Testosterone is a natural hormone in women, alongside oestrogen and progesterone, that gradually decreases with age, starting in the reproductive years and continuing through menopause. The biggest drop usually happens before menopause, and after about age 70 levels may stop falling or even rise slightly.

This change is a normal part of ageing and is not usually a cause for concern unless it is linked to symptoms such as low sexual desire. There is no set level that defines “low testosterone” in women, so doctors generally only test or treat if there are clear symptoms affecting wellbeing. Routine testosterone testing or treatment is not recommended without a specific reason. Not every woman needs testosterone replacement.

For some however, low levels may be linked to Hypoactive Sexual Desire Disorder (HSDD), a recognised condition that can affect quality of life. Research shows testosterone therapy can improve desire and satisfaction in postmenopausal women.

Some women also notice improved mood, energy, and mental clarity, though research in these areas is still developing.

Testosterone is the only proven, evidence-based benefit of testosterone therapy for women is in improving sexual desire and satisfaction, particularly in women with low libido that hasn’t improved on HRT alone.

However, newer research suggests testosterone may also help with:

• Mood and psychological wellbeing – some women report feeling calmer, less irritable, or more motivated. A recent large UK study showed significant improvements in anxiety, self-esteem, and low mood when testosterone was added to HRT.
• Cognitive function – women often describe clearer thinking and less “brain fog.” Research shows improvements in memory, concentration, and energy for some.
• Bone and muscle health – testosterone plays a role in maintaining strength and density, though evidence in women is still limited.
  Urogenital health – androgen receptors in the vaginal wall suggest testosterone may contribute to vaginal comfort and sexual function, though more research is needed.

Important to note: testosterone is not prescribed as a first-line treatment for mood, fatigue, or cognition. These possible benefits are still being studied, and treatment decisions should always be based on your overall symptom picture.

Levels naturally decline with age, but they may fall more sharply due to:

• Surgical removal of the ovaries
• Chemotherapy or radiotherapy
• Certain medical conditions (e.g., Addison’s disease)
• Medications such as oral oestrogen, opioids, or hormonal contraception
  

Testosterone may be considered if:

• You are already using HRT (oestrogen ± progesterone)
• Low libido persists despite HRT
• Blood tests and symptoms suggest a possible benefit

Some women may also notice improvements in mood, energy, or cognition, but this varies and is not guaranteed.

Testosterone therapy may not be suitable for:

• Women with breast cancer, ovarian cancer, or certain other hormone-sensitive cancers (although this can be discussed with your specialist)
• Women with active liver disease
• Women who are pregnant or breastfeeding
• Women with uncontrolled cardiovascular disease
• Women with polycythaemia (high red blood cell count)
• Women with untreated sleep apnoea

Your specialist will discuss whether testosterone is appropriate for you.

• Apply to clean, dry, hair-free skin often around upper thigh/buttocks
• Rotate application sites to reduce irritation or hair growth
• Let the gel/cream dry fully before dressing or skin contact (including with pets)
• Wash hands thoroughly afterwards

Benefits—especially for sexual desire—can take 3–6 months. If symptoms persist, your clinician may:

• Check your testosterone levels
• Review your hormone balance (oestrogen and progesterone)
• Look at other factors such as thyroid health, vaginal health, nutrition, or mental wellbeing
• Adjust your prescription or stop testosterone and explore other ways to support libido

AndroFeme® Cream is licensed in Australia and is expected to launch in the UK in 2026 for postmenopausal women with HSDD. In the meantime, AndroFeme® can still be prescribed privately in the UK, although this is an unlicensed use. Another option is Testogel®, a preparation licensed for men but sometimes used off label at much lower doses for women under specialist care.

Your treatment will only start if:

• You are already on appropriate HRT
• You have symptoms and blood results suggesting a possible benefit

Monitoring schedule:

• Before starting: baseline blood test
• 3 months: repeat blood test and symptom review
• 6–12 months: follow-up blood test and consultation
• Annually: ongoing monitoring

Treatment will generally be stopped if no benefit is seen after 6 months.

Testosterone can support some symptoms, but overall wellbeing is improved by lifestyle choices. Evidence shows:

• Regular physical activity improves energy, mood, strength, and bone health. Resistance training is especially beneficial.
• Balanced nutrition supports hormonal health — prioritise protein, healthy fats, whole grains, and plenty of fruit and vegetables.
• Sleep hygiene helps hormone regulation and recovery. Aim for 7–9 hours of quality sleep each night.
• Stress management through mindfulness, yoga, or counselling can support emotional wellbeing.
• Healthy relationships and open communication about sexual health can improve libido and satisfaction. Counselling or sex therapy may be helpful for relationship or emotional factors affecting desire.
• Vaginal health — vaginal moisturisers and lubricants can improve comfort and sexual satisfaction, especially if dryness or discomfort is present. We recommend YES products, which we can provide. Vaginal oestrogen can also help maintain vaginal integrity and lubrication for some women. For certain cases, pelvic floor physiotherapy specialists may also be beneficial.

If you're experiencing low sexual desire, several resources and approaches may help alongside or instead of testosterone therapy:

Podcast

• Is It Hot In Here? Menopause Podcast — Hosted by Dr. Naomi Potter with Dr Karen Gurney (a psychosexual psychologist), exploring libido, menopause, and midlife health.

Book

• Mind the Gap by Dr. Karen Gurney — A compassionate guide to female desire, debunking myths and offering practical tools to rekindle intimacy.
• Come as You Are by Dr. Emily Nagoski - An evidence-based book that delves into the science of women's sexuality, emphasizing the importance of context and emotional well-being.
• Better Sex Through Mindfulness by Dr. Lori A. Brotto offers an evidence-based, compassionate guide to rekindling sexual desire through mindfulness and body awareness.

TED Talks

• The Truth About Faking Orgasms — Dr. Gurney explores sexual pleasure, societal expectations, and communication barriers, offering insights for genuine intimacy.
• The Power of Orgasms to Address Gender Inequality — Examines the orgasm gap, its societal implications, and the importance of inclusive sexual health.

Webinar

Sexual Health, Libido, and Hormonal Change in Menopause with Dr Charlotte Gooding and Dr Liz Andrew. Watch on YouTube.

Starting testosterone can feel like a big step. Our specialist team will guide you through treatment, ensuring your care is safe, personalised, and closely monitored.

📧 info@menopausecare.co.uk | ☎️ +44 208 164 4090