Just Because We Can, Doesn't Mean We Should: The Not-So-Simple Truth About Testosterone Therapy

Sometimes the most powerful medicine isn’t in a prescription bottle

Oct 28, 2025

ICYMI 👉

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, author of the recent New York Times piece, “‘I’m on Fire’: Testosterone Is Giving Women Back Their Sex Drive — and Then Some.”

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The headlines are breathless. Social media influencers are glowing. Your friend swears testosterone changed her life. And now you’re wondering: Should I be on testosterone too?

Last week the New York Times published a feature on testosterone therapy for women, painting a picture of midlife revival—women reclaiming their sex drive, their energy, their very sense of self. The article is part of a larger cultural moment where testosterone has emerged from the medical shadows into the Instagram spotlight, complete with testimonials of transformation and tales of renewed vitality.

The conversation about testosterone is long overdue. Historically women’s sexual health has been treated by the medical establishment as non-essential. Why worry about a woman’s orgasm (or lack thereof) when she can reproduce just fine without one? But here’s what often gets lost in the enthusiasm about supplemental testosterone: Just because supplemental testosterone exists doesn’t mean you should use it. And just because your testosterone level may look low doesn’t mean you need it. Conversely, a normal testosterone level doesn’t automatically rule out a potential benefit.

Welcome to one of medicine’s most important—and most misunderstood—principles: We treat the patient, not the lab test.

white and orange plastic tube — Photo by Testalize.me on Unsplash

The Context Crisis

I see this pattern regularly in my office. A woman comes in with her lab results, pointing to her testosterone level with concern. “It’s low,” she says. “That must be why I have no energy and no libido.” Or conversely: “My level is normal, so why do I still feel terrible?”

Both assumptions miss the fundamental truth about laboratory values: numbers without context are just numbers.

Consider my newly menopausal patient who called me last week convinced she needs testosterone. She’d read the New York Times piece and promptly had her labs drawn with her GYN. Her total testosterone was 15 ng/dL—technically on the lower end of the reference range for women (15-70 ng/dL). Her GYN admitted to her on the phone that she’d been jammed with requests for testosterone since the NYT piece—and, in less than 30 seconds, she prescribed testosterone gel.

But when I spoke with the patient a few days later, her story (fatigue and weight gain) was more complex. She was juggling a hectic job and caring for a mother with dementia. She was sleeping poorly, skipping lunch, and hadn’t exercised in months. Sex with her husband had dwindled as their relationship had devolved into logistical coordinations about her mother’s care. (Read my article on other reasons why your sex life may be suffering here.)

My patient didn’t need testosterone gel. She needed time to care for her body, mind, and marriage. She also needed basic hormone replacement therapy, which is the standard of care for postmenopausal women who lack a contraindication to it. (In other words, when HRT is initiated within the last 10 years of a woman’s menstrual cycle, the benefits outweigh the downsides of it for the vast majority of women.) Sure, supplemental testosterone is still an option for her—but it isn’t a substitute for traditional HRT and wasn’t going to replace time spent reconnecting with her partner.

The Libido Labyrinth

Let’s talk about what the research actually shows. For postmenopausal women with hypoactive sexual desire disorder (HSDD)—persistently low sexual desire that causes personal distress—testosterone therapy does show clear benefit. Studies demonstrate that women on testosterone have approximately one additional satisfying sexual event per month compared to placebo. That’s the data.

But libido isn’t just about hormones. It’s influenced by relationship dynamics, stress, sleep quality, medications (hello, SSRIs), body image, past trauma, life stage, fatigue, and whether you feel valued and seen in your partnership. A testosterone level doesn’t capture whether you feel emotionally connected, or whether you’re so exhausted from caregiving that sex feels like another chore on a long list.

This is why the International Society for the Study of Women’s Sexual Health recommends testosterone as a second-line therapy—after psychosocial and relationship factors have been addressed. It’s not because hormones don’t matter. It’s because they’re only part of the story.

I’ve had patients whose testosterone levels were solidly “normal” who genuinely benefited from testosterone therapy. I’ve also had patients with measurably low levels who saw no improvement with treatment. The difference? The complexity of their individual situation, their responsiveness to therapy, and what else was happening in their lives.

