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Clinical practice guidelines based on the most comprehensive meta-analysis of benefits and risks of testosterone therapy to date state that the sole evidence-based indication for testosterone therapy is hypoactive sexual desire disorder (HSDD) in postmenopausal women. Transdermal therapy provides the most physiologic form of replacement, thus, transdermal testosterone is recommended for postmenopausal women with HSDD.Testosterone is an important evidence-based therapy for hypoactive sexual desire disorder (HSDD) in postmenopausal women. Clinical practice guidelines based on the most comprehensive meta-analysis of benefits and risks of testosterone therapy to date state that the sole evidence-based indication for testosterone therapy is HSDD in postmenopausal women. The guidelines also provide recommendations regarding identification of patients, dosing, monitoring, and follow-up. This Practice Pearlwill discuss evidence-based testosterone therapy for management of HSDD in postmenopausal women.