Low libido in women: is testosterone really the missing piece?

What did @nadia_bokody actually say?

Bokody, who identifies as an intimacy coach, argues that women in low-sex relationships are wrong to blame their bodies. Her central claim: arousal in women has "very little whatsoever to do with your hormones, your body or your genitals" and "almost everything to do with your brain." She extends this even to menopausal women and those on antidepressants, saying she has watched both groups go from convinced they had no libido to "not being able to keep their hands off their partner." The fix, in her telling, is a partner who makes a woman feel "truly seen, heard and wanted."

The brain-first framing is not invented. It draws loosely on real sex research, particularly Emily Nagoski's work on responsive desire. But Bokody takes that framework and runs it so far past the evidence that the original science would barely recognize it.

Does the science back this up?

Partly, but the parts she overstates are the most medically significant ones. The brain matters enormously for female sexual desire. That is well established. What is not established is that hormones are nearly irrelevant.

Testosterone is the most studied androgen in female sexual function, and the evidence is not ambiguous. A 2019 systematic review and meta-analysis by Davis et al. in The Lancet Diabetes and Endocrinology analyzed 36 randomized controlled trials and found that testosterone therapy significantly improved sexual function in women, including desire, arousal, and frequency of satisfying sexual events. Low estrogen after menopause causes genitourinary syndrome, which directly impairs arousal through physical tissue changes, not through emotional disconnection. Saying hormones have "very little" to do with female arousal contradicts a substantial body of peer-reviewed evidence.

The responsive desire model she references, described by Nagoski in Come As You Are and grounded in work by Basson (2001, Journal of Sex and Marital Therapy), does show that many women experience desire after, not before, sexual context. But even Basson's model does not claim hormones are irrelevant. It accounts for biological factors as one of several inputs.

What did they get wrong (or right)?

She got the relational piece meaningfully right. Feeling emotionally safe, seen, and wanted does affect female desire. This is not pop psychology. Brotto et al. (2016, Journal of Sexual Medicine) found that mindfulness-based interventions targeting attention and psychological safety significantly improved desire and arousal in women with sexual dysfunction. Relationship quality predicts sexual satisfaction across multiple studies. Bokody is correct that many men do not understand how context shapes female desire, and that point deserves credit.

Where she goes badly wrong is in the sweep of the dismissal. Telling menopausal women that their hormones are not the issue is clinically reckless. Menopause involves a dramatic drop in estrogen and testosterone. Genitourinary syndrome of menopause affects roughly 50 percent of postmenopausal women (Portman and Gass, 2014, Menopause) and causes physical changes that make arousal and intercourse genuinely painful or difficult regardless of emotional context. Similarly, SSRIs and SNRIs cause sexual dysfunction through direct pharmacological mechanisms, including delayed orgasm and blunted arousal, not simply because a partner is failing to engage a woman's brain. Coaching cannot reverse serotonin reuptake inhibition.

• Testosterone therapy has Level 1 evidence for improving female sexual desire (Davis et al., 2019, Lancet Diabetes and Endocrinology).
• Menopause-related physical changes are not purely contextual problems.
• Antidepressant sexual side effects have biological mechanisms coaching cannot override.

What should you actually know?

Female sexual desire is genuinely complex, and the brain-body split Bokody draws is a false one. Real clinicians treat both. If your desire has changed, the causes worth ruling out include low testosterone, low estrogen, thyroid dysfunction, medication side effects, depression itself (separate from its treatment), and chronic pain conditions. None of those require you to accept that your relationship is broken or your partner is failing you.

Responsive desire is real and worth knowing about. Many women do not experience spontaneous desire the way it is depicted in media, and that is not pathology. But responsive desire still requires a body that can respond. A woman with untreated genitourinary syndrome, low testosterone, or medication-induced anorgasmia is not going to "not be able to keep her hands off her partner" because her partner started listening better.

The claim that coaching alone reversed low libido even in menopausal and medicated women is unverifiable from a single coach's anecdotal caseload. That is not data. If low desire is affecting your life, a conversation with a clinician who can actually measure your hormone levels and review your medications is a more defensible starting point than assuming the problem is your partner's emotional attunement.