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You don’t want sex.
Fine. But you also don’t want dinner out. Or the trip. Or the phone call. Or the show everyone keeps telling you to watch. You don’t want the version of your life you used to be excited about.
That’s the part nobody asks you about.
No libido. None. No passion. No desire for anything. You hate everyone, including people who have done nothing to you. You move through your own day like a zombie in your own house.
And somewhere along the way you decided it was you. Your marriage. Your personality. You decided you’d turned into a cold woman who used to be fun.
You didn’t. This one is really about testosterone.
Half of us. Not a few of us.
In a study of more than 1,900 women aged 30 to 70 in stable relationships, 26.7% of premenopausal women reported low sexual desire. Among naturally menopausal women it was 52.4%. Surgically menopausal women were more than twice as likely to have low desire that genuinely distressed them.
Read that again. Roughly half of menopausal women. Not the unlucky ones. Half.
So the odds that you personally became a defective wife at 44 are low. The odds that your hormones changed are close to certain.
Testosterone is a woman’s hormone too
We were all taught testosterone is the male one. It isn’t. Your body makes it, uses it, and misses it when it’s gone.
About 25% of your androgen production happens in your adrenal glands, about 25% in your ovaries, and the rest happens out in your tissues. Androgen receptors sit in your reproductive tissue, your brain, your breast, your bone, your muscle and your blood vessels. This is not a niche hormone with one job.
Here’s the honest version of the decline, because you deserve better than a scary graphic on Instagram. Your androgen levels start falling in your mid thirties and keep falling, and that drop is driven more by age than by menopause itself. Your ovaries keep making testosterone after menopause. But ten years past the start of menopause, circulating testosterone is roughly half of perimenopausal levels.
A slow bleed, not a cliff. Which is exactly why it took you years to notice, and why you blamed everything else first.
One thing here is actionable tonight. If you’re already on estrogen in pill form and your libido is still flat on the floor, the route matters. Oral estrogen raises sex hormone binding globulin, and SHBG grabs testosterone and pulls it out of circulation. In the KEEPS trial, 670 women near their final period got oral estrogen, a transdermal estradiol patch, or placebo. The patch produced a real improvement in sexual function. The pill was no better than placebo.
Nobody told you that either.
Why your doctor won’t prescribe it
This is the part that should make you angry.
In the United States there is no FDA approved testosterone product for women. Zero. There are dozens approved for men. The FDA declined a testosterone patch developed for women back in 2004 over long term safety data, and nothing has replaced it since.
So every woman in America who takes testosterone takes a men’s product, off label, at roughly one tenth of a male dose. Usually a 1% cream or gel, dosed down to around 5 mg a day.
That’s why you got the face. That’s why you got “let’s try an antidepressant first.” Plenty of providers won’t prescribe off label hormones at all, and plenty more were never taught how. It isn’t always that she thought you were exaggerating. Often she genuinely didn’t know the dose.
It isn’t like this everywhere. AndroFeme 1, a testosterone cream made specifically for women, is licensed in Australia, New Zealand and South Africa, and was approved by the UK regulator with availability expected in 2026. If you’re reading this outside the US, ask. You may have a licensed option.
There is also now one FDA approved pill for low desire itself. Flibanserin was approved in 2015 for premenopausal women, and in December 2025 the FDA extended it to postmenopausal women under 65. It is not testosterone, and it carries a boxed warning about severe low blood pressure and fainting, especially with alcohol. Worth knowing it exists. Different conversation.
What the evidence actually says about testosterone
In 2019 a coalition of the major menopause and sexual health societies published the Global Consensus Position Statement on testosterone therapy for women. It’s still the reference document, and it’s blunt in both directions.
What it supports: testosterone for postmenopausal women diagnosed with hypoactive sexual desire dysfunction after a proper assessment. That is the one evidence based indication, graded at the highest level. Trials show improvement in desire, arousal, orgasm and pleasure, plus less distress about sex. The average effect is about one additional satisfying sexual event per month above placebo.
What it does not support: everything else. In the panel’s own words, there are insufficient data to recommend testosterone in premenopausal women for sexual function or any other outcome. That’s the perimenopause gap, and it’s real. And for the rest of the list the trials came back empty. No demonstrated effect on general wellbeing. None on depression. None on bone density, lean mass or muscle strength. Cognition, insufficient evidence.
