Does low libido in women always come down to hormones?

What did @dr.allen.hormones actually say?

Dr. Allen laid out a specific hormonal decline sequence in women: testosterone drops first, especially after a second delivery, then progesterone goes low, and estrogen is "the last one." He also tied low libido directly to the combination of high estrogen, low progesterone, and low testosterone, saying that's when women have "no desire for intimacy." He framed testosterone as the hormone behind energy, fat loss, collagen, and recovery. The caption frames all of this as a reframe for women who think relationship problems are causing low sex drive. That's actually a reasonable clinical instinct. The specific hormonal sequencing claims are where things get more complicated.

Does the science back this up?

Partially, but the confident sequencing is not well-supported by evidence. The claim that testosterone is universally the first hormone to decline in women after childbirth oversimplifies a genuinely complex picture. Postpartum hormonal shifts are dominated by the rapid fall of estrogen and progesterone after delivery, not testosterone. Studies like Davis et al. (2005, Journal of Clinical Endocrinology and Metabolism) confirmed that testosterone does play a role in female sexual function, but its decline pattern varies widely by age, reproductive stage, and individual physiology. The idea of a neat, predictable sequence, testosterone first, then progesterone, then estrogen, reflects clinical pattern recognition more than established endocrinology. That's not nothing, but it's not the same as peer-reviewed consensus. On the libido question, the evidence is stronger. Wierman et al. (2014, Journal of Clinical Endocrinology and Metabolism) reviewed the literature and found some evidence linking low testosterone to decreased sexual desire in women, though the effect size and causality remain debated.

What did they get wrong (or right)?

Let's give credit where it's due. The core message, that low libido in women often has a hormonal basis and isn't purely psychological or relational, is supported by research. Braunstein et al. (2005, NEJM) demonstrated that transdermal testosterone improved sexual function in surgically menopausal women. That's real. But the framing of testosterone as "the first hormone to go low" after a second delivery is stated as clinical fact when it's actually a clinical impression. Postpartum, prolactin surges and estrogen bottoms out. Testosterone in the postpartum period is complicated by lactation, sleep deprivation, and HPA axis stress, and it doesn't follow a clean decline rule. The claim that "when estrogen's high, progesterone's low and testosterone" drives no desire is also an oversimplification. Relative hormone ratios matter, but the research on libido involves dopaminergic pathways, relationship context, and mental health, not just three hormone levels. Reducing it to that formula is too tidy.

What should you actually know?

If you're experiencing low libido, fatigue, or other symptoms that feel hormonal, the honest answer is that hormones are worth checking, but no provider can tell you in advance which one will be low. Female hormonal physiology doesn't follow a universal script. A proper workup should include free and total testosterone, estradiol, progesterone (timed to cycle phase if premenopausal), FSH, LH, prolactin, and thyroid function. Interpreting those results requires clinical judgment, not a predetermined decline sequence. For women in perimenopause or menopause, the evidence for testosterone therapy improving sexual desire is reasonably solid, though the FDA has not approved any testosterone product specifically for women in the US. That's a real regulatory gap, not a conspiracy. Any provider offering hormone therapy should be working from your actual lab values, not a one-size-fits-all narrative about which hormone falls first. Symptoms matter, but so does the data.