typically take 8 to 12 weeks or longer.
Is testosterone for women the same as testosterone for gender-affirming care?
No. The doses, goals, and monitoring are entirely different. Testosterone for low libido in cis women uses roughly one-tenth the dose used in gender-affirming care, with the goal of restoring levels to the premenopausal female range — not masculinization. FOLX clinicians are experienced in both contexts and will tailor care accordingly.
Can testosterone affect my fertility?
For cis men, yes. TRT suppresses sperm production and can significantly reduce fertility. If biological children are part of your future plans, discuss this with your clinician before starting. Alternatives may be considered. For cis women on low-dose transdermal testosterone, significant fertility effects are unlikely, but it is worth discussing your plans. It is not recommended for people with ovaries and uteruses to take while trying to get pregnant or during pregnancy.
What if testosterone does not help my libido?
Libido is multifactorial. If testosterone does not produce meaningful improvement, your clinician will reassess — looking at contributing factors like medications, mental health, relationship dynamics, sleep, pain, and stress. Other treatments, such as flibanserin, bremelanotide, therapy, or combination approaches, may be explored. Sometimes the answer is not one thing but several things working together.
FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), menopause care, mental health care, sexual and reproductive health care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more.