This is the hardest paragraph in this post to write, so I’m going to write it straight.
The flatness is real. The zombie feeling is real. Women in this community describe the most dramatic changes they have ever felt from adding testosterone, and they are not making that up. But the trials measured “general wellbeing” and did not find it. So I will not tell you testosterone is a proven treatment for feeling dead inside, because that is not what the data says. What I can tell you is that desire, arousal and pleasure are measured, replicated and real, and that for a lot of women getting those back does something to the rest of her life that a questionnaire was never built to catch.
Two more honest limits. Safety data at physiologic doses doesn’t extend past 24 months, so long term effects on heart, breast and brain are genuinely unknown. And pellets, injections and compounded “bioidentical” testosterone are specifically not recommended, because they push levels above the normal female range. If someone offers you a pellet, keep shopping.
So where does DHEA come in?
Here’s the real problem with everything above. Testosterone means a provider who prescribes it, an appointment, labs and money. That’s weeks away, minimum. Sometimes months. Sometimes a fight.
You need something now.
DHEA is why so many women start there. It’s a hormone your adrenals make, and it sits upstream of both androgens and estrogens. Your body converts it. It’s the raw material. It’s also available over the counter in the US, which testosterone is not.
The biochemistry is real. Here’s what the trials found.
A 2025 meta analysis of 21 randomized trials found DHEA did raise hormone levels in postmenopausal women. Testosterone rose an average of 24.31 ng/dL and estradiol by 7.86 pg/mL. But dose mattered enormously. At 50 mg a day or more, testosterone rose about 29.65 ng/dL. Below 50 mg the increases were not meaningful, with estradiol moving 0.64 pg/mL. The authors also flagged huge variation between studies, with heterogeneity above 90%.
So DHEA can move a number on a lab. At a real dose. In some women.
Now the part that matters more. Did it move the symptom?
A Cochrane review of 28 randomized trials in 1,273 menopausal women concluded DHEA “may slightly improve sexual function” versus placebo, but that the improvement would not be clinically justified given the possible side effects. It found no evidence DHEA improves quality of life. About 15% of women on DHEA got androgenic side effects, mainly acne, against under 3% of controls. A separate meta analysis of 23 trials found DHEA was not associated with significant improvement in libido or sexual function, on low quality evidence.
And the Global Consensus statement says it outright: systemic DHEA is not associated with significant improvement in libido or sexual function in postmenopausal women with normal adrenal function, and cannot be recommended for women with HSDD.
I’m not hiding that from you to sell you a bottle.
So here’s the honest verdict. DHEA is not testosterone and it will not do what testosterone does. The formal evidence that it fixes libido is weak. What’s also true is that individual response varies wildly, and enough women here have reported feeling different on it that I won’t pretend they didn’t.
If your symptoms are just starting, or testosterone isn’t in the budget this month, or you’re six weeks out from an appointment, DHEA is a reasonable place to begin. It might be enough on its own. It might just be the bridge. That’s as far as I’ll go, and anyone going further is selling.
And if you’re at the end of your rope right now, skip the bridge. Go get the real thing. There’s a section below on exactly how.
DHEA is a hormone, not a vitamin
American supplement aisles made this confusing. DHEA sits on a shelf next to magnesium and vitamin D, so it reads like a nutrient. It isn’t. It’s a steroid hormone precursor, and it deserves the same respect as anything else hormonal you put in your body.
- It’s prescription only in much of the world. In the UK you can’t buy it over the counter at all. In Switzerland it’s prescription only and personal imports get confiscated at the border. If you’re one of our readers outside the US, check your own rules before you click.
- It’s banned in sport. DHEA is prohibited at all times as an anabolic agent. If you compete in anything drug tested, don’t take it.
- Quality control is inconsistent. Because it’s sold as a supplement in the US, the amount in the capsule isn’t guaranteed to match the label. Buy from a company you can actually reach.
- It can raise estrogen as well as testosterone. Same conversion pathway, working in both directions.
- Don’t take it if you have a hormone sensitive cancer or a history of one, and talk to your oncology team before anything hormonal. Mayo Clinic also flags caution with high cholesterol and heart disease, because DHEA can lower HDL, and with mood disorders, because it can worsen them or trigger mania. Skip it in pregnancy and breastfeeding.
