Key Takeaways
Understanding the role of testosterone for women in overall health can transform menopause treatment outcomes, helping address symptoms that standard HRT often leaves unresolved.
• Testosterone is women's dominant sex hormone by concentration - Women produce 3x more testosterone than estrogen before menopause, making it essential for energy, mood, and sexual function.
• Low libido with fatigue signals potential testosterone deficiency - These symptoms together, especially when standard HRT fails to help, indicate testosterone therapy consideration per NICE guidelines.
• Access depends on your healthcare pathway - NHS requires specialist referral for male gel products, while private clinics offer faster access to AndroFeme cream designed specifically for women.
• Results take 3-6 months with proper monitoring - Sexual function improves within 4-12 weeks, while energy and mood benefits may appear sooner. Regular blood tests ensure safe, effective dosing.
• Safety requires correct female dosing - Women need only 5mg daily versus 60mg for men. Side effects remain minimal when testosterone levels stay within female physiological ranges through proper monitoring.
The key to successful testosterone therapy lies in working with knowledgeable healthcare providers who understand female-specific dosing and can provide appropriate monitoring throughout treatment.
Testosterone for women has seen a surge in medical attention. NHS prescriptions increased approximately 10-fold between November 2015 and November 20221916. This change followed NICE guidelines approving testosterone for low libido menopause treatment in 201519. Testosterone remains an overlooked component of hormone therapy among estrogen and progesterone, despite growing recognition of its role in women's health. This piece explores why testosterone matters for women during menopause and how to access testosterone HRT women's treatments. We examine what products like testosterone gel women can use and the evidence supporting its benefits for symptoms beyond sexual function.
What Is Testosterone for Women and Why Is It Needed?
Testosterone production in women
Women's bodies manufacture testosterone through multiple pathways. One quarter comes from the ovaries, another quarter from the adrenal glands located atop each kidney, and half is produced in peripheral tissues from precursors made by the ovaries and adrenal glands20. The ovaries convert androstenedione (the main precursor) into testosterone, while the adrenal glands contribute through DHEA and DHEA-S precursors20.
This production system is different from men's testosterone manufacturing. Women produce about 1/10th to 1/20th of the testosterone levels found in men's bodies2. Normal testosterone levels in women range from 15 to 70 nanograms per deciliter (ng/dL) of blood2. The ovaries continue producing testosterone even after menopause. Research shows that postmenopausal women who had both ovaries removed had lower blood testosterone levels than those with at least one ovary intact21.
Testosterone serves multiple functions beyond sexual health. The hormone supports bone density and muscle mass, cognitive function, mood regulation, energy levels, and vitality overall22. These roles make adequate testosterone levels necessary for maintaining musculoskeletal health and potentially supporting vascular and brain function22.
How testosterone differs from estrogen
A common misconception places estrogen as the dominant sex hormone in women. Women produce three times as much testosterone as estrogen before menopause when measured by concentration22. The confusion arises from measurement units. Oestradiol (the main estrogen form) is measured in picomoles per liter (pmol/L), while testosterone appears in nanomoles per liter (nmol/L)23.
When we convert both hormones into similar units, the actual picture reveals itself. Before menopause, testosterone averages around 1600 pmol/L compared to oestradiol's 400 pmol/L23. After menopause, testosterone averages about 600 pmol/L while oestradiol drops to about 100 pmol/L23. Testosterone remains the predominant sex hormone in women by concentration both before and after menopause23.
The hormones serve distinct physiological purposes. Testosterone influences sexual desire and arousal, energy and vitality, mood and emotional wellbeing, cognition (including memory and concentration), plus muscle and bone strength23. Estrogen regulates reproductive function and bone health through density maintenance, and manages symptoms like hot flushes during HRT menopause treatment. Both hormones work together, but optimal ovarian function requires a balance between estrogen, testosterone, and other androgens4.
Natural decline with age
Research challenges the assumption that testosterone drops at menopause. Studies of 1,400 women showed testosterone blood levels did not change at menopause but declined from about age 2021. Researchers found no measurable differences between premenopausal, perimenopausal, or postmenopausal women when they used gold-standard measurement methods21.