The Men’s Side of the Story

This isn’t just a women’s health issue. I see the same pattern with men seeking testosterone therapy. A patient in his mid 40s came to see me earlier this year, convinced his fatigue and decreased libido meant he had “low T.” (Joe Rogan told him so.) His level was 400 ng/dL—within the normal range for adult men (300-1,000 ng/dL), though on the lower end.

But my patient was working a high-stress job, drinking two or three glasses of wine nightly, and sleeping only six hours a night. He’d gained 20 pounds over five years and had newly high blood pressure and pre-diabetes. His wife was fed up by his work schedule and irritability.

Before considering testosterone, we addressed the fundamentals: sleep, stress management, alcohol reduction, and exercise. I also screened him for depression, which his fatigue and low mood suggested. I started him on a GLP1 medication and recommended couples therapy. He followed up with me this fall. With lifestyle changes, a low dose of Wegovy, and a brief course of therapy, he was starting to feel like himself again. His testosterone level? Still 400 ng/dL.

For men, just like women, the decision to prescribe testosterone requires looking beyond a single number. Some men do genuinely need testosterone replacement—those with true hypogonadism from testicular injury, pituitary disorders, or other medical conditions. But common things are common. Feeling tired with a testosterone level of 400 ng/dL doesn’t automatically warrant treatment, especially when sleep deprivation, poor diet, and chronic stress offer simpler explanations.

The FDA Reality Check

Sadly in the US, there is no FDA-approved testosterone product for women. Every prescription is off-label, typically using male formulations at adjusted doses. The FDA explicitly states that no product has passed safety and efficacy trials for female use (despite supplemental T being available for women in other countries like Canada and Australia).

This doesn’t mean testosterone can’t be helpful for some women—the evidence for treating HSDD in postmenopausal women is actually quite strong! But it does mean we’re operating without the long-term safety data we’d ideally have. We don’t fully understand the cardiovascular effects, the potential cancer risks, or the optimal dosing and duration of therapy for women.

For men, while FDA-approved products exist, they’re approved for specific conditions—not for men with borderline-normal levels who are tired from working too much and sleeping too little.

When Testosterone Makes Sense

I don’t want to sound like a testosterone naysayer. There are absolutely patients for whom testosterone therapy is appropriate and potentially life-changing:

Postmenopausal women with low sexual desire causing distress, after ruling out other medical and psychological factors
Women who’ve had their ovaries removed (which dramatically drops testosterone production)
Men with documented hypogonadism from testicular failure, pituitary disorders, or other medical conditions
Patients who’ve tried addressing lifestyle factors and other underlying causes without improvement

The key is the comprehensive evaluation. It’s the conversation about what else is happening in your life. It’s the consideration of alternative explanations. It’s the honest discussion about what testosterone can and cannot do.

The Upshot

The explosion of interest in testosterone therapy isn’t wrong; it’s just incomplete. Women and men deserve access to treatments that can improve their quality of life. The research on testosterone for specific conditions is legitimate. The experiences of people who’ve benefited are real.

But we’re in danger of making testosterone into the latest shiny object—a medical fix for problems that often have deeper roots in how we’re living our lives. The wellness industry has enthusiastically embraced testosterone, and telemedicine companies are happy to prescribe it after a brief questionnaire. But a hormone level drawn in isolation, interpreted without context, and treated without addressing the full picture isn’t good medicine.

As the testosterone trend continues to grow—propelled by compelling personal stories and cultural conversations about vitality and agency—let’s not lose sight of what actually serves patients best: careful evaluation, honest conversations, attention to the full context of someone’s life.

If you’re struggling with low libido, fatigue, or brain fog, you’re not imagining it and you shouldn’t be dismissed. But the solution might not be a prescription. It might be a good night’s sleep, a tough conversation, or the permission to put yourself first. And sometimes, after all of that, testosterone therapy might indeed be the right choice for you.

🙋🏻‍♀️ So tell me—What are your questions? Would you like to hear more about men and testosterone supplementation next week?