- Get a baseline where you can. DHEA-S and total testosterone before you start, so you’re treating a person instead of a guess.
- Acne and unwanted hair are the first signs of too much. That’s your dose telling you something.
Vaginal DHEA is a completely different thing
This trips women up constantly, so let’s separate them properly.
| Oral DHEA capsules | Sold over the counter in the US as a supplement. Raises circulating hormones at 50 mg and up. Evidence for libido is weak, and the major guidelines do not recommend it for low desire. |
| Vaginal DHEA, prasterone | An FDA approved prescription medicine. A 6.5 mg insert, once nightly. Approved for moderate to severe painful sex caused by menopausal vulvar and vaginal atrophy. Studies suggest it doesn’t meaningfully raise blood hormone levels, so it works locally. Roughly $210 a month without coverage. |
| Testosterone | No FDA approved female product in the US. Prescribed off label at about a tenth of a male dose. The only evidence based indication is distressing low desire in postmenopausal women. |
Three different things wearing similar names. If sex hurts, the vaginal one is the conversation. If desire is gone, the systemic one is the conversation. They are not substitutes for each other.
What else is stealing your desire
I’d be doing you a disservice if I let you leave thinking one bottle was the answer. Every serious guideline says deal with these first, and they’re right.
Sleep. In a study following 171 young women for two weeks, every extra hour of sleep raised the odds of sex the next day by 14%, and longer sleep predicted more desire the next day, independent of mood and tiredness. That study wasn’t done in menopausal women, so hold it loosely. But you already know what four broken nights does to you. If you’re not sleeping, start there. Our full breakdown of magnesium and what progesterone actually does for sleep are both worth your time.
Pain. Desire does not survive pain. If sex hurts, your brain quietly stops asking for it, and no amount of testosterone overrides that. Vaginal tissue thins without estrogen and it does not fix itself. Treat the tissue first, then talk about desire.
Your medications. This is the one nobody mentions. Sexual side effects are reported in a large share of people on SSRIs, and reduced desire is the most commonly reported one in women taking them. Some antidepressants carry far less of this than others. That is not permission to stop your medication. It’s permission to ask your prescriber whether a switch is possible, because most women have never been told the option exists.
The boring medical stuff. Thyroid disease, anemia, and untreated hot flashes wrecking your nights all show up as no drive. Rule them out.
Your actual life. Resentment is not a hormone. If you’ve carried everything alone for four years and you no longer want to be touched by the person who let you, testosterone won’t fix that, and pretending otherwise is its own kind of dismissal. Sometimes it’s both. Usually it’s both.
Where our community landed on DHEA
None of the recommendations on this site come from me.
They come from more than 60,000 women who have been talking to each other for over four years about what worked, what did absolutely nothing, what was too expensive to justify, and what turned out to be reasonable. On providers, those same women reported back on who listened and who didn’t. That’s a kind of due diligence no review site can do.
For DHEA, the community’s answer has been Raena Health.
Here’s why, and I want to be precise, because I’d rather be trusted than convincing.
Raena was founded by Alannah Connealy, who built the thing she needed and couldn’t find. Her interest in hormones started in her mother’s cancer clinic. The company covers at home hormone testing, bioidentical options you can order directly, and a separate prescription portal with provider review for the things that require one. It spans progesterone and estrogen as well as DHEA, so if this post sends you three directions you’re not signing up with three companies.
Woman owned, run by a woman who made the solution she personally needed, with the energy going into educating and supporting women rather than moving units. When I point you at them, I’m not recommending a supplement company. I’m recommending women who care whether this actually works for you.
Now the fine print, because you’re an adult. Raena’s DHEA is an over the counter 10 mg capsule. Ten milligrams sits well below the 50 mg and up that moved hormone levels in the trials above. That doesn’t make it useless, and starting low on a hormone is a defensible choice. It does mean you shouldn’t expect a 10 mg capsule to deliver a therapeutic testosterone level, and you should settle your dose with a provider rather than with a blog. Their prescription portal is separate from their over the counter shelf, so check which one you’re ordering from.
I’d rather tell you that than have you order, feel nothing in three weeks, and decide hormones don’t work for you.
What to say to your provider so you’re not dismissed
This is the most important section on this page. Not the supplement. This.
