Blood Testosterone Levels Do Not Predict Low Sexual Desire In Midlife Women, Study Finds

Routine blood tests for testosterone and related hormones cannot reliably diagnose low sexual desire in midlife women, according to new research published in Fertility and Sterility. The study found no meaningful link between blood testosterone levels and women’s reported libido across different stages of menopause.

The findings challenge a long-held assumption that low circulating testosterone is a key biological cause of low sexual desire in women. They also raise questions about the value of ordering hormone panels to evaluate women who seek medical help for a loss of interest in sex.

Testosterone And Women’s Sexual Health

Doctors have prescribed testosterone for postmenopausal women with low desire for more than 80 years. This practice helped fuel the belief that measuring testosterone could identify which patients would benefit most from hormone therapy.

Susan R. Davis, director of the Women’s Health Research Program at Monash University, led the new investigation to test those assumptions. She aimed to clarify how circulating sex hormones truly relate to different aspects of women’s sexual function.

Overcoming Limits Of Older Research

Earlier studies on hormones and female sexuality often relied on older laboratory methods that struggled to measure the very low testosterone levels typical in women. Many also failed to clearly distinguish between premenopausal, perimenopausal, and postmenopausal stages.

These limitations made it difficult to draw firm conclusions about how hormones affect desire, arousal, or orgasm during different reproductive phases. The new research was designed to address these weaknesses and provide more reliable evidence.

How The Australian Study Worked

The analysis used data from 731 women aged 40 to 69 who participated in the Australian Women’s Midlife Years Study. The sample was broadly representative of the Australian population by age and region.

Researchers classified 136 women as premenopausal, with regular menstrual cycles, and 595 women as perimenopausal or postmenopausal, with irregular or absent periods. This separation allowed the team to examine hormone effects across distinct life stages.

Participants completed a 37-item questionnaire assessing their sexual experiences over the previous 30 days. The survey generated scores for sexual desire, arousal, orgasm, and overall sexual responsiveness, with higher scores indicating better function.

Advanced Hormone Testing Methods

To measure hormones, the team used liquid chromatography–tandem mass spectrometry, a highly precise technique suited for detecting very low concentrations. This approach is considered the gold standard for sex hormone testing in women.

Blood samples were analyzed for testosterone and two precursor hormones, dehydroepiandrosterone (DHEA) and androstenedione. These precursors are produced by the adrenal glands and ovaries and can be converted into testosterone and estrogen within body tissues.

The researchers excluded women who were pregnant, breastfeeding, using hormone therapies, or taking medications known to strongly affect hormone levels. They also removed participants with thyroid disease, elevated prolactin levels, moderate to severe depression, or those taking psychiatric medications in order to reduce confounding factors.

Low Desire Common, But Not Hormonal

The study found that sexual difficulties were common. Around 24 percent of women reported low sexual desire, 19 percent experienced arousal problems, 10 percent struggled to reach orgasm, and nearly 8 percent reported poor overall sexual responsiveness.

Despite this, there was no association between any measured hormone and women’s reported desire scores. After adjusting for age, body mass index, relationship status, and prior trauma, testosterone levels did not predict low libido in any menopausal group.

“We found no relationship between any hormone measured and sexual desire or libido,” Davis said. The result remained the same even when examining women with the most severe complaints of low desire.

Subtle Links With Arousal And Orgasm

While desire showed no hormonal association, the team observed modest and complex relationships between certain hormones and arousal or orgasm. In premenopausal women, testosterone levels showed an S-shaped association with orgasm scores, meaning the relationship was not linear.

Among perimenopausal and postmenopausal women, androstenedione levels were linked in a nonlinear way to both arousal and orgasm. However, these hormones explained only a small proportion of the overall variation in sexual function.

Women with severe orgasm or sexual responsiveness problems tended to have slightly lower median testosterone, DHEA, and androstenedione levels than those without these issues. Even so, hormone level ranges overlapped substantially between groups.

Davis noted that while a small group-level pattern existed, “a blood level was not useful for distinguishing symptoms in an individual woman.” In other words, no clear diagnostic cutoff emerged from the data.

Why Blood Tests Miss The Full Picture

The authors caution that the findings do not mean testosterone is irrelevant to women’s sexual health. Instead, they argue that standard blood tests capture only hormones circulating in the bloodstream, not those produced locally within tissues.

Tissues such as the brain, vagina, and fat can manufacture testosterone on-site, where it may directly influence sexual response. These local hormone levels may not correspond to what appears in a single blood sample taken from a vein.

Because of this mismatch, a normal or low blood testosterone result cannot reliably indicate whether a woman has sufficient hormone levels in key tissues. Clinicians therefore cannot use these values to determine who should or should not receive testosterone therapy.

Limits Of The Research And Next Steps

The study was cross-sectional, capturing a single moment in time, and therefore cannot establish cause and effect. The team did not standardize blood collection times or menstrual cycle phases, which may have introduced small measurement differences, particularly among premenopausal women.

Researchers also could not fully account for relationship quality, relationship duration, and other psychosocial factors that strongly influence sexual desire. These factors, along with mental health, stress, and life circumstances, are known to be major drivers of libido.

Future research may include repeated hormone measurements and more detailed assessments of interpersonal factors to clarify how biological and psychological influences interact. The team is already recruiting premenopausal and perimenopausal women with low libido for a trial examining whether testosterone treatment can improve desire.

Implications For Women And Clinicians

For now, the evidence suggests that ordering testosterone panels to investigate low sexual desire in midlife women offers little diagnostic value. Davis concludes that “testing hormones is not useful in assessing low sexual function or how to treat low sexual function.”

Experts say clinicians should instead take a broad, nuanced history that includes mental health, medications, relationship dynamics, and life stressors when addressing sexual concerns. Hormone therapy, if considered, should be based on symptoms, risks, and patient preferences rather than a single testosterone measurement.

The study adds to a growing body of evidence that female sexual desire is shaped by a complex combination of biological and psychosocial factors. A simple blood test, the authors argue, cannot capture that complexity for midlife women seeking help with low libido.