Testosterone, HRT, and Low Libido in Women

Does Testosterone Hormonal Replacement Improve Libido

Dr. Jolene BrightenPublished: Last Reviewed: Libido, Sex Hormones, Sexual Health Leave a Comment

It’s often said that a strong libido is a sign of health and vitality—yet one-third of women report low sexual desire. But what does “strong” mean anyways? In this article, we’re going to talk about what’s normal, what’s not, and just what might be the cause of your disinterest in getting down with your partner.

Like many women’s health issues, you may not be super eager to discuss low libido with your healthcare provider. Women often feel alone, embarrassed, or they may feel like their provider views low sex desire as unimportant or non-essential. You may worry that your symptoms will be brushed aside as part of being a woman or getting older—a reasonable concern, because it happens. 

The truth is that sexual health and pleasure are essential for quality of life. Many of us want to feel a healthy sexual desire, pleasure, and fulfilling intimate relationships. But, when it doesn’t come easily, there isn’t much information available. Or the first thing we find is, you have to correct your low testosterone, which may be true, but there’s more to that story.

Today I’m going to talk about the possible reasons for low libido. Is it that you need to understand yourself and what makes you tick? Is it connected to psychological symptoms, or is it physical? 

I’ll walk you through the connection between libido and testosterone, how to identify symptoms of low testosterone, and how to address the root cause. Spoiler: testosterone replacement isn’t the only option! 

Low Sexual Desire in Women

Low sexual desire is the most common complaint women have regarding their sexual health. It affects around a third of adult women at some point throughout life. 

Like many health issues women face, low libido is often under-discussed, under-detected, and undertreated. In fact, less than half of women discuss low sexual desire with their doctor. 

There isn’t a single cause of low sexual desire in women. Many factors may play a role, and causes may differ for each woman. Likewise, there isn’t one treatment. We must understand the root cause first. 

Let’s discuss some possible reasons for low libido. 

Spontaneous Vs. Responsive Desire

Understanding spontaneous vs. responsive desire may help some women gain insight into their libido. 

Simply put, spontaneous desire is when you’re thinking about or interested in sex without much prompting. Whereas, responsive desire requires external stimulation to get you in the mood. 

Our culture teaches us that spontaneous desire is the best, or sometimes, only “normal” way to experience desire, but many people experience spontaneous desire, which is normal. In fact, both are normal.

Spontaneous and responsive desire may explain a mismatch in desire, initiation, or expectations with your partner. Sometimes we might think we have low libido, but we are normal in that we might require a lot more stimulation in the right ways and removal of blockages that would otherwise inhibit us from getting in the mood. I detail this all in my Boost Your Desire course where I teach you how to troubleshoot the common issues that inhibit your sexual desire so you can amplify your pleasure. 

If you’re the responsive desire type, does this mean you should have sex when you don’t want to? No way—you should never feel like you have to do something you don’t want to do. Think of it more as needing other forms of intimacy and closeness with your partner to get things going, which includes removing the common issues that pump the brakes on the sexy train.

Psychological Reasons For Low Libido

Mental health is a risk factor for low libido, but it goes beyond just your day-to-day mood. Past experiences, current relationship status, and a personal history of mental illness can all impact your sexual desire. 

Psychological reasons for low libido include:

  • Mental illness
  • Past trauma
  • Relationship problems 
  • Anxiety – linked to low arousal, low pleasure, and pain
  • Depression – linked to low desire 

Hypoactive sexual desire disorder (HSDD) is a diagnosable psychological condition. It’s associated with a lower quality of life, less satisfying relationships, and negative emotions. But what is HSDD? 

Firstly, what it is not is you having a lower interest in sex relative to anyone else, including your partner. Instead, HSDD is defined by a persistent diminished interest in sexual desire or sexual fantasies that you feel is problematic for you or your relationship. It’s not enough to say it’s a low sexual desire issue—it has to be persistent and cause you distress or issues in your relationship. 

This is all to say, don’t jump on the “pathologize your sexual desire or function bandwagon” that many people find themselves on.

