Attention women: Low sex drive? Testosterone won’t help


Talk to your doctor about helping you address the true cause of your low sex drive.

By Bruce Carr, M.D.

You know that look. The one that says your partner is ready to go, but sex is absolutely the last thing you want to do. “Not tonight, honey. I have a headache.”

If this sounds familiar, and if lack of sex is putting a strain on your relationship, you may wonder if you have a low sex drive, also known as low libido. I see women with this concern every week, and many want to try a “quick fix” they’ve heard about on TV or online: testosterone injections, patches, or pellets that corrects low sex drive in women.

But our research indicates that it doesn’t work that way. Not only is testosterone ineffective at increasing a woman’s libido, it also can cause adverse side effects that can make getting in the mood for sex even more difficult.

But TV and internet ads say testosterone works for women!

That may be what the ads say, but there is absolutely no data to indicate that low testosterone levels in women cause low sex drive. Any positive effects claimed by participants in or data pulled from these types of clinical trials is almost absolutely a placebo effect.

The reason I can say that so confidently is because it’s been well-documented that the testosterone levels in women with low sex drives are in the same range as those of women with normal sex drives. In my opinion, there is absolutely no reason to give testosterone to premenopausal women – those in their 30s, 40s, and early 50s – to help with lack of interest in sex. It’s also been found to be ineffective for women who have already gone through menopause.

If it doesn’t work, why did my doctor give it to me?

Many physicians prescribe testosterone to help increase men’s stamina, fatigue, and sex drive. So, they assume testosterone replacement drugs will work the same way for women. But they don’t.

Doctors have an alternative to testosterone since a new drug, flibanserin, was approved by the FDA for low sex drive. But it works differently because it is an SSRI drug that affects the brain. Before prescribing flibanserin, the doctor must take a 30-minute online course, and patients who take it must avoid alcohol. Although it’s approved, it’s only slightly more effective than placebo. Recent reviews suggest that it is not effective. So women are left with no medication for low sex drive.

My team and I conducted a research study of existing literature surrounding the trend of prescribing testosterone to premenopausal women. The maximum length of the studies was 12-24 weeks, and none showed significant improvements in sex drive. In other words, testosterone prescribed to women works no better than a placebo, yet physicians continue to prescribe it because their patients demand a drug for treatment.

Even if a woman is satisfied with the placebo effect of increasing her testosterone levels, the unexpected side effects are likely to outweigh those benefits over time.

Side effects of women taking testosterone

We’ve seen a number of women who have taken testosterone to increase their sex drive but instead developed side effects that make them feel even less excited about sex. Some of these side effects include:

  • Acne
  • Balding
  • Deepening of the voice
  • Excessive hair growth, particularly on the face
  • Enlargement of the clitoris, a part of the outside of a woman’s genitals 

We know that in men the long-term use of testosterone drugs, such as anabolic steroids, causes heart attacks, high blood pressure, and other heart diseases. And it’s safe to say those risks would be at least the same in women.

However, a large clinical trial of testosterone use in premenopausal women has not been conducted. And, in my opinion, it should never be done. The health risks of the drug are just too great, the preliminary data show absolutely no benefit, and we’d never want women to take a drug like that just for the sake of science.

So how can we treat low sex drive in women?

Women and couples come to me and say, “When I first got together with my partner, everything was good. But all of a sudden I just have no sex drive. Is there something you can give me for that?”

When it comes to the female sex drive, there really is no effective treatment we can offer except couples therapy or couples sex therapy. Many women and their partners are disappointed in this answer, but it’s the simple truth.

Many of the women I’ve spoken with in my office and during research studies have said their low sex drive is not because of their relationship. They want to pin not wanting to have or instigate sex on something biological that can be fixed with a pill. This actually is a common problem in relationships, and it’s more common in women than in men.

But if they dig into their relationship and the stressors in their lives (work, school, family), they may be able to uncover the root of their hesitancy to have sex with their partners. And it’s important to keep in mind that “low sex drive” is a subjective diagnosis. There’s no way to measure it except to ask the woman what has changed.

I don’t anticipate that in the future we will have a drug treatment for low sex drive in women. Though we do have testosterone treatment for men with low sex drives, it’s a fairly rare problem in men and therefore difficult to gauge true effectiveness.

Rather, we need to start educating physicians about effective options for addressing low sex drive. At the American Society for Reproductive Medicine conference in 2009, I debated the use of testosterone in postmenopausal women – women who have already gone through menopause. My fellows and I developed and distributed information for doctors to start the discussion about why testosterone is ineffective and why it shouldn’t be prescribed to women.

We need to do a better job in general of educating women about testosterone therapy and why it’s not effective. As women live longer, healthier lives, many of them will want to continue having sex for years longer than our ancestors did. If your sex life is important to your happiness and quality of life, talk with your doctor about safe, non-testosterone therapies that could help get to the root of and potentially eliminate your low sex drive problem.

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