Treatments

Testosterone in menopause

A clear, specialist conversation about whether it could help you.

If something still feels missing after HRT, you deserve to have that taken seriously. Our menopause specialists can assess whether testosterone might help, and prescribe it safely when it is right for you.

Book a consultation Is it right for me?

"I'm on HRT. So why don't I feel like me yet?"

When things are better on paper, but not in how you feel in yourself

The hot flushes have settled down. You're sleeping better. On paper, things have improved.

But your interest in sex has disappeared. Or desire is there in theory, and your body just doesn't follow.

You might have mentioned it to someone and been told it's just your age. Or you haven't mentioned it at all, because it felt too awkward to bring up.

Low sexual desire is one of the most common things women raise with us, and one of the least talked about.

You might also be experiencing low mood, lack of motivation, fatigue or changes in memory and concentration, and are wondering what else can be done.

Testosterone is a women's hormone too

Women make testosterone in the ovaries and adrenal glands. In fact, before menopause, we produce more testosterone than oestrogen.

For some women, falling levels show up as reduced desire, arousal or sexual pleasure, even once oestrogen has been replaced.

Made by

Your ovaries and adrenal glands

Gradual fall

Levels decline from our twenties and thirties onwards

Sudden drop

Levels can fall suddenly if the ovaries are removed, or after some cancer treatments

At a glance

Symptoms testosterone may help with

The evidence is strongest for low sexual desire and sexual function. Some women also notice improvements in other areas.

Low sexual desire

Little or no interest in sex, which is causing you distress.

Strongest evidence

Arousal and pleasure

Finding it harder to become aroused, or sex feeling less satisfying.

Strongest evidence

Orgasm and responsiveness

Finding orgasm harder to reach, or less intense than it used to be.

Strongest evidence

Sexual confidence

Feeling less confident or less like yourself in your sexual relationships.

Strongest evidence

Fatigue

Feeling drained or low on energy, even once your HRT is settled.

May help some women

Brain fog

Difficulty concentrating, remembering things or finding the right words.

May help some women

Low mood

Feeling flat, low or not quite yourself.

May help some women

Reduced motivation

Losing your drive, or struggling to get going with things.

May help some women

Muscle strength and stamina

Feeling weaker, or tiring more quickly when you exercise.

May potentially help - limited evidence

Sense of wellbeing

A general sense that your spark or zest for life has dimmed.

May potentially help - limited evidence

For all symptoms other than sexual desire and sexual function, using testosterone is outside current guidance. We will always discuss the possible benefits and risks with you individually.

Desire is complex

Sexual desire and libido are complex, and in midlife they are affected by many different factors, not just hormones. Sleep, stress, relationships, body image, vaginal comfort, health and medication can all play a part.

Being in a long-term relationship can also lower desire over time. This is very common and a normal part of how desire changes, not a sign that something is wrong with you or your relationship.

Testosterone can help, but it is rarely the whole answer on its own. We look at the full picture with you.

Low levels don't always mean symptoms

A low testosterone level on a blood test doesn't necessarily mean it is causing how you feel. Many women have low levels and feel well, and low testosterone doesn't cause problems for every woman.

That's why we look at your symptoms and your whole picture, rather than a number on its own, when deciding together whether testosterone is worth trying.

What testosterone can and can't do

We think you deserve a straight answer here, because there is a lot of noise online.

Where the evidence is strong

The best research supports testosterone for low sexual desire that is causing you distress, in women who are menopausal. This is the use recommended by NICE, the British Menopause Society and the International Menopause Society.

In studies, women who respond tend to notice more interest in sex, easier arousal, and more satisfying sex.

Where we may offer a trial outside guidance

Some women also notice a real lift in mood, energy, motivation or mental clarity on testosterone. We have seen this make a significant difference for some of our patients.

However, research hasn't yet shown a benefit above placebo for these symptoms, so using testosterone for them sits outside current guidance. That doesn't rule it out. Where it makes sense for you, we may offer a carefully monitored trial, after talking openly through the possible benefits and risks for you as an individual.

What it won't do

Testosterone isn't a quick fix, and it won't override exhaustion or low mood due to other factors, a stressful relationship or pain during sex.

Those things matter too, and we will look at them with you.

We will always be clear about which category your symptoms fall into, so the decision is one we make together.

Desire is about more than hormones

Sexual desire and libido are multi-layered, and in midlife they are affected by many different factors, not just hormones. How we feel about sex is shaped by our bodies, our minds, our relationships and our lives.

Vaginal dryness or discomfortSleepStress and overwhelmBody imageMedication side effectsPast experiencesConnection with your partner, or yourself

This is why we never look at testosterone in isolation. Our whole health approach means we consider the full picture: optimising your HRT, treating vaginal symptoms where needed, and talking openly about anything else that might be getting in the way.

Sometimes testosterone is the missing piece. Sometimes something else is. Often it's a combination.

Could testosterone be right for me?

It may be worth exploring if:

Other symptoms

We may also discuss a trial if low mood, fatigue, brain fog or low motivation are still affecting you despite well-optimised HRT. This is outside guidance, so we'll weigh it up with you carefully.