Testosterone needs a provider who prescribes it properly, and the difference between a nine minute brush off and an actual plan is often just the words you walk in with. Print this. Take it in.
- “My sexual desire has dropped significantly from my own baseline, it’s been months, and it distresses me. I’d like to be assessed for hypoactive sexual desire dysfunction.”
- “I understand there’s no FDA approved testosterone product for women in the US and that it would be off label at about a tenth of a male dose. I’m comfortable with that. Are you comfortable prescribing it?”
- “Before we talk about testosterone, I want to rule other things out. Can we check thyroid and iron, and look at whether my current medications could be contributing?”
- “I’d like baseline labs: total testosterone and SHBG, plus DHEA-S. Liver function and a fasting lipid panel if we’re going to treat.”
- “I’d like a repeat testosterone level 3 to 6 weeks after starting, then every 4 to 6 months, to make sure I stay inside the normal premenopausal range and not above it.”
- “I’d prefer a transdermal cream or gel over pellets or injections, because supraphysiologic levels aren’t recommended.”
- “If sex is painful, I want to talk about local vaginal estrogen or vaginal DHEA separately from desire.”
- “I’m on oral estrogen. Given that it raises SHBG and lowers free testosterone, would switching to a patch be worth trying?”
- “If we try testosterone and I feel no meaningful benefit by six months, I’d like a plan to stop.”
If she says no, that’s information, not a verdict. Ask directly: “Is there someone you’d refer me to who does prescribe testosterone for women?” Then go find one.
Our provider directory is free. More than 660 providers, including telehealth for the states and countries where nobody local will help you. Every listing is there because a woman in this community pointed us to it. Find someone near you, then call and ask one question before you book: does this provider prescribe testosterone for women?
That single question saves months.
The part I need you to hear
You did not stop wanting your life because you’re broken.
You stopped because a hormone you were never taught you had has been quietly draining out of you since your mid thirties. Because the medical system in your country has approved dozens of testosterone products for men and none for you. And because when you finally said something out loud, you got handed a prescription for your mood instead of your hormones.
DHEA might help you. It might be the thing that carries you through the next six weeks. Start it if it makes sense for you, with your eyes open about what it can and can’t do.
But if you’re reading this on your last strand of hope, don’t spend three more months on a bridge. Go find the person who will prescribe the real thing. Use the directory. Bring the script above. Don’t leave that appointment without a plan.
And if you want to understand the rest of what’s happening to you, everything we’ve written is on the education page.
You are not crazy. It is your hormones.
Sources
- Davis SR et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Journal of Clinical Endocrinology & Metabolism, 2019.
- Parish SJ et al. ISSWSH Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. Journal of Sexual Medicine, 2021.
- Cleveland Clinic Journal of Medicine. Prescribing testosterone and DHEA: The role of androgens in women. 2021.
- US Department of Veterans Affairs. Transdermal Testosterone (Off-Label) for Hypoactive Sexual Desire Disorder, clinical summary. March 2025.
- Scheffers CS et al. Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database of Systematic Reviews, 2015.
- Elraiyah T et al. The benefits and harms of systemic dehydroepiandrosterone in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. 2014.
- Impact of DHEA supplementation on testosterone and estradiol levels in postmenopausal women: a meta-analysis of randomized controlled trials. Diabetology & Metabolic Syndrome, 2025.
- American Family Physician. Prasterone (Intrarosa) for Dyspareunia. 2019.
- Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women. Menopause, 2008.
- Kalmbach DA et al. The Impact of Sleep on Female Sexual Response and Behavior: A Pilot Study. Journal of Sexual Medicine, 2015.
- Kronos Early Estrogen Prevention Study (KEEPS) sexual function analysis, on oral versus transdermal estrogen, SHBG and free testosterone.
- Mayo Clinic. DHEA drugs and supplements monograph.
- Harvard Health Publishing. DHEA supplements: Are they safe? Or effective?
- US Anti-Doping Agency. What Should Athletes Know about DHEA?
- Swissmedic. Warning about imports of melatonin and DHEA by private individuals.
- FDA approval of flibanserin for hypoactive sexual desire disorder in postmenopausal women, December 2025.
This post is education, not medical advice. Nothing here replaces a conversation with a provider who knows your history. If you have a history of hormone sensitive cancer, unexplained vaginal bleeding, or liver disease, talk to your care team before starting anything hormonal.
