What is testosterone in women?
Testosterone is often called a “male hormone”, but women make it too – in fact, it is the most abundant active sex hormone in women, just at lower levels than in men. It is produced mainly by the ovaries and adrenal glands.
In women, testosterone helps support sexual desire and arousal, energy and motivation, mood, cognitive function (focus, concentration) and muscle and bone health, alongside oestrogen and progesterone.
Why might testosterone be used in menopause?
Testosterone levels gradually decline with age and can fall more abruptly after surgical menopause (removal of the ovaries) or some cancer treatments. This drop can contribute to reduced sexual desire and enjoyment for some women.
In menopause care, testosterone is considered an “add‑on” treatment for selected women whose main ongoing concern is low sexual desire, even after their oestrogen (and progesterone if needed) has been optimised. It is not a routine third hormone for everyone on HRT.
Who might benefit?
Current guidance supports testosterone for women who:
- Are peri‑ or postmenopausal (natural or surgical).
- Have persistent, distressing low sexual desire (often called hypoactive sexual desire disorder, HSDD) for several months.
- Feel that low desire is affecting their quality of life or relationships.
Have tried to address other possible causes, such as:
- Relationship issues, stress, low mood, past trauma.
- Pain with sex or vaginal dryness (often improved with local oestrogen).
- Medications that can lower libido (for example some antidepressants).
- Are already on well‑managed HRT, yet still have troublesome low desire.
In this setting, a menopause‑trained clinician may suggest a trial of low‑dose testosterone, after a detailed discussion of benefits, risks and alternatives.
Who is it not suitable for?
Testosterone is usually not recommended when:
- You are pregnant, trying to conceive, or not using reliable contraception.
- You have certain hormone‑sensitive cancers, unless a specialist team advises otherwise.
- Your testosterone level is already high, or you have significant androgen‑excess symptoms.
- Low desire appears mainly situational (for example due to unresolved relationship issues) and is not causing personal distress on its own.
- You are mainly seeking help for energy, mood, weight, hair, skin or “healthy ageing” rather than libido – the evidence here is more limited.
How is testosterone given?
In the UK, testosterone for women is usually prescribed as a low‑dose skin preparation:
- A small amount of gel or cream is applied once daily (or on alternate days) to clean, dry skin, often on the outer thigh, buttock or lower abdomen.
- Doses are much lower than those used for men. The aim is to keep testosterone within the normal female range.
At present, most products are technically “off‑licence” for women, although a testosterone cream specifically formulated for postmenopausal women has now been licensed in the UK and is gradually becoming available via specialist prescribing pathways.
Expected benefits
The best‑proven benefit of testosterone in menopause is improvement in sexual function in women with HSDD. Studies show that, at the right dose, testosterone can:
- Increase sexual desire and spontaneous sexual thoughts.
- Improve arousal, orgasm and sexual satisfaction.
- Reduce distress related to low libido.
Some women also describe:
- Better energy and motivation.
- Improved concentration and reduced “brain fog”.
- A greater sense of wellbeing.
These additional benefits are promising but not yet as strongly supported by long‑term research as the effects on sexual desire. Because of this, guidelines still recommend using testosterone primarily for low sexual desire, not as a general treatment for mood, memory or energy.
Improvements usually build gradually over 8–12 weeks. If there is no clear benefit after about 3–6 months, continuing treatment is unlikely to help and it may be stopped.
Risks and side‑effects
Most women tolerate low‑dose testosterone well. However, as with any treatment, side‑effects can occur.
Possible side‑effects include:
- Acne or slightly oilier skin.
- Increased facial or body hair in some areas.
- Mild weight change or fluid retention.
Less common, usually with higher doses or blood levels above the female range, are:
- Thinning of scalp hair.
- Deepening of the voice.
- Enlargement of the clitoris.
These “androgenic” changes may only partly reverse if they develop, so it is important to report them promptly and adjust or stop treatment but they are very rare.
Monitoring and follow‑up
Safe testosterone use includes:
- Before starting
- Detailed menopause and sexual‑health assessment.
- Review of HRT, medications and other health issues.
- Blood test to check your baseline testosterone (and sometimes SHBG and other tests) to ensure it is not already high
- After starting
- Repeat testosterone level about 2–3 months later, then every 6–12 months, to keep levels in the normal female range.
- Review of your symptoms: Has sexual desire improved? Are there any side‑effects (skin, hair, voice, mood)?
Your clinician will adjust the dose, pause, or stop treatment based on results and how you feel. If there is no meaningful improvement in distressing low desire after 3–6 months, testosterone is usually discontinued.
Frequently Asked Questions
FAQs and myths
Common questions include:
Will testosterone make me masculine?
At carefully monitored doses that keep levels in the female range, testosterone should not make you
look or feel “like a man”, although mild skin or hair changes can happen and need checking.
Do all women on HRT need testosterone?
No. Testosterone is an optional add‑on for selected women with distressing low sexual desire that has not improved enough with well‑managed HRT and other support.
Will it fix my energy, mood and weight?
Some women feel better in these areas, but the strongest evidence is for libido. It should not be used as a stand‑alone treatment for fatigue, depression or weight loss.
Shared decision‑making and next steps
Deciding whether testosterone is right for you is a shared process between you and your clinician. Together you can:
- Before starting
- Detailed menopause and sexual‑health assessment.
- • Discuss potential benefits, side‑effects and uncertainties.
- Blood test to check your baseline testosterone (and sometimes SHBG and other tests) to ensure it is not already high
If you think testosterone might be appropriate for you, bring this information to your consultation and feel free to ask questions. The aim is to help you make an informed, personalised decision about your menopause care.