Testosterone has long been described as our “desire hormone”. On social media and by many private providers, it is often presented as the obvious—and only—solution to reduced sexual desire. Sales of testosterone products have risen sharply.
The body of scientific research shows that testosterone can have an important role in treating some patients, but far from everyone. Many people who use testosterone today do not have a medical need for it, and it is not the only possible treatment for low sexual desire. For both women and men, sexual desire is far more complex than a hormone level in the blood. There is much talk today about the body’s hormonal balance as though it were faulty and needed correcting. In fact, the hormonal system is carefully regulated, and genuine hormonal disorders are much less common than many people believe. When symptoms such as low desire arise, the explanation is often found somewhere other than hormone levels.
Desire begins in the brain—not through a higher concentration of testosterone in the blood
Sexual desire does not arise as a response to high testosterone levels. It begins in the brain’s desire centres and is triggered by different stimuli, such as touch or fantasies.
Many factors—including stress, performance pressure, difficult feelings such as guilt and shame, pain, erection difficulties or relationship problems—can block desire even when testosterone levels are entirely normal.
Testosterone and women—a considerably smaller effect
In recent years, more and more women have sought testosterone treatment for low sexual desire. At the same time, the research has become increasingly clear.
International guidance from the International Society for the Study of Women’s Sexual Health (ISSWSH) states that the only evidence-based indication for testosterone in women is low sexual desire in postmenopausal women, after other possible causes have been investigated.
This means testosterone is not recommended as a general treatment for reduced sexual desire. Sexological counselling is often a more appropriate and effective approach.
How large is the effect?
The major meta-analysis underlying the international guidelines shows that testosterone produces a statistically significant but relatively small effect.
On average, treatment results in approximately one additional satisfying sexual event per month compared with placebo. Many women experience an improvement, but far from everyone does.
Research also shows no clear link between a woman’s testosterone level and her sexual desire. Women with low testosterone can have a satisfying sex life, while women with higher levels may experience a pronounced lack of desire.
The placebo effect is greater than many people realise
One of the most interesting findings from randomised studies is the large placebo effect.
Women who received a placebo also often reported improved sexual desire.
This shows how strongly the brain influences sexuality. Expectations, hope, greater attention to the relationship and better communication with a partner can themselves improve sexual function.
This does not mean that the difficulties were imagined. On the contrary, it shows that sexuality is governed by many more mechanisms than hormones alone.
Testosterone deficiency in men—usually a symptom, not a disease
Low testosterone levels in men are discussed more and more, but it is important to distinguish between a laboratory value and a medical diagnosis.
Clinical hypogonadism means that a man has both typical symptoms and repeated test results showing low testosterone levels. This is very uncommon in younger men who are otherwise healthy.
It is far more common for low testosterone levels to be caused by other illnesses or lifestyle factors.
Common underlying causes include obesity, diabetes, chronic illness, prolonged stress or depression, opioid use and high alcohol consumption.
In many cases, testosterone levels improve when the underlying cause is treated. Weight loss, better sleep, physical activity and treatment of underlying illness can restore the body’s own testosterone production.
Men with suspected testosterone deficiency are therefore advised to undergo a careful medical assessment before testosterone treatment is considered.
When does testosterone help men?
For men with confirmed hypogonadism, testosterone treatment can bring significant improvements, and many experience increased sexual desire and improved erections. Treatment is therefore often very effective for men with a genuine testosterone deficiency.
The body reduces its own production
There is, however, an important aspect that is rarely discussed.
When testosterone is supplied from outside the body, the brain registers that the body already has enough. The testicles then gradually reduce their own testosterone production, while sperm production also decreases.
Many men experience a clear improvement during treatment. When treatment ends, however, the body may have very low testosterone levels for a period before its own production recovers.
What happens when treatment ends?
During the recovery phase, men may experience even lower sexual desire and poorer erections than before starting testosterone treatment. Other common symptoms during this period include fatigue, low mood, reduced motivation and poorer physical performance.
The time it takes for the body’s own hormone production to return varies between individuals. Many recover within a few months, but after long-term treatment or higher doses it may take six months or longer for testosterone production to normalise. For some men, recovery can take even longer, and in isolated cases medical treatment is needed to stimulate the body’s own hormone production.
Testosterone is not the answer to every difficulty with desire
In both women and men, low sexual desire is far more commonly linked to factors other than testosterone. Common causes include stress, performance pressure, difficult feelings such as guilt and shame, pain, erection difficulties, medication side effects, low sexual self-esteem or relationship problems.
Why sexological counselling is recommended
For most people, sexological counselling can have a greater and more lasting effect on sexual desire than testosterone treatment. By identifying and addressing the factors that block the brain’s desire centres, sexual desire may return without altering the body’s hormonal balance.
Conclusion
Testosterone is an important hormone, but it is not synonymous with sexual desire.
Testosterone can be a valuable treatment for some postmenopausal women with low sexual desire and for men with medically confirmed hypogonadism.
For most people, increased desire comes from understanding and reducing what gets in the way, while actively creating conditions that support sexual desire.
Treating only a hormone level risks missing the real cause. Looking at the whole person offers much better conditions for a lasting improvement in sexual health.
Ninni Stålhammar, Auktoriserad Sexolog, Legitimerad barnmorska