The Hormone Women Aren't Told About: Testosterone, Low Desire, and HSDD

When women think about hormones, they think estrogen and progesterone. Testosterone rarely enters the conversation—and that's a problem. Testosterone is not solely a "male" hormone. It is the most abundant biologically active sex hormone in a woman's body across her lifespan, and its decline can quietly erode energy, mood, muscle, cognition, and, most notably, sexual desire.

Yes, women make testosterone—and yes, it runs out

A woman's ovaries and adrenal glands produce testosterone throughout her life. Levels peak in the twenties and fall steadily thereafter, so that by her forties a woman typically has roughly half the circulating testosterone she had at her peak. Surgical removal of the ovaries causes an abrupt drop. Certain medications, including oral estrogen and some hormonal contraceptives, raise sex hormone-binding globulin, which further lowers the free, active testosterone available to tissues.

The result is a hormone deficiency that often goes unrecognized because both women and their clinicians assume the symptoms—low libido, fatigue, brain fog, diminished sense of well-being—are simply stress, aging, or "in their head."

What HSDD actually is

Hypoactive Sexual Desire Disorder (HSDD) is the most common form of female sexual dysfunction. It is defined as a persistent or recurrent absence of sexual thoughts, fantasies, or desire for sexual activity that causes personal distress and is not better explained by another condition, medication, or relationship problem.

That word—distress—is essential. Low desire only qualifies as HSDD when it genuinely bothers the woman experiencing it. This is a real, diagnosable medical condition, not a character flaw or a relationship failure. And for postmenopausal women, the strongest evidence-based treatment we have is testosterone therapy.

A validated way to screen: the DSDS

Because HSDD is under-recognized, clinicians use a brief, validated tool called the Decreased Sexual Desire Screener (DSDS). It is five questions, and you can reflect on them yourself:

1. In the past, was your level of sexual desire or interest good and satisfying to you?

2. Has there been a decrease in your level of sexual desire or interest?

3. Are you bothered by your decreased level of sexual desire or interest?

4. Would you like your level of sexual desire or interest to increase?

5. Please indicate whether any of the following may be contributing to your decreased desire:

   • a medical condition, surgery, injury, or depression

   • medications, drugs, or alcohol you currently take

   • pregnancy, recent childbirth, or menopausal symptoms

   • other sexual concerns (pain, low arousal, difficulty with orgasm)

   • your partner's sexual problems

   • dissatisfaction with your relationship or partner

   • stress or fatigue

How it's interpreted: if you answer yes to questions 1 through 4 and check none of the factors in question 5, the screen points toward generalized, acquired HSDD. If you check one or more factors in question 5, that doesn't rule out HSDD—it simply means your clinician needs to weigh whether that factor is the true driver of your low desire. The DSDS is a starting point for a conversation, not a substitute for a full evaluation.

What treatment looks like

For postmenopausal women who meet criteria for HSDD, major bodies including the International Society for the Study of Women's Sexual Health and the Global Consensus Position Statement endorse testosterone therapy. In clinical trials it produces a moderate but meaningful improvement in sexual desire, arousal, orgasm, and satisfaction, along with reduced distress.

An important honesty point: there is currently no FDA-approved testosterone product designed for women in the United States. Reputable clinicians therefore prescribe approved male formulations at a fraction of the male dose—roughly one-tenth—carefully titrated to keep blood levels within the normal premenopausal female range. This is standard, evidence-based off-label practice when done correctly, which is exactly why monitoring matters. Proper care means baseline and follow-up blood levels, tracking of symptoms, and attention to side effects rather than a one-size-fits-all pellet or an unmonitored prescription.

Testosterone is not a fix for low desire caused by relationship conflict, untreated depression, thyroid disease, or the side effects of another medication. A thorough workup rules those in or out first—which is precisely why self-diagnosis and unregulated products are risky.

You deserve to be taken seriously

If your desire has faded, if it bothers you, and if you've been told it's just part of getting older—that answer is incomplete. Low testosterone is a legitimate, measurable, and often treatable cause, and you deserve a clinician who will actually investigate it.

At Finger Lakes FNP, we specialize in comprehensive hormone optimization for women, including evaluation and evidence-based treatment of HSDD. Schedule a consultation to get your levels tested and your symptoms taken seriously.

-Melissa Vorhis, FNP-C

This blog post is for educational purposes only and is not medical advice, diagnosis, or treatment. It is not a substitute for consultation with a qualified healthcare provider, and reading it does not establish a provider-patient relationship with Finger Lakes FNP. Testosterone therapy carries individual risks and benefits; decisions should be made with your own clinician.