2019 Meta-analysis of 36 RCTs Confirms Testosterone Improves Sexual Desire in Postmenopausal Women with HSDD but Broader Claims Lack Randomized Support

Women are obtaining testosterone gel by posing as men after BBC reporting highlighted limited licensed female formulations. Testosterone production falls gradually before menopause yet routine assays cannot reliably quantify the low female range, complicating diagnosis. International guidelines endorse its use solely for HSDD based on the 36-trial meta-analysis; no equivalent RCT evidence exists for mood, cognition or energy outside that indication. An observational UK study of 510 menopause-clinic patients reported four-month gains in libido, mood and cognition after gel addition, yet lacked randomization or placebo controls and therefore cannot isolate drug effects from expectation or concurrent estrogen therapy. Real-world prescribing therefore rests on extrapolation from sexual-function data and mechanistic plausibility rather than direct trial outcomes.