10
Ten international medical societies endorse testosterone for low desire after menopause.
The 2019 Global Consensus Position Statement — backed by ten societies including the International Menopause Society, the Endocrine Society, and the North American Menopause Society — concluded that testosterone at physiological doses improves sexual desire, arousal, orgasm, and pleasure, and reduces sexual distress. It graded that evidence Level I, Grade A — the highest classification available.
Global Consensus Position Statement on the Use of Testosterone Therapy for Women, 2019
A standard panel versus a full one.
MARKER
STANDARD PANEL
OUR FULL PANEL
Estradiol (E2)
Usually
Yes
FSH & LH
Usually
Yes
Total testosterone
Sometimes
Yes
Free testosterone
Rarely
Yes
DHEA-S
Rarely
Yes
SHBG
Rarely
Yes
Prolactin
Sometimes
Yes
Full thyroid panel
TSH only
TSH, free T3, free T4
Metabolic markers
Varies
Yes
Inflammatory markers
Rarely
Yes
Why SHBG matters more than people think
Sex hormone-binding globulin binds testosterone and makes it unavailable to tissue. A woman can have a total testosterone reading in the normal range and almost no usable testosterone, because SHBG is high. Measuring total testosterone alone can therefore produce a normal result in someone who is functionally deficient — which is exactly the scenario that explains a great many "your labs are fine" conversations.
What each one actually tells us.
Estradiol
Governs vaginal tissue thickness, lubrication, blood flow, and urinary tract health. The primary driver of genitourinary symptoms.
Thyroid panel
Underactive thyroid produces fatigue, low mood, and low libido that are frequently attributed to menopause instead.
Free testosterone
The fraction actually available to tissue. Most directly associated with sexual desire, arousal, and orgasm.
Prolactin
Elevated prolactin suppresses desire directly and has treatable causes worth excluding.
SHBG
Determines how much testosterone is usable. High SHBG can mask a functional deficiency on a total testosterone reading.
Metabolic markers
Insulin resistance and lipid changes affect vascular function — which affects arousal and sensation.
DHEA-S
A precursor the body converts into both testosterone and estrogen. Declines steadily with age.
Inflammatory markers
Chronic inflammation affects tissue healing and correlates with symptom severity.
Who this is for — and who it isn't.
Likely a fit if
-
Desire dropped and you've been told your labs are normal
-
You've had your ovaries removed and nobody replaced testosterone
-
You're on hormone therapy that helped partway but not with desire
-
You've never had free testosterone, DHEA-S, or SHBG measured
-
You want levels monitored over time rather than a single prescription
Not a fit if
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You want a prescription without testing — we don't do that
-
You have undiagnosed abnormal vaginal bleeding, which we evaluate first
-
You're pregnant or breastfeeding