"Lack of Sexual Libido and What Testosterone Has to Do with the Pleasure You Forgot"

Dra Andreia de Almeida
May 6
4 min read

Dear powerful woman: if you’ve ever felt disconnected from your body, with your desire dormant and sexual pleasure seeming like a distant memory... take a deep breath and read on. You are not alone.

As a medical doctor specialised in functional medicine and hormonal modulation, one of the most frequent complaints I hear in my clinic is a decrease in sexual desire and difficulty reaching orgasm.These are well-informed women, many with demanding careers and structured lives, who come to me describing a deep sense of disconnection from their sexuality.

"Could it be that I no longer fancy my husband?""Is it just the routine?""It's the kids' fault – they’ve taken over our bedroom!"

In most cases, the answer lies not only in emotional or relational factors. It lies in hormonal imbalance.And among the most overlooked hormones in women’s health is testosterone.

Testosterone: a female hormone too

Although socially associated with men, testosterone plays a vital role in the female body. It is produced mainly in the ovaries, and to a lesser extent, in the adrenal glands. When balanced, it supports:

Libido and sexual response
Orgasmic capacity
Muscle tone and physical strength
Mental clarity and motivation
Emotional stability

However, from the age of 35 – or even earlier, in cases of chronic stress, prolonged contraceptive use or ovarian dysfunction – testosterone levels may begin to drop significantly.

“Without adequate hormonal support, the body simply may not respond.”

Clinical signs of testosterone deficiency in women

Common symptoms include:

Decreased muscle mass and increased abdominal fat
Persistent fatigue, even after rest
Low or absent libido
Difficulty achieving orgasm (or less intense orgasms)
Irritability, apathy or lack of motivation
Loss of focus and mental clarity
Vaginal dryness (especially in perimenopausal and menopausal women)

These symptoms are often dismissed or attributed to ageing, stress or “life phases”, which delays diagnosis and worsens the impact on a woman's quality of life.

How to test for testosterone deficiency

In functional clinical practice, laboratory testing should be done strategically. Ideally, the following are recommended:

Total testosterone
Free testosterone
SHBG (Sex Hormone Binding Globulin)
DHEA-S (an androgen precursor produced in the adrenals)
Optional: cortisol, oestrogens, progesterone and TSH, for a broader picture

Total testosterone alone doesn’t always reflect a patient’s true hormonal state. Many women show "normal" total testosterone levels, yet low free testosterone, due to high SHBG (common in women taking the pill, for instance). It’s free testosterone that has real biological action in tissues.

How to correct it: start bioidentical testosterone modulation

When deficiency is confirmed both clinically and through lab tests, bioidentical testosterone replacement may be considered — tailored to each individual.This is a substance molecularly identical to what the human body produces, with proven safety and efficacy when correctly prescribed.

The most commonly used form is a daily transdermal gel or cream, applied to hair-free skin (arms or other areas), with a dosage adjusted to the patient’s needs.It’s essential to underline that testosterone should never be prescribed without prior assessment and regular monitoring, due to the risk of adverse effects (such as acne, increased hair growth, liver changes, etc., if overdosed).

With well-adjusted dosing, most women experience:

Return of sexual desire
Enhanced response to stimulation and ability to reach orgasm
A sense of “feeling like themselves again”
Improved mood, energy and motivation
Reduced abdominal fat and better body composition

Special cases: women in menopause

During menopause, production of all sex hormones decreases drastically. Often, in addition to testosterone, there is a deficiency in oestrogen and progesterone.In such cases, combined hormonal modulation (including other bioidentical hormones) may be indicated to restore overall balance.

Clinical reports show that many menopausal women who appropriately replace testosterone experience a sexual and emotional rebirth — positively impacting their relationships, self-esteem and general wellbeing.

Libido and orgasm: more than just a psychological issue

It’s important to make it clear that female sexuality is multifactorial. Emotional state, relationship quality, life context and body image certainly influence it.However, without proper hormonal support, the body may simply not respond.

Emotionally well-balanced women, with stable lives and healthy relationships, can still feel deep frustration for lacking desire or pleasure.In these cases, focusing solely on therapy or “emotional work” falls short — and the woman remains disconnected from her body.

And since we can’t guess — each case must be evaluated individually.

As a doctor, I do not see testosterone as a magic solution, but rather as an essential part of modern women’s health.Our current lifestyle — marked by chronic stress, poor nutrition, sedentary habits, and even hormonal pollution (check the labels on your food and see how they impact your hormones!) — fosters endocrine imbalance.We must look at the body deeply, with respect for its complexity.