When there is a true psychological issue underlying a diminished or absent interest in sexual activity, cognitive behavioral therapy, mindfulness, and other psychological interventions may be supportive. I’d encourage you to meet with a qualified sex counselor or therapist to ensure you’re getting the best care 

Physical Reasons For Low Libido

In addition to how we experience desire and psychological influences, there may be medical reasons for low libido. Some reasons for low libido include:

  • Hypogonadism – low hormone production in ovaries, including estrogen and testosterone
  • Use of certain medications, such as SSRIs (selective serotonin reuptake inhibitors) and oral contraceptives
  • Increased stress, impacting adrenal gland health
  • Hypothyroidism, low thyroid hormone production
  • Nutrient deficiencies, including zinc, vitamin D, and other nutrients 

Many of these physical reasons link to low testosterone and testosterone’s impact on libido. 

Testosterone and Libido

We typically think of testosterone as a male sex hormone, but it is crucial for women’s health as well. The ovaries and adrenal glands produce testosterone in women. It helps us feel motivated, strong, and lean. With androgen deficiency, women feel less sexual desire.

The connection between testosterone and libido is apparent, and low testosterone may explain low libido in many cases. 

Let’s find out what causes low testosterone in women to uncover possible root causes and learn how to increase testosterone. But first, let’s answer the question: what are the symptoms of low testosterone in women? 

causes of low testosterone in women

What Are The Symptoms Of Low Testosterone?

Symptoms of low testosterone in women include:

  • Decreased libido, low sexual desire
  • Difficulty reaching orgasm
  • Low muscle mass and tone
  • Decreases in bone density, osteopenia, or osteoporosis
  • Depressed mood
  • Anxiety
  • Thinning hair
  • Dry skin
  • Decreased motivation
  • Fatigue

If you are feeling any of these symptoms, work with your naturopathic doctor for proper testing and evaluation. You’ll want to peel back the layers to understand what is driving low testosterone. 

Causes Of Low Testosterone In Women

Root causes leading to low testosterone levels include: 

  • Stress and adrenal imbalance: The adrenal glands are a significant source of female testosterone hormone production.
  • Hypothyroidism: Thyroid hormone is required in the ovaries and adrenal glands to promote hormone production. Low thyroid hormone may explain low testosterone and low libido
  • Increased age: In menopause, we stop ovulating, and estrogen, progesterone, and testosterone levels decline. As we get older, adrenal gland hormone production becomes more important. 
  • Nutrient deficiencies: Vitamin D and zinc are required to synthesize testosterone. Low vitamin D, low zinc, and high copper levels are associated with low T. 
  • Oral contraceptives: A significant side effect of hormonal birth control is low testosterone. I’ll discuss this next. 

Birth Control And Testosterone

Low libido is a common side effect of hormonal birth control and low testosterone may explain why. Birth control affects testosterone in two ways.  

First, the birth control pill suppresses ovarian output of testosterone, so the body produces less testosterone, lowering levels. 

Second, the pill increases SHBG (sex hormone binding globulin), a transport protein that binds to free testosterone, so the body can’t use it, further lowering testosterone levels. After discontinuing the pill, SHBG tends to remain elevated. So, your testosterone levels after stopping birth control may remain low, which means low libido and other symptoms. 

If you want to boost testosterone and your sex drive post-pill, read this article

How To Increase Testosterone

There are some options to increase female libido and testosterone. They include testosterone replacement therapy, supplements to boost testosterone, and adrenal support.

Testosterone Replacement Therapy

Treating low testosterone in women can be tricky. I often recommend other solutions prior to trying testosterone hormone replacement therapy. However, this may be an option for some women with low sexual desire. 

Currently, testosterone therapy for women remains non-FDA approved but is available through doctors who prescribe it at low doses “off-label” to women.

In a meta-analysis of research using testosterone replacement in post-menopausal women, researchers found testosterone to be an effective solution for low libido. Transdermal testosterone is preferred over oral hormones, as oral testosterone tends to increase LDL cholesterol. 

Side effects of testosterone replacement may include weight gain, acne, and unwanted hair growth, such as on the chin and chest. 

Another study suggests testosterone replacement is most effective when combined with estrogen replacement. In clinical practice, testosterone is almost always prescribed in conjunction with other hormone replacement therapy, including estrogen and progesterone. 

You may not be a candidate for testosterone replacement if:

  • You haven’t addressed other root causes, such as stress, thyroid health, and nutrient deficiencies
  • You have high SHBG
  • Your symptoms are due to another hormonal imbalance

Hormone replacement therapy requires regular monitoring by a qualified healthcare provider. 