The decline follows a predictable age pattern. Between ages 18 and 39 years, testosterone levels decrease by around 25%21. Levels decline by another 25% on average from 40 to 58-59 years21. Testosterone levels tend to decrease by around 50% from about age 20 through to about age 6021. Testosterone blood levels increase from age 58-59 years, with this upward trend continuing into the eighth and ninth decades of life21.
Surgical menopause creates a different scenario. Women who have their ovaries removed experience around 50% of testosterone production lost overnight23, which can affect wellbeing, energy levels, and libido. This abrupt change is different from the age-related decline experienced during natural menopause. By the time someone reaches menopause, their testosterone levels may have decreased by half of what they once were24.
Signs you might need testosterone therapy
Recognizing low testosterone symptoms proves challenging because many signs overlap with other menopause-related changes. Women often attribute fatigue or mood shifts to aging or stress and miss the hormonal component. Several specific patterns point toward testosterone deficiency that may benefit from treatment.
Low libido and sexual dysfunction
Sexual dysfunction represents the most recognized symptom of low testosterone in women. One in three women struggle with low sexual desire, with most patients noticing changes after menopause25. The symptoms extend beyond wanting sex less often. Affected women report decreased sexual thoughts or fantasies, reduced pleasure during intimacy, difficulty reaching orgasm, and diminished response to erotic cues from partners26.
Hypoactive Sexual Desire Disorder (HSDD) affects about 10% of women in the United States27. This condition involves persistent lack of interest in sex lasting more than six months and causes distress or relationship problems16. Around 73% of women diagnosed with HSDD also meet criteria for Sexual Interest-Arousal Disorder (SIAD)28. The difference matters because not every woman with reduced libido needs testosterone. Some women experience natural phases of lower interest without distress. Treatment becomes relevant when the lack of desire persists, causes personal distress, or impacts relationships and self-esteem16.
Women who undergo surgical menopause face particular risk for sexual dysfunction. The abrupt loss of ovarian testosterone production can trigger immediate changes in sexual response. Taking oral estrogen therapy can reduce testosterone production and worsen libido issues during menopause29. Other medical conditions like diabetes and heart disease can also cause low libido, making proper evaluation essential30.
Fatigue and low energy levels
Low energy levels rank among the most common yet overlooked testosterone deficiency symptoms. Women describe persistent physical fatigue that is different from normal tiredness. This exhaustion doesn't improve with rest and can impact daily functioning by a lot16. The fatigue often accompanies reduced stamina and decreased motivation to do activities that were once enjoyable31.
Energy depletion from low testosterone is different from typical menopause fatigue patterns. Women taking estrogen-only HRT for menopause may still experience profound tiredness if testosterone remains deficient. Studies show testosterone replacement can improve energy and stamina in affected women16. The lack of energy often intertwines with other symptoms and makes it difficult to attribute to testosterone levels alone.
Mood changes and brain fog
Testosterone influences mood and emotional wellbeing in ways many women don't recognize. Low levels can trigger anxiety, depression, irritability, and mood swings1632. Women may experience anxiety or panic attacks for the first time during perimenopause, often unaware of the hormonal connection33. Depression can emerge without previous history and comes with increased irritability and emotional instability31.
Cognitive difficulties represent another subtle but meaningful symptom. Women describe brain fog as difficulty concentrating, memory problems, and trouble with tasks requiring focus27. These changes affect day-to-day function, multitasking ability, and recall of simple information like names33. Research suggests testosterone may help protect the brain from cognitive decline, though cognitive symptoms remain less common than sexual or mood changes27.
Audit data reveals that mood and anxiety symptoms often improve more with testosterone than libido issues do. About 56% of women reported improvement in 'loss of interest in most things', while 55% saw improvement in crying spells, and 52% experienced better interest in sex16. These findings suggest testosterone's impact extends well beyond sexual function.
Muscle weakness and bone health concerns
Physical strength and musculoskeletal health depend in part on adequate testosterone levels. Women with low testosterone often notice muscle weakness, reduced muscle mass, and decreased physical strength2429. This decline can affect daily activities and increase injury risk. Maintaining muscle strength becomes harder despite exercise efforts.
Bone health concerns present a more serious long-term risk. Research exploring 2,198 females aged 40-60 years found positive associations between testosterone levels and lumbar bone mineral density34. Lower testosterone may accelerate bone loss during the transition to menopause and increase osteoporosis risk34. The mechanism involves testosterone's direct effects on bone cells and inhibits bone breakdown while promoting bone formation34.
