Testosterone often gets talked about as a men's hormone, but women produce it too, and for some it is now a recognised part of UK menopause care. Specifically, testosterone can be considered when low sexual desire hasn't improved with standard hormone replacement therapy (HRT) alone. This is a narrower, more closely defined treatment than it can sound online: it isn't licensed for women in the UK, it isn't a general libido booster, and it isn't the right next step for everyone. Here is what British Menopause Society (BMS) and NICE guidance actually say, how treatment works in practice, and what tends to be tried first.
Testosterone's role in women's bodies
The ovaries and adrenal glands both produce testosterone in women, in much smaller amounts than in men, but it is biologically active throughout life. Levels decline gradually with age and fall further, sometimes sharply, after surgical removal of the ovaries or during the years around the menopause, although natural menopause tends to affect testosterone more gradually than it affects oestrogen. A woman who has had both ovaries removed, whether for endometriosis, ovarian cysts or as part of cancer treatment, typically sees a steeper drop in testosterone than someone going through a natural menopause, which is one reason surgical menopause comes up often in this conversation.
Testosterone contributes to sexual desire and arousal, alongside broader roles in energy, mood, bone and muscle health. Its relationship with libido isn't straightforward, though: a blood level on its own doesn't reliably predict how someone feels about sex, which is why testosterone testing isn't used to diagnose low libido, and treatment decisions are made mainly on symptoms rather than a single number. A naturally low testosterone level with no bothersome symptoms is not, by itself, a reason to start treatment; equally, some women with reduced sexual desire have testosterone levels within the normal range, which is why a wider assessment matters more than the blood result on its own.
UK and BMS guidance on testosterone after the menopause
NICE's menopause guideline states that testosterone supplementation can be considered for menopausal women with low sexual desire if HRT alone hasn't been effective. The British Menopause Society's consensus position is more specific still: it supports testosterone for hypoactive sexual desire disorder (HSDD) in postmenopausal women, once other contributing factors have been considered and oestrogen (with progestogen if needed) is already at an effective dose.
This is a deliberately narrow indication. Testosterone isn't recommended for low mood, fatigue, general low libido unrelated to the menopause, or as a first-line menopause treatment in its own right. There is currently no testosterone product licensed for women in the UK, so treatment is prescribed off-label, almost always by a menopause specialist or a clinician experienced in this area, using a product licensed for men at a much lower, female-appropriate dose.
In practice, being considered for testosterone usually means you have already tried an adequate trial of HRT, that your desire for sex is causing you personal distress rather than simply being a change you have noticed, and that other explanations have been thought through. A GP can start that conversation, but prescribing itself is typically handled by, or done in close consultation with, a menopause specialist, reflecting the off-label status and the closer monitoring the treatment needs.
What testosterone treatment involves
In UK practice, off-label testosterone for women typically means a testosterone gel or cream, formulated and licensed for male use, applied at a fraction of the male dose, usually daily to the skin. Because there is no bespoke UK product licensed for women, doses are estimated at the outset and then adjusted based on blood testosterone levels and how you respond, which makes this a more individualised, closely supervised treatment than most other parts of HRT.
Before starting, a clinician will typically check baseline testosterone levels and take a full history to look for other contributors to low libido, including relationship factors, mood, other medication, and vaginal dryness or pain during sex. They will also confirm that HRT itself, if you are using it, is already at an effective dose, since correcting that alone often resolves the problem without testosterone being needed at all.
Once treatment starts, benefit is not immediate. Because testosterone works gradually on desire and arousal, most clinicians ask patients to allow a period of consistent daily use, typically several months, before judging whether it is making a meaningful difference, with a follow-up blood test and review scheduled for around that point. If there has been no improvement after a fair trial, the usual next step is to stop rather than continue indefinitely on an unclear benefit, and to revisit what else might be contributing.
Risks and monitoring
Testosterone treatment in women is monitored more closely than standard HRT, because the aim is to stay within, not exceed, the normal female physiological range. Blood testosterone levels are usually checked before starting, then again after a few months, to guide dose and check for excess.
Using more than needed, or continuing without monitoring, raises the risk of androgenic side effects: acne, oily skin, unwanted hair growth, scalp hair thinning and, less commonly, voice changes, some of which aren't fully reversible if they occur. Longer-term safety data for testosterone in women, particularly around breast and cardiovascular outcomes over many years, is more limited than the equivalent evidence base for oestrogen. That is part of why BMS guidance sets a defined threshold, specifically HSDD once other options have been tried, rather than positioning testosterone as a routine menopause add-on. Access on the NHS is inconsistent across the UK, and many women end up seeing a private menopause specialist for testosterone treatment specifically.
Because there is no licensed female product, using a male-dose gel or an unregulated product bought online without clinical supervision is a different, considerably riskier situation than the monitored, low-dose approach described here. Dosing a male-licensed product by eye, without blood monitoring, makes androgenic side effects far more likely, and products marketed directly to consumers for "female libido" outside a clinical pathway are not subject to the same scrutiny. Any testosterone treatment should be started and reviewed by a registered UK clinician, not self-managed.
Alternatives and the wider HRT picture
Low libido after the menopause is rarely caused by one thing alone, which is why testosterone is usually only considered once other contributors have been addressed. For many women, optimising standard HRT, an oestrogen product such as Oestrogel or a combined option like Utrogestan taken alongside it, resolves symptoms including reduced desire without testosterone being needed at all.
Vaginal dryness and discomfort, which can make sex painful and understandably reduce desire, often respond well to local vaginal oestrogen or, in some cases, a vaginal DHEA product such as Intrarosa, independently of systemic HRT. Non-hormonal contributors are worth exploring too: sleep, stress, mood, relationship context and certain medications, including some antidepressants, can all affect libido, and addressing these alongside hormonal treatment often makes more difference than any single medicine on its own.
A thorough assessment will usually ask about all of this together rather than jumping straight to a hormone. That might mean a joint conversation with a partner, a review of other medications that are known to lower libido as a side effect, or simply time to let an HRT dose settle before deciding anything further is needed. Testosterone tends to be most useful once this wider picture has genuinely been looked at, not as a shortcut past it.
A consultation as part of your wider women's health care can help place testosterone in that fuller picture rather than treating it in isolation, drawing on the same assessment used for HRT more broadly and for related symptoms like vaginal dryness after the menopause. A Farmeci clinician can talk through where you are in that picture, and advise whether testosterone looks like it could be relevant for you.