Testosterone for women: what it treats and how it is used

Testosterone is often thought of as a male hormone, but women produce it too, and the amount falls gradually with age. For some women, a small dose of testosterone can help with persistent low sexual desire that has not improved with standard HRT. It is prescribed off-label, within careful limits, and it is not a general energy tonic. This article explains what it is for, how it is used, and where the honest limits of the evidence lie.

How we use it follows British Menopause Society guidance, and we keep this part of care under close review. Your own suitability, and the specifics of dose and monitoring, are decided individually at your assessment.

What testosterone does in women

Women produce testosterone in the ovaries and adrenal glands, in much smaller amounts than men. It contributes to sexual desire and arousal, and probably plays some part in energy and mood, though the evidence is strongest and clearest for desire. Unlike oestrogen, which can drop sharply around menopause, testosterone tends to decline slowly with age rather than fall off a cliff. That gradual change is part of why its role can be easy to overlook.

What it is, and is not, used for

There is currently no testosterone product licensed specifically for women in the UK. It is prescribed off-label, which means a licensed male preparation is used at a much lower, female-appropriate dose. Off-label prescribing is common and legitimate in medicine when it is supported by evidence and guidance, and here it follows British Menopause Society guidance.

The one indication backed by good evidence is persistent low sexual desire that is causing you distress, sometimes called hypoactive sexual desire disorder, after oestrogen replacement has already been optimised. It is not, on the current evidence, a treatment for low energy, low mood, brain fog or general wellbeing, and it should not be offered or taken as a tonic for those things.

Who it may help

The woman most likely to benefit is one whose low desire genuinely troubles her and persists despite adequate oestrogen. Because desire has many inputs, testosterone is considered only after the other contributors have been looked at and addressed where possible:

• Oestrogen replacement optimised, since low oestrogen alone can dampen desire.

• Vaginal dryness or discomfort treated, as pain understandably reduces interest.

• Mood, sleep, stress and relationship factors considered, all of which affect libido.

• Medication reviewed, since some, including certain antidepressants, can lower desire.

Testosterone comes into the conversation when desire is still low and distressing once those are in hand, not as a first move.

How it is used

Testosterone for women is given as a small amount of a transdermal preparation, a gel or cream applied to the skin, using a UK product at a fraction of the dose a man would use. The aim is replacement, keeping your level within the normal range for a woman, not pushing it above it. There is no benefit to higher doses, and supraphysiological levels are exactly what careful prescribing avoids. The precise preparation and dose are chosen for you at assessment, because this is an area we tailor to the individual.

Monitoring and judging benefit

Before starting, a blood test usually checks your baseline testosterone and a related measure, both to avoid treating someone whose level is already normal and to give a reference point. Levels are then rechecked during treatment to keep them within the female range, alongside a clinical review for any androgenic effects such as acne or unwanted hair growth.

Benefit is reviewed after a few months of use. Sexual desire is slow to shift, so it is given a fair trial, but if there is no meaningful improvement, it is stopped. There is no reason to continue a treatment that is not working, and continuing it would mean carrying a small ongoing need for monitoring for no return.

Side effects and safety

At correct female doses, side effects are uncommon. The ones that do occur usually relate to the level drifting too high: acne, greasy skin, and increased body or facial hair, and very rarely a deeper voice or clitoral enlargement. These are the reason levels are monitored and the dose kept in range, and most settle if the dose is reduced. Apply it to a consistent area of skin and let it absorb, taking care to avoid transferring it to others by skin contact, particularly children and partners. Testosterone is not used in pregnancy.

The honest summary

Testosterone can genuinely help a specific group of women: those with distressing low sexual desire that persists despite optimised oestrogen, when it is used in small, monitored doses kept within the female range. It is prescribed off-label, it is not a cure-all for energy or mood, and it is stopped if it does not help. Whether it is right for you, and the exact dose and monitoring, are decided individually at your assessment.

Ready to start?

If you want to move from reading to acting, the next step is a short assessment with a doctor on the GMC GP Register. It takes about ten minutes and tells you whether HRT is right for you.

Begin your assessment at this link. Online or in person at Westfield London.