When it may not be suitable

If you are pregnant or breastfeeding, have a hormone-sensitive cancer (unless agreed with your oncology team), or have certain conditions such as active liver disease. We will go through this with you carefully.

Your care

How testosterone care works at MMH

  1. 1

    A proper conversation

    In your consultation, we take time to understand your symptoms, your health history and what matters to you.

  2. 2

    A baseline blood test

    Before starting, we check your testosterone level and a protein called SHBG. This isn't used to diagnose low testosterone, but it gives us a safe starting point and helps guide your dose later. We arrange this for you through one of our partner laboratories. More about our blood tests

  3. 3

    A low, female-appropriate dose

    If testosterone is right for you, and we agree it together, we prescribe a small daily dose of cream or gel, rubbed into the skin of your lower tummy or outer thigh. The aim is to bring your levels back into the normal range for women, never above it.

  4. 4

    Review and a repeat blood test

    You will have a follow-up appointment and a blood test after around two to three months. We look at how you feel, any side effects, and whether the dose needs adjusting.

  5. 5

    Ongoing care, or stopping

    If testosterone is helping and you choose to continue, you will need at least an annual review and an annual blood test. If it hasn't helped after six months, we usually discuss stopping treatment. There is no benefit in staying on a treatment that isn't working.

Staying on testosterone: you will need a minimum of one review and one blood test every year. We can only continue to prescribe testosterone when these are up to date, to ensure your treatment remains safe and appropriate, in line with NICE and BMS guidance.

Which product will I be prescribed?

Testosterone can be prescribed as a cream or gel. We will explain exactly what you are using and why.

Designed for women

AndroFeme 1% cream

Approved by the UK medicines regulator for postmenopausal women, but not yet widely available. Where it is available and suitable, we may prescribe it. At present it is imported from Australia and is not available on the NHS.

Often more cost-effective

Testosterone gels at a lower dose

We may also prescribe testosterone gels that are licensed for men, at a much lower dose. These are usually the more cost-effective option. Using these off-label for women is common, legal and supported by national guidance.

What we don't prescribe

Implants, injections or compounded creams

Testosterone pellets, injections and compounded "bioidentical" creams can lead to unpredictable levels and aren't recommended by the British Menopause Society.

Side effects

Most women have no side effects at the right dose. When they do happen, they are usually mild and settle if the dose is reduced or treatment is stopped.

The most common are:

  • spots or oily skin
  • extra hair growth where the cream is applied (so it helps to rotate where you apply it)
  • hair growth on the face and chest

Rarer, sometimes irreversible side effects, such as frontal hair loss, a deeper voice or enlargement of the clitoris, are linked to doses that are too high. That's exactly why we use low doses and monitor your levels.

Long-term safety: studies of testosterone at doses suitable for women are reassuring, but there is not yet long-term safety data on its use in women. This is one of the reasons we review you every year and talk through whether continuing is still right for you.

Costs

Initial consultation£270 videoFrom £280 in person
Follow-up consultation£175 videoFrom £180 in person
Blood testsFrom £60plus phlebotomy fee
Medication, paid to the pharmacyTestogel approx. £35 for 3 monthsAndroFeme approx. £115 for 3 months

We will always explain the full costs before you start anything, so there are no surprises.

Your questions

Do I need to be on HRT first?

Usually, yes. Guidance recommends getting your oestrogen right first, as this often helps desire and energy on its own. If you can't take HRT, we can talk through whether testosterone might still be an option.

How long until I notice a difference?

It is a gradual change. Most women notice something within 6 to 12 weeks, and it can take up to six months to feel the full effect.

Will testosterone make me bulk up or change my voice?

Not at the doses we use. We prescribe a small fraction of a male dose and keep your levels within the normal female range.

I'm in perimenopause. Can I still have testosterone?

Most of the research is in postmenopausal women, but testosterone can still be considered in perimenopause where symptoms fit. We'll look at your individual situation.

I've had breast cancer. Is testosterone an option?

This needs a careful, individual conversation, ideally with input from your oncology team. Menopause after cancer is one of our specialist areas, so you're in safe hands to explore it.

Can my GP prescribe it?

Some GPs can, but many have local restrictions or would rather a specialist starts it. If you start testosterone with us, we will send a copy of your clinic letter to your GP with our treatment recommendations. Whether they take over prescribing is their decision.

Do I have to come into the clinic?

Not if you don't want to. We see women in person in Manchester and Birmingham, and online across the UK. You will need a blood test before starting and at follow-up, which we arrange through one of our partner laboratories if we don't see you in clinic. Your prescription is sent electronically to our partner pharmacy, who deliver your medication to your home, so there is no paper prescription to collect.

Ready to talk it through?

You don't need to have decided anything before booking. Many women come to us simply wanting to understand their options.

We'll listen, explain the evidence in plain language, and only recommend testosterone if we genuinely think it will help.

Not ready yet?

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Guidance this page draws on

NICE guideline NG23: Menopause British Menopause Society: Testosterone replacement in menopause Global Consensus Position Statement on Testosterone Therapy for Women (2019)