Supplements To Boost Testosterone

Supplements that support testosterone levels include: 

  • Vitamin D – Optimize vitamin D levels to promote testosterone production. When supplementation is required, I often suggest vitamin D3 + K2 to support bone health, heart health, immunity, hormone balance, and more. 
  • Zinc – The ovaries and adrenals require zinc to produce testosterone. You’ll find zinc in our prenatal vitamin, or it can be supplemented separately. Please work with your provider for dosing, as more isn’t always better. 
  • DHEA – DHEA (dehydroepiandrosterone) is the hormonal precursor to testosterone and estrogen. DHEA hormone replacement is available over the counter as a supplement, but I recommend working with a provider for testing, dosage, and guidance. 

Oral supplementation of DHEA increases testosterone levels in women. In premenopausal women, supplementation supports fertility and egg quality. There is support for its use for women with low libido. In addition, DHEA replacement may be an option for women taking oral contraceptives to combat the side effect of diminished testosterone levels. 

Because DHEA levels decrease with age, supplementation may support women in perimenopause and menopause to improve estrogen and testosterone levels. As the ovaries decrease hormone production, adrenal gland testosterone production becomes more important for sexual function and overall health. 

testosterone boosting food

Benefits Of Adrenal Support For Testosterone

The ovaries are the first place we think of when it comes to female sex hormones, but the adrenal glands are a significant source of DHEA and testosterone in women. 

When the adrenal output is low, as with adrenal fatigue (HPA-axis dysfunction), DHEA and testosterone levels may be compromised, leading to symptoms of low testosterone including low libido.

When the root cause of low testosterone is stress, adrenal support helps improve adrenal function and hormonal output. 

In addition to addressing the sources of stress and working on nervous system regulation, supplements including adaptogenic herbs, B vitamins, and other key nutrients may support the adrenal glands in hormone production.

The Optimal Adrenal Kit contains the following:

  • Adrenal Support, which provides adaptogenic herbs and nutrients to revitalize and reenergize the adrenals. 
  • B-Active Plus, which provides all the B vitamins in their active, coenzyme forms to support energy levels, mitochondria health, and hormone production. 
  • Adrenal Calm, a night-time formula to support relaxation and deep, rejuvenating sleep. 


Low libido is one of the most common symptoms of low testosterone in women and affects women of all ages. When you identify low testosterone, natural solutions, including supplements and adrenal support, help increase testosterone production, improving sexual desire and other symptoms. 

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  1. Brotto LA.. Evidence-based treatments for low sexual desire in women.. Front Neuroendocrinol.. 2017. 45. 11-17.
  2. Parish SJ, Hahn SR.. Hypoactive Sexual Desire Disorder: A Review of Epidemiology, Biopsychology, Diagnosis, and Treatment.. Sex Med Rev.. 2016. 4(2). 103-120.
  3. Basson R, Gilks T.. Women's sexual dysfunction associated with psychiatric disorders and their treatment.. Womens Health (Lond). 2018. 14. 1745506518762664.
  4. D'Andrea S, Martorella A, Coccia F, et al. Relationship of Vitamin D status with testosterone levels: a systematic review and meta-analysis. Endocrine.. 2021. 72(1). 49-61.
  5. Chang CS, Choi JB, Kim HJ, Park SB.. Correlation between serum testosterone level and concentrations of copper and zinc in hair tissue.. Biol Trace Elem Res.. 2011. 144(1-3). 264-271.
  6. Raps M, Helmerhorst F, Fleischer K, et al.. Sex hormone-binding globulin as a marker for the thrombotic risk of hormonal contraceptives.. J Thromb Haemost.. 2012. 10(6). 992-997.
  7. 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.
  8. Cappelletti M, Wallen K.. Increasing women's sexual desire: The comparative effectiveness of estrogens and androgens. Horm Behav.. 2016. 78. 178-193.
  9. Li Y, Ren J, Li N, et al.. A dose-response and meta-analysis of dehydroepiandrosterone (DHEA) supplementation on testosterone levels: perinatal prediction of randomized clinical trials.. Exp Gerontol.. 2020. 141. 111110..
  10. Rabijewski M, Papierska L, Binkowska M, et al.. Supplementation of dehydroepiandrosterone (DHEA) in pre- and postmenopausal women - position statement of expert panel of Polish Menopause and Andropause Society.. Ginekol Pol.. 2020. 91(9). 554-562.
About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.