Testosterone for Menopausal Women: The Overlooked Third Hormone
When testosterone is added to HRT for low libido, what the evidence supports, why it's off-label in the UK, and how prescribing works.
Part of the Complete Hormone Replacement Therapy Guide.
Key fact: The established, evidence-backed use of testosterone in menopause is for distressing low sexual desire that persists after conventional HRT has been optimised — and it is prescribed off-label in the UK.
Before menopause, women produce more testosterone than oestrogen. It contributes to libido, energy, mood and muscle strength — and its gradual decline with age, accelerated by surgical menopause, leaves some women with symptoms that oestrogen alone doesn't fix. Testosterone is increasingly discussed in UK menopause care, and the British Menopause Society updated its prescribing guidance for clinicians in May 2026. Here's what the evidence does — and doesn't — support.
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The established, evidence-backed indication is hypoactive sexual desire disorder (HSDD) — persistent, distressing low sexual desire — in menopausal women, after optimising conventional HRT and addressing other causes (relationship factors, mood, medication side effects such as SSRIs, vaginal dryness). Trials and the 2019 global consensus statement show meaningful improvement in desire, arousal and sexual satisfaction in this group.
Claims that testosterone reliably improves energy, mood, cognition or muscle mass in menopausal women are not currently supported by good trial evidence. Some women anecdotally report these benefits; guidelines don't recommend prescribing for them alone.
Why is it "off-label" in the UK?
No testosterone product is currently licensed for women in the UK. Prescribers therefore use licensed male products at roughly one-tenth doses — typically Testogel or Tostran gel — or the female-dosed cream AndroFeme, which is imported and unlicensed in the UK. Off-label prescribing is legal and common, but it means prescribing should follow specialist guidance (the BMS tool), with baseline and follow-up blood testing.
How treatment works in practice
1
Optimise standard HRT first
Low libido often improves once oestrogen is right and vaginal symptoms are treated.
2
Baseline blood test
Total testosterone (± SHBG) to confirm levels aren't already mid-range and to guide dosing.
3
Low-dose gel or cream
Applied daily to the lower abdomen or thigh.
4
Review at ~3 months
Repeat bloods, keeping levels in the female physiological range.
5
Continue only if it's clearly helping
Reassess the benefit after 6 months.
Side effects at physiological doses are uncommon but can include acne, increased hair growth at application sites, and — with excessive dosing — voice changes or male-pattern hair effects. Keeping blood levels in the female range makes these unlikely.
Access: NHS and private
NHS access varies by area — some GPs prescribe following specialist or BMS guidance, others refer to menopause clinics, and waiting lists can be long. Private menopause services prescribe more readily but should still test bloods and follow the same guidance. Note that testosterone is not covered by the NHS HRT prepayment certificate — see our HRT cost guide.
Specialist-guided prescribing: Because testosterone for women is off-label with limited long-term data, it should be prescribed following BMS guidance with baseline and follow-up blood monitoring.
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Access Doctor provides conventional HRT online and can advise whether testosterone is worth discussing with a specialist in your case.
Start an HRT consultation →Frequently Asked Questions
Can women take testosterone in the UK?
Yes — prescribed off-label at low doses, usually for distressing low libido that persists despite optimised HRT.
Will testosterone give me more energy?
The trial evidence supports benefit for sexual desire, not energy or mood. Some women report broader benefits, but guidelines don't recommend prescribing for those alone.
Do I need blood tests?
Yes — baseline testosterone before starting, then periodic checks to keep levels within the normal female range.
Will I grow facial hair or my voice deepen?
At correctly monitored physiological doses these effects are unlikely. They're associated with excessive dosing — which monitoring exists to prevent.
Can I get testosterone on the NHS?
Possibly, depending on local policy — often via a menopause clinic. Availability is inconsistent across the UK.
Is testosterone safe long-term for women?
Long-term safety data (beyond a few years) is limited, which is another reason for specialist-guided prescribing and regular review.
Getting your core HRT right is the first step. Access Doctor's pharmacist independent prescribers can assess you through a confidential online consultation and, where appropriate, prescribe conventional HRT with discreet next-day delivery.
References
- British Menopause Society. Tool for clinicians: Testosterone replacement in menopause. Updated May 2026. thebms.org.uk
- Davis SR et al. Global consensus position statement on the use of testosterone therapy for women. J Clin Endocrinol Metab 2019. pubmed.ncbi.nlm.nih.gov
- NICE. Menopause: identification and management (NG23). 2015, updated November 2024. nice.org.uk
- Islam RM et al. Safety and efficacy of testosterone for women: systematic review and meta-analysis. Lancet Diabetes Endocrinol 2019. pubmed.ncbi.nlm.nih.gov
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.