If closeness with your partner has quietly changed since menopause, you are not imagining it — and wanting that closeness back is neither unusual nor something to apologize for. What follows is a plain look at the hormones behind desire in women, including one marker that conversations about intimacy sometimes skip over.
Desire after menopause is a biology story, not a character flaw
Somewhere around the menopause transition, many women notice two separate things at once: less spontaneous interest in sex, and more physical discomfort with it. These often get lumped together, but they have different mechanisms.
The physical side — dryness, thinning tissue, discomfort — is largely tied to declining estrogen and a cluster of changes providers call the genitourinary syndrome of menopause (GSM)[1]. The desire side is more complex. It involves mood, sleep, relationship context, and a set of hormones that includes not just estrogen but also androgens like testosterone and its precursor DHEA[2].
Wanting to feel close at 56 or 58 is normal. Persistent, distressing low desire even has a clinical name — hypoactive sexual desire disorder — and it is common enough that major medical societies have written formal guidance on evaluating it in women[2].
Source: [1] The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society, [2] Sexual Dysfunction in Women: A Practical Approach (and Endocrine Society clinical guidance on androgen therapy in women)
Estrogen and DHEA are part of the picture — but not the whole picture
When intimacy comes up, the first hormones discussed are usually estrogen (for comfort and tissue health) and sometimes DHEA, an adrenal precursor the body can convert into other sex hormones. Both are legitimate topics for a provider to review.
But testosterone is a hormone in women too, produced by the ovaries and adrenal glands. Women's levels are far lower than men's, yet androgens still play a role in sexual desire, arousal, and overall vitality[2][3]. Testosterone in women declines gradually with age — much of the drop happens across the reproductive years, well before the final period — which is one reason the connection to menopause can be easy to miss[3].
This is the marker that intimacy conversations sometimes overlook: a provider evaluating low desire may consider a woman's androgen status alongside estrogen and thyroid, not in place of them.
What a provider actually reviews before framing intimacy support
There is no single blood test that "diagnoses" low desire, and international guidelines are clear that testosterone should not be used as a standalone diagnostic tool in women[2]. Instead, an independent provider typically builds a fuller picture:
- History and context. Sleep, mood, stress, relationship factors, medications (some antidepressants and blood pressure drugs affect desire), and how much the change is bothering you.
- Estrogen-related symptoms. Dryness, discomfort, and other GSM signs that have their own well-studied local options[1].
- Thyroid and general health. Fatigue and low libido overlap with many conditions.
- Androgen context. Where appropriate, testosterone may be measured — often using a total testosterone level — to help interpret symptoms, while recognizing that assays for the low ranges seen in women are technically difficult and imperfect[2][4].
The Global Consensus Position Statement — endorsed by the Endocrine Society, the International Menopause Society, and others — concluded that the only evidence-based use of testosterone in women is for postmenopausal hypoactive sexual desire disorder, after other causes have been addressed[4]. It also emphasized that a woman's levels should not be pushed above the normal premenopausal female range[4]. That is a careful, balanced position — and exactly the kind of current framing worth expecting from a provider.
relative androgen level · marker = Guideline ceiling
Source: [4] Global Consensus Position Statement on the Use of Testosterone Therapy for Women
The old hormone-scare headlines, revisited
If you stepped away from hormone therapy years ago because of frightening headlines, you are far from alone. Those headlines largely traced to early readings of the Women's Health Initiative in the early 2000s. In the years since, the underlying data have been re-examined in ways that changed the conversation, particularly around a woman's age and how many years past menopause she is when therapy is considered[5].
The North American Menopause Society's current position statement reflects this evolution: for many healthy women who are under 60 or within 10 years of menopause and are bothered by symptoms, the balance of benefits and risks around hormone therapy is generally considered more favorable — while decisions remain individualized based on personal and family history[5]. "Too late" is not a foregone conclusion; it is a conversation to have with a provider who knows the up-to-date science.
None of this means hormones are right for everyone. It means the blanket fear of two decades ago has been replaced by a more nuanced, personalized approach.
Source: [5] The 2022 Hormone Therapy Position Statement of The North American Menopause Society
Safety context worth knowing
Any hormone therapy carries considerations that belong in a provider conversation, not a self-guided decision:
- Testosterone in women is used at much lower amounts than in men, and providers monitor for androgenic effects. There are currently no testosterone products approved by the FDA specifically for use in women in the United States, which is part of why any use is carefully individualized and off-label[2][4].
- Estrogen therapy decisions weigh a woman's history, including whether she still has a uterus (which affects whether a progestogen is also needed) and cardiovascular and breast-health background[5].
- Timing and monitoring matter. Follow-up labs and symptom review are part of responsible care[4].
Compounded medications are not reviewed or approved by the FDA for safety, effectiveness, or quality. Compounded products are not equivalent to or interchangeable with any FDA-approved brand-name drug. Availability varies by state.
What to bring to the conversation
You do not need the perfect vocabulary to start. It is enough to say: *"Since menopause, both my desire and physical comfort have changed, and I'd like to understand my options."* From there, a provider can help separate the comfort question (often estrogen-related) from the desire question (which may involve androgens), and explain what, if anything, fits your health picture. A prescription is never guaranteed — it is a clinical decision made by an independent licensed provider.
This article is educational and is not medical advice. Please talk with a qualified clinician about your individual situation.
Where Velri fits
Velri is a technology and coordination company — it does not provide medical care. What Velri can do is make the path less confusing: coordinating lab work, connecting you with an independent, licensed provider for an evaluation and discussion of your goals, and — only if that provider determines it is appropriate and writes a prescription — coordinating fulfillment through an independent, licensed pharmacy. Care decisions, including whether any hormone therapy is suitable for you, rest entirely with the independent provider. The aim is simply to make it easier to have a modern, judgment-free conversation about closeness and vitality after menopause.