Additional symptoms of low testosterone include dry or brittle skin, thinning hair, trouble sleeping, and irregular menstrual cycles2430. Blood tests remain the only definitive way to diagnose low testosterone. Values under 25 ng/dL in women younger than 50, or under 20 ng/dL in women 50 and older, indicate deficiency29. A low testosterone level alone doesn't mean replacement therapy is needed. Treatment requires both low levels and symptoms affecting quality of life16.
Women experiencing any combination of these symptoms should discuss concerns with a menopause specialist or healthcare provider. Many symptoms get misdiagnosed or attributed to mental health issues rather than hormonal causes27. Proper evaluation through NHS menopause services or private clinics can identify whether testosterone deficiency contributes to the problem.
How testosterone helps menopause symptoms
Evidence supports testosterone's role in addressing specific menopause symptoms, especially when standard HRT menopause proves insufficient. Research demonstrates benefits across sexual function, energy levels, cognitive performance, and musculoskeletal health, though the strength of evidence varies by symptom category.
Evidence for low libido menopause treatment
Sexual function represents the most researched benefit of testosterone HRT women treatments. NICE guidelines permit testosterone consideration for menopausal women with low sexual desire when standard HRT fails to improve symptoms22. The British Menopause Society extends this indication to include women with both low sexual desire and tiredness22.
Clinical trials show testosterone supplementation improved several domains of sexual response, including desire, pleasure, arousal, orgasm, and self-image in postmenopausal women22. A study of 510 women already using HRT found 52% reported improvement in libido after four months of transdermal testosterone treatment35. More, the frequency of satisfying sexual encounters increased compared to placebo in multiple randomized controlled trials3637.
Women who went through surgical menopause may benefit from testosterone therapy due to the abrupt 50% loss in production. Studies examining women with hypoactive sexual desire disorder found testosterone patches delivering 300 μg daily increased satisfying sexual events36. Recognized benefits included improved sexual desire, arousal, orgasm, and pleasure, together with reduced concerns and distress about sex22.
Effect on energy and vitality
Testosterone addresses fatigue that persists despite adequate estrogen replacement. The same study of 510 women found that feeling tired or lacking energy ranked as the most prevalent cognitive symptom, reported by 92% of participants at baseline35. British Menopause Society recommendations advise considering testosterone for menopausal women with low sexual desire and tiredness22.
Many women notice testosterone improves their mood, concentration, motivation, and energy levels22. Results may appear within days for some women due to individual variation, though it can sometimes take several weeks or even months to notice beneficial effects22. Menopause specialists prescribe testosterone in three-month amounts, with monitoring blood tests scheduled after that period5.
Cognitive function improvements
Research reveals cognitive benefits beyond sexual function. The 510-woman study found 39% reported improvement in cognition after four months of testosterone therapy, with mean symptom scores decreasing by 22%35. Memory problems, reported by 91% of women at baseline, showed measurable improvement35.
Mood symptoms responded even better than cognitive issues. 47% of women reported mood improvement compared to 39% for cognition35. The symptoms most likely to improve were loss of interest in most things (56% improvement), crying spells (55%), and loss of interest in sex (52%)3516. Testosterone strengthens nerves in the brain and contributes to mental sharpness and clarity3839.
Effects on muscle and bone strength
Bone health benefits emerge from testosterone's direct action on bone cells. Research examining females aged 40-60 found higher serum testosterone levels associated with higher lumbar bone mineral density up to levels of 30 ng/dL40. Testosterone influences bone via androgen receptors and through conversion to estrogen after aromatization40.
Treatment with both testosterone and estradiol proves more effective in increasing bone mineral density than estradiol alone in menopausal women41. Testosterone promotes bone formation through direct action on osteoblasts while inhibiting bone breakdown4042. On top of that, adequate testosterone supports muscle mass, strength, and reduces frailty risk in later life43. Women seeking these benefits should consult NHS menopause services or private menopause clinics for proper evaluation and monitoring.
Getting testosterone: NHS vs private access
NICE guidelines and NHS availability
NICE guidelines published in 2015 recommend testosterone supplementation for menopausal women with low sexual desire when HRT menopause alone proves ineffective44. The approval follows specific criteria: women must already be taking systemic estrogen replacement, have persistent low libido causing distress, and show no other identifiable physical or psychosocial causes for sexual dysfunction45.
