I’m on Fire: How Testosterone Became Women’s Midlife Revival

Wednesday, October 22, 2025.

When The New York Times ran Susan Dominus’s feature “‘I’m on Fire’: Testosterone Is Giving Women Back Their Sex Drive — and Then Some,” readers could practically hear the collective exhale.

Women everywhere nodded along: the exhaustion, the flatline libido, the polite marital drift. Then came the whisper — or maybe the rallying cry — testosterone!

In Dominus’s piece, women described feeling “alive again.”

Not metaphorically — hormonally.

They talked faster. They had ideas. They wanted sex. They wanted an enhanced sense of life.

And they were quite willing to risk a hair or two of peach fuzz for it.

The irony is that this isn’t at all new.

As early as the 1930s, researchers like Fred Koch were extracting testosterone from bull testicles and noting its striking effects on vigor and mood — in both sexes.

By the 1940s, physicians were experimenting with testosterone therapy for women with fatigue or “frigidity.”

Then came the estrogen revolution.

The 1960s turned “hormone replacement therapy” into the shiny object of women’s medicine.

Testosterone quietly left the conversation, collateral damage of the Women’s Health Initiative panic decades later. No pharmaceutical company wanted the liability of putting testosterone in a pink box again.

Now, in the age of telehealth and bioidentical medicine, testosterone is back — reborn as a midlife revivalist!

The Science (and the Caveats)

Here’s the key fact most of these TikTok “hormone optimization” influencers omit: there’s no FDA-approved testosterone product for women.

Every current prescription is off-label — typically borrowed from male formulations and delicately adjusted.

The FDA explicitly warns that no product has passed safety and efficacy trials for female use.

That said, the evidence is surprisingly strong for one thing: treating Hypoactive Sexual Desire Disorder (HSDD) in postmenopausal women.

A global consensus statement in The Journal of Clinical Endocrinology & Metabolism (Davis et al., 2019) reviewed over 35 randomized trials and found that physiologic-dose testosterone can safely improve sexual desire, arousal, and satisfaction.

Similarly, the International Society for the Study of Women’s Sexual Health (ISSWSH) guideline (Parish et al., 2021) recommends testosterone as a second-line therapeutic after psychosocial and relationship factors have been addressed — which, as a therapist, is the part that interests me most.

Feeling Alive or Just Feeling?

In my office, a few women have described testosterone’s effects on them in two domains.

There’s the physical one: energy, clarity, libido — the spark that once felt so acutely missing.
Then there’s the emotional one: permission. A reclamation of agency over desire, long buried under caretaking and fatigue.

Testosterone, in that sense, becomes more than a hormone; it’s a symbol of vitality and self-ownership. But like all symbols, it can get mythologized.

As one study on transdermal testosterone therapy and mood (Ping et al., 2024) noted, improved mood may stem as much from increased self-efficacy as from hormonal modulation itself.

And that matters — because no amount of gel or pellet can compensate for emotional neglect, loneliness, or a partner who’s tuned out.

The Cultural Overdrive

What fascinates me as a therapist is how quickly testosterone has moved from taboo to trend.

In the 1990s, “male menopause” jokes were cocktail chatter; now, “female testosterone” is a movement. Instagram clinics promise “optimized womanhood.” Influencers talk about “getting their edge back.”

We’ve entered the era of hormonal hustle — where feeling tired is pathology, and every mood has a molecule to fix it.

But when women say, “I feel like myself again,” it’s not just about libido. It’s about visibility.

After years of invisibility — in their homes, in the workplace, even in the mirror — testosterone feels like a rebellion against fading quietly.

The Relationship Shift

Here’s what I see in couples therapy: a woman starts testosterone and suddenly feels revived and vitalized.

Her partner, often bewildered, wonders where this version of her has been hiding. Sometimes it reignites connection; sometimes it begins to reveal just how long they’ve been on autopilot.

Desire is relational chemistry — not just endocrine.

When one partner’s internal thermostat turns up, the other must learn to adjust to the new climate. Testosterone may light the fire, but emotional fluency keeps it burning.

So before you sign up for pellets or creams, ask the larger question: What, or whom, am I trying to feel alive for?

A Word on Safety (and Sanity)

The research consensus is clear: when testosterone is kept within female physiologic range, adverse effects are mild — sometimes acne, hair growth, or voice changes.

But push into “bodybuilder doses” or compounded potions of unknown purity, and you’re in the Wild West of endocrinology.

The British Menopause Society warns clinicians to avoid compounded testosterone creams and monitor blood levels regularly. The Mayo Clinic offers a simple truth: more isn’t better — balance is.

Therapist’s Takeaway

In therapy, testosterone often becomes shorthand for midlife transition. It’s not just about sex — it’s about vitality, attention, ambition, and reclaiming emotional bandwidth.

When I’ve worked with couples where one partner begins testosterone therapy, we talk about emergence — the shock and delight of rediscovering self-sovereignty.

The emotional system of a life-partnership has to expand to make room for this new energy.

It’s sorta like chemistry meeting consciousness in an abrupt and sometimes startling way.

Final thoughts

If you’re curious about testosterone, start with your physician — and your own reflections. Know precisely why you want it.

Then talk to your partner, not as patient and observer, but as co-conspirators in rediscovery .

And if you find that you’re both navigating this midlife shift — in body, desire, or relationship — you can reach out here to start a conversation with me on how to make the most of it.

Be Well, Stay Kind, and Godspeed.

REFERENCES:

Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Islam, R. M., & Parish, S. J. (2019). Global consensus position statement on the use of testosterone therapy for women. The Journal of Clinical Endocrinology & Metabolism, 104(10), 4660–4666.

Parish, S. J., Simon, J. A., Davis, S. R., Giraldi, A., Goldstein, I., & et al. (2021). ISSWSH clinical practice guideline for the use of systemic testosterone for HSDD in women. The Journal of Sexual Medicine, 18(5), 849–867.

Ping, Q., et al. (2024). Effect of transdermal testosterone therapy on mood and cognitive symptoms in perimenopausal and postmenopausal women. Archives of Women’s Mental Health.

British Menopause Society. (2022, December). Testosterone replacement in menopause: Tools for clinicians.

Mayo Clinic. (n.d.). Testosterone therapy in women: Does it boost sex drive?.

U.S. Food and Drug Administration. (2025, February 28). Testosterone information.

Islam, R. M., Bell, R. J., Green, S., Page, M. J., & Davis, S. R. (2019). Safety and efficacy of testosterone for women: A systematic review and meta-analysis. Menopause, 26(9), 1069–1083.

Dominus, S. (2025, October 14). “I’m on Fire”: Testosterone Is Giving Women Back Their Sex Drive — and Then Some. The New York Times.

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