Why Testosterone in Women Is So Misunderstood—And What That Costs Your Sexual Health

Testosterone in women is rarely discussed, frequently misunderstood, and often withheld despite being a naturally occurring hormone with wide-ranging health benefits beyond sexual function. According to urologist and sexual medicine specialist Prof Mohit Khera, testosterone remains one of the most misunderstood and underused hormones in medicine, particularly when it comes to women's health. The problem isn't that the hormone doesn't work—it's that outdated fears and incomplete information are keeping women from accessing treatment that could significantly improve their quality of life.

Why Is Testosterone So Misunderstood in Women?

The confusion around testosterone in women stems from several interconnected issues. First, testosterone has been historically framed as a "male hormone," which creates an automatic psychological barrier for both patients and providers. Second, the conversation around testosterone in women has been narrowly focused on libido, missing the broader picture of what this hormone actually does in the body. Third, there's lingering fear—often unfounded—about the safety of testosterone replacement therapy in women.

Prof Khera's work highlights a critical insight: sexual dysfunction is rarely an individual problem. When one partner experiences sexual difficulties, it affects the relationship dynamic. Yet the standard medical approach often treats only one person, which can actually create new difficulties rather than resolve them. This siloed approach misses the relational and hormonal complexity of sexual health.

What Does Testosterone Actually Do Beyond Libido?

The conversation around testosterone needs to expand far beyond sexual desire. While libido is certainly affected by testosterone levels, this hormone influences multiple systems throughout the body. According to the research presented by Prof Khera, testosterone should be understood as part of a three-hormone foundation alongside estradiol and progesterone. When all three are in balance, women experience benefits that extend well beyond the bedroom.

The health benefits of adequate testosterone in women include:

• Bone Health: Testosterone plays a critical role in maintaining bone density, which becomes increasingly important as women age and face higher osteoporosis risk.
• Muscle Strength and Metabolism: Adequate testosterone supports muscle maintenance and metabolic function, helping women maintain strength and healthy weight as they age.
• Cardiovascular Function: Testosterone contributes to heart health and blood vessel function, making it relevant to long-term cardiovascular outcomes.
• Cognitive Function: Emerging research suggests testosterone supports brain health and cognitive performance in women.
• Mood and Energy: Many women report improved mood, motivation, and overall energy levels when testosterone is optimized.

This broader understanding transforms testosterone from a "sex hormone" into what it actually is: a disease-modifying hormone with implications for long-term health and quality of life.

Why Are Doctors and Patients Afraid of Testosterone Therapy?

Fear around testosterone replacement in women often stems from outdated or misinterpreted research, combined with cultural anxiety about women using a hormone associated with masculinity. However, Prof Khera's perspective is direct: "being scared to replace it is often doing more harm than good". This fear-based approach means women are denied access to a hormone their bodies naturally produce, in doses their bodies can safely tolerate.

The irony is significant. Women naturally produce testosterone throughout their lives—it's not a foreign substance being introduced into the body. During perimenopause and menopause, testosterone levels decline just as estradiol and progesterone do. Yet while hormone replacement therapy involving estradiol and progesterone has become more widely accepted, testosterone remains controversial, despite being part of the same natural hormonal system.

When testosterone deficiency goes untreated, women may experience persistent sexual dysfunction, loss of motivation, declining bone density, and reduced quality of life—all preventable with appropriate treatment. The cost of this caution isn't safety; it's suffering.

How Should Women Approach Testosterone and Sexual Health?

The key shift required is moving from fear-based medicine to evidence-based medicine. This means recognizing that testosterone is a legitimate treatment option for women experiencing deficiency, and that the risks of appropriate replacement are far lower than the risks of untreated deficiency. It also means understanding that sexual health is not an isolated concern—it's connected to overall hormonal balance, relationship dynamics, and long-term health outcomes.

For women considering testosterone therapy, the conversation should include assessment of all three key hormones—estradiol, progesterone, and testosterone—rather than treating them separately. It should also involve both partners when possible, since sexual dysfunction affects relationships and addressing it requires understanding the full context.

The bottom line, according to experts like Prof Khera, is that testosterone in women deserves the same thoughtful, evidence-based approach we've extended to other hormones. Women naturally make this hormone. It offers real health benefits. And the fear preventing its use is often doing more harm than the hormone itself ever could.