This endorsement faces most important implementation barriers in NHS menopause services. Testosterone gel can be prescribed on NHS for off-license use, though the cream formulation remains available only through private channels46. Most areas require specialist initiation before GPs will prescribe. Women must first see a consultant endocrinologist, gynecologist, or GP with special interest in menopause145. Some regions permit primary care initiation following specialist recommendation through advice and guidance systems45.
Why access remains limited
No testosterone products hold UK marketing authorization for use in women4511. All prescriptions involve off-license use of male products adapted to female doses. This unlicensed status creates hesitancy among healthcare providers46. The lack of regulatory approval doesn't indicate safety concerns but reflects that manufacturers haven't conducted the required clinical trials for women with menopausal symptoms46.
So few GPs feel confident prescribing testosterone gel women formulations without specialist guidance47. The prescriber assumes full responsibility for the decision and requires informed consent documentation45. Women seeking testosterone HRT women treatments through NHS pathways often face lengthy waits for menopause specialist UK appointments before accessing prescriptions.
Private prescription costs
Private menopause clinic services offer faster access to testosterone therapy. Tostran testosterone gel costs £50-60 for a 60g tube lasting about six months48. AndroFeme testosterone cream, the only product formulated for women, costs £90-100 for a 50g tube lasting three to four months4849. AndroFeme requires private prescription as it's not available through NHS and must be imported from Western Australia under special MHRA license1.
Medication costs get paid directly to pharmacies, separate from consultation fees48. All prescribing follows British Menopause Society and NICE guidelines to ensure evidence-based treatment48.
The two-tier system problem
Access disparities create a troubling inequality. Women who can afford private menopause clinic appointments receive testosterone with ease, especially when they seek AndroFeme cream designed for female physiology. Women relying on NHS face regional variation in access, mandatory specialist referrals in most areas, and restriction to male gel products1. This two-tier system means treatment availability depends on financial resources rather than clinical need, despite NICE endorsement of testosterone for low libido menopause symptoms.
Testosterone HRT women: products and dosing
Women now have several testosterone formulations available, though product choice depends largely on whether treatment comes through NHS menopause services or private menopause clinic channels. Dosing becomes critical to understand because most products weren't designed for female physiology.
AndroFeme cream for women
AndroFeme represents the first testosterone cream created specifically for women and approved by the UK regulator MHRA6. The UK became the fourth country to license AndroFeme after Australia, New Zealand, and South Africa where it's known as TestaFeme6. The product contains 1% testosterone cream in a 50ml tube and is body identical. This means it mirrors testosterone that ovaries produce612.
AndroFeme became licensed in August 2025. The UK-approved version became available in 20266[212]. The cream comes with a supplied syringe for accurate dosing. Doses begin at 2.5mg testosterone daily (0.5ml) and progress to the most common 5mg daily dose if needed7[212]. Higher doses of 7.5mg or 10mg daily exist but require close monitoring7.
Testosterone gel women options
Testosterone gel women formulations licensed for men include Testogel and Tostran. Testogel comes in 2.5g sachets that contain 40.5mg testosterone128. Women apply a pea-sized amount daily, with one sachet lasting around 8 days121314. The sachet requires sealing with a clip between uses and needs refrigeration13.
Tostran arrives as a 2% gel in a pump dispenser. One measured pump delivers 10mg testosterone12[213]. Women apply half a pump daily or one full pump on alternate days1[241]. Each 60g canister lasts about 240 days111.
Male products adapted for women
Female testosterone replacement requires about 5mg daily. This starkly differs from male hypogonadism doses of 60mg15. Therefore, women must split male formulations into much smaller amounts. Testogel sachets get divided into roughly eight doses12[213], while Tostran users apply half-pump measures12.
Women can apply the gel to upper outer thigh, lower abdomen, or outer arms on clean, dry skin12[213]1. Rotation prevents hair growth at application sites12[213]. The gel must dry for about 10 minutes before dressing. No washing should occur for 2-3 hours to ensure absorption13[214][241]. Women must wash hands right after application and avoid skin contact with partners or children until the application site gets washed13[231].
