Many women think of testosterone as purely a male hormone. However, before menopause women also produce testosterone from the ovaries and the adrenal glands and it plays an important role in our sex drive and pleasure, in muscle and bone strength, cardiovascular health, cognitive function and energy levels.
Testosterone levels usually decline steadily with age once we are in our thirties, or they may fall abruptly if a woman has her ovaries removed, for example.
Given all that testosterone does in our bodies, it’s no wonder there can be signs and symptoms when testosterone levels fall, and these are recognised symptoms of peri/menopause.
Not all women – or even all health professionals – identify that these symptoms are related to low testosterone specifically, and it’s often treated as the forgotten (or even dismissed) third hormone, after estrogen and progesterone.
What does testosterone do?
There are testosterone receptors all over your body and this hormone is involved in many different physiological processes, especially in the brain. It is best known for boosting libido and helping sexual arousal and pleasure. But it also strengthens nerves and arteries in the brain, helps regulate and enhance uptake of serotonin, and stimulates the release of dopamine. These effects contribute to improving mental sharpness, memory, mood and feelings of pleasure.
What are the signs and symptoms of low testosterone?
In brief, here are some of the most common signs of low testosterone, but remember, many of these are also related to low estrogen as well:
- Lack of interest in sex (low libido)
- Lack of pleasure during sex
- Physical fatigue
- Loss of bone density
- Loss of muscle
- Insomnia
- Hot flushes
- Brain fog
- Low mood
Does this mean I need to take testosterone replacement?
The answer to this question is ‘that depends…’
Firstly, if you’re experiencing some of these symptoms, a trial of estrogen (and usually progesterone) will be recommended if you’re not already taking HRT.
To find out more about HRT in general, read our guide on Understanding the different types of HRT .
Secondly, if your concerning symptoms predominantly relate to pain and discomfort during sex, the issue of vaginal dryness and other symptoms affecting the genitals should be discussed and possibly treated with vaginal estrogen. You can read our guide on Vaginal Dryness here.
And lastly, if problems in your sex life are linked with relationship issues, these should also be addressed through communication and possibly counselling. Our guide Revitalising your Sex Life covers more about improving things with your partner.
So you have sorted the vaginal dryness, your relationship is going well, and most of your other symptoms are helped by taking HRT but why has your sex drive and pleasure not improved at all?
Hypoactive Sexual Desire Disorder
Many factors impact our libido: how we feel about our body, how we feel about our partner, work and life stressors and so on. Hypoactive Sexual Desire Disorder (HSDD) is a diagnosis made when a woman has a complete lack of interest in sex, no sexual thoughts, reduced pleasure from sex, has little interest in masturbation and when these symptoms have lasted for more than 6 months.
If this rings true for you, consider the following questions:
In the past, was your level of sexual desire or interest good and satisfying to you?
Has there been a decrease in your level of sexual desire or interest?
Are you bothered by your low level of sexual desire or interest?
Would you like your level of sexual desire or interest to increase?
Are any of the following factors contributing to your current decrease in sexual desire or interest:
- an operation, depression, injuries, or other medical condition
- medications (e.g. antidepressants), drugs, or alcohol you are currently taking
- pregnancy, recent childbirth, menopausal symptoms
- your partner’s snoring can reduce sex drive
- other sexual issues you may be having (e.g. pain or trauma from past experiences)
- your partner’s sexual problems
- dissatisfaction with your relationship or partner
- stress or fatigue
You may want to think how you can change or address some of the factors above if they are affecting your sexual interest. For example, reducing alcohol consumption, focusing on quality time with your partner where you can connect and discuss your personal needs, consensual sexual experimentation and planning in times for intimacy can all help. It may also help to see a psychosexual counsellor if connection is an issue.
Testosterone replacement
For HSDD:
If your other menopausal symptoms are mostly controlled by HRT, there’s no ongoing problems with vaginal dryness, and you don’t feel the issue relates to your relationship, you may benefit from a trial of testosterone supplementation for HSDD type symptoms.
Currently, national and international guidelines recommend testosterone replacement therapy only for treating HSDD in menopausal women and NHS practitioners can prescribe testosterone for this reason under license.
For other symptoms of low testosterone:
Putting the issue of libido aside, what if you’re still suffering with other symptoms like low energy, low mood, poor sleep, hot flushes and brain fog even after taking HRT for a few months?
Many menopause specialist clinicians also use testosterone therapy to treat other symptoms of peri/menopause and not just for symptoms relating to low libido. Prescribing testosterone in women for issues such as fatigue, brain fog, low mood and insomnia is currently ‘off license’ as the medication is not officially licensed to treat these other symptoms. This is why some GPs are reluctant to prescribe testosterone for these reasons and many women go to private providers to receive testosterone therapy as part of their menopause management.
Benefits of testosterone replacement
For the women we see in clinic who use testosterone supplementation, many report not only improved libido and levels of sexual arousal and pleasure, but also improved muscle and bone strength, energy levels, mental focus and clarity, improved mood and enhanced sleep quality.
Will I need any blood tests?
A blood test is usually recommended before treatment is started. This is not to make a diagnosis but rather a check to ensure that adding testosterone to your HRT treatment will not lead to testosterone levels that are above the normal range for women and provide a baseline for ongoing monitoring.
Testosterone cream or gel
Testosterone is usually given as a cream or a gel that is applied once daily to the thighs or buttocks.
At present there is only one licensed preparation of testosterone for use in women in the UK and this is called AndroFeme®. (Note: AndroFeme® contains almond oil and should be avoided by women who are allergic to almonds).
Products that are made for use in men can be used in smaller doses for women and are prescribed ‘off license’ in these cases. This does not mean that they are unsafe, simply that no company holds a license for women.
Testogel® and Tostran® are gels formulated in a dose appropriate for men so dosage adjustment is required for use in women and in some areas, these can be prescribed on the NHS. (Note: These products cost considerably less than Androfeme).
How soon will it work?
It can take up to 3 months before women notice an improvement in symptoms. A trial of treatment for 3-6 months is normal. If at the end of 6 months there has been no improvement, then the testosterone will be stopped and alternative reasons for low libido should be explored.
What follow-up will I need?
You will need to have a repeat blood test after 2-3 months and if you continue on the treatment, you will need a blood test to check your testosterone levels every 12 months. This is to ensure that your level remains in the normal range for females.
Are there any side effects?
When testosterone levels stay in the normal female range, side effects are uncommon.
Some women notice a little hair growth where they rub in the cream or gel. This can usually be avoided by varying the site of application and applying the cream in a thin layer.
Other side effects of testosterone treatment such as acne, greasy skin, hair growth, hair loss, voice changes are rarely experienced if normal female levels are maintained.
Are there any risks?
There is a lack of data from long-term research studies in using testosterone in women, but the limited evidence we do have suggests no adverse effects in healthy menopausal women for up to two years after commencing treatment.
Last updated: June 2026