Safe dosing guidelines
Blood tests should occur before starting testosterone HRT women treatment, then 2-3 months after initiation and annual monitoring follows115. Treatment requires a 3-6 month trial period before you can assess effectiveness8[241]. Women should omit their testosterone dose before blood testing to avoid results that are falsely elevated1. If testosterone levels exceed 1.5 nmol/L, dose frequency should reduce to twice weekly1.
Safety, side effects, and what to expect
Common side effects to watch for
Testosterone is safe and effective when prescribed at correct low doses for women5. Most women experience no side effects because testosterone HRT women treatments merely replace deficient hormones16. Side effects, when they occur, link to dosage and remain mild, dose-dependent, and reversible3.
Skin reactions at the application site rank as the most frequent concern and affect about 10% of users3. Increased body hair growth at the gel or cream application site occurs on occasion9. You can manage this by spreading the product more thinly and varying application locations9. Some women report greasy skin or acne93. These common effects resolve without stopping treatment in most cases.
Uncommon side effects include generalized hirsutism (thicker body hair beyond the application site) and male pattern hair loss9. Rare but serious side effects involve voice deepening and clitoral enlargement, both potentially irreversible911. These risks remain minimal when testosterone levels stay within the female physiological range through proper monitoring1.
Women more sensitive to physiological androgen levels may experience symptoms despite normal blood results11. So clinical assessment of potential adverse effects is just as important as laboratory monitoring11. Anyone experiencing severe HRT side effects should contact their menopause specialist UK for guidance3.
How long before results appear
Response timelines vary between individuals. Sexual function improvements, if they occur, emerge within four weeks and reach maximum effect around 12 weeks10. Some women notice benefits within days, while others require patience as effects sometimes take several weeks or months516.
Energy and [fatigue menopause](https://goldmanlaboratories.com/blogs/blog/menopause-vs-[perimenopause](https://goldmanlaboratories.com/fr/blogs/blog/perimenopause) symptoms may improve earlier than sexual concerns. Mood and brain fog changes often respond within the first few months. It can take more than four weeks to notice improvement in symptoms9.
Most doctors prescribe testosterone in three-month amounts for the original assessment5. The British Menopause Society advises that response may not be immediate and can take 8-12 weeks in some instances for effects to become significant3. Treatment should be trialed for a minimum of three months and a maximum of six months before discontinuation due to lack of efficacy3.
Blood tests at three months help determine whether treatment works5. Many women feel benefits more quickly, but every person responds differently5. Patience is essential for those not experiencing rapid improvements. Full effects of testosterone, whether using cream, gel, or implant, can sometimes require a few months to demonstrate fully16.
When to stop or adjust treatment
Treatment discontinuation becomes appropriate when no improvement appears after six months171. Therapy should stop at this point if symptoms remain unchanged, and other causes for sexual problems should be explored10.
Doctors may suggest increasing testosterone dosage after three months if symptoms persist and blood results permit9. Conversely, if total testosterone levels exceed 1.5 nmol/L after starting treatment, dose frequency should reduce to twice weekly with levels rechecked after three months1.
Specific adverse effects require immediate action. Total testosterone levels above the upper limit of normal necessitate ensuring appropriate usage, reducing dosage, or stopping treatment11. Generalized hirsutism, alopecia, acne, voice deepening, or enlarged clitoris all warrant the same approach: confirm proper usage, reduce dose, or discontinue11.
Increased hair growth at application sites gets managed less drastically by spreading gel more thinly, varying application sites, or reducing dosage11. Women can reduce or stop testosterone without significant issues17. Those wishing to wean off HRT menopause entirely should reduce and stop testosterone first before discontinuing estrogen17.
Testosterone continues as long as women remain on estrogen replacement therapy3. It gets used alongside types of HRT rather than alone, with standalone use requiring specialist recommendation only3. Women can restart treatment if symptoms return after stopping18.
Blood tests and monitoring
Baseline blood tests before starting testosterone replacement should include total testosterone, SHBG (sex hormone-binding globulin), and FAI (Free Androgen Index)3[271]. These establish reference points for future monitoring and ensure levels aren't already in the upper range before treatment commences1110.
A low FAI below 2.0% in women with symptoms of low sexual desire supports testosterone supplementation use3. Women with SHBG levels above 160 nmol/L are unlikely to benefit from therapy3. Healthcare providers should check baseline levels before starting to ensure they're not already high10.
Follow-up testing occurs 2-3 months after starting treatment1[282]5. The "HRT Monitoring" blood test set (FSH, E2, total testosterone, SHBG) gets recommended at this stage to assess hormone balance3. Results allow doctors to verify appropriate absorption and that testosterone isn't excessive9.
Blood samples should be taken before applying testosterone gel, with the opposite arm used if applying treatment to the arm9. Women should omit their testosterone dose before blood testing to avoid falsely elevated results1[271].
Repeat estimation at the three-month follow-up demonstrates whether levels have increased appropriately3. The goal involves maintaining total testosterone within the normal physiological range for women using the laboratory reference range where testing occurs11. The premenopausal range should be used as the treatment goal when laboratories report pre- and postmenopausal adult female reference ranges11.
The Free Androgen Index should remain below 5% to minimize side effects9. Some laboratories target 4-9% as the acceptable range3. Monitoring values within the female physiological range, less than 3-6%, makes androgenic side effects less likely3.
Annual blood monitoring follows the original three-month check to screen for overuse and continued treatment appropriateness3[272]. Monitoring should occur more often if concerns arise about adverse effects or overuse11. Women need treatment for a few years, until most what is menopause symptoms pass18.
Reviews with the prescribing doctor or nurse include checking that symptoms remain controlled, asking about side effects and vaginal bleeding, monitoring weight and blood pressure, and reviewing the type of HRT with necessary changes18. Women receiving care through private menopause clinic services or NHS menopause services follow similar monitoring protocols to ensure safe, effective treatment.
Despite the unlicensed status of testosterone for women, long-term use of safely prescribed testosterone replacement shows no association with adverse health risks and is beneficial for muscle, bone, cardiovascular, and brain health16. Women should be made aware before starting treatment of the lack of long-term clinical trial safety data beyond 24 months3.
Conclusion
Testosterone represents a vital yet underused component of menopause treatment for women experiencing persistent low libido, fatigue, and mood changes despite standard HRT. Access remains unequal between NHS and private pathways, but the evidence supporting its benefits continues to strengthen. Women experiencing symptoms that affect their quality of life should discuss testosterone therapy with their healthcare provider. Treatment proves both safe and effective when it follows proper dosing guidelines and regular monitoring. Making an informed choice about testosterone supplementation requires understanding the available options and realistic timelines for results. It also demands commitment to appropriate medical oversight throughout treatment.
FAQs
Q1. Is testosterone therapy recommended for women going through menopause? Testosterone therapy may be beneficial for menopausal women experiencing specific symptoms such as persistent low sexual desire, fatigue, mood changes, and reduced energy levels that haven't improved with standard hormone replacement therapy. The British Menopause Society recommends considering testosterone for women with low libido and tiredness. It also supports bone density, muscle mass, cognitive function, and overall wellbeing when prescribed appropriately.
Q2. Can testosterone be used alone to treat menopause symptoms? Testosterone is typically not recommended as a standalone treatment for menopause symptoms. It's usually prescribed alongside estrogen replacement therapy rather than on its own. Women should only use testosterone alone if specifically recommended by a specialist, as it works best when combined with other hormone therapies to address the full range of menopausal changes.
Q3. What are natural ways to support testosterone levels during menopause? Lifestyle strategies can help support healthy testosterone levels, including managing stress effectively, getting adequate quality sleep, maintaining a balanced diet rich in nutrients, and considering DHEA supplements after consulting with a healthcare provider. However, these approaches may not be sufficient for women with significantly low testosterone levels who are experiencing distressing symptoms.
Q4. What forms of testosterone treatment are available for menopausal women? The most common testosterone treatments for menopausal women include transdermal gels (such as Tostran and Testogel) and testosterone cream (AndroFeme). These topical applications allow for precise dosing and safer administration compared to other methods. AndroFeme is the only product specifically formulated for women, while the gels are male products adapted to lower female doses.
Q5. How long does it take to see results from testosterone therapy? Response times vary between individuals. Some women notice improvements in energy and mood within days to weeks, while sexual function improvements typically emerge within 4 weeks and reach maximum effect around 12 weeks. A minimum trial period of 3-6 months is recommended before determining whether the treatment is effective, as full benefits can sometimes take several months to manifest.
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