Hormones

Testosterone and Menopause

Creator: Dr Nadira Awal
Published: 2026-01-15

The role of testosterone in women's health and how to access treatment.

By Dr Nadira AwalBMS Specialist2 min readMedically reviewed 9 July 2026

Amber dropper bottle beside a single rose on stone slab

Testosterone is a female hormone too. When levels fall, energy, libido and cognitive sharpness can suffer. UK BMS guidance supports its use in carefully selected women alongside oestrogen.

Testosterone is a female hormone too — it just gets less airtime because most of the pharmaceutical industry has focused on men. In carefully selected women, testosterone replacement can restore libido, energy, motivation and mental sharpness that oestrogen alone does not fully address. Used correctly, at physiological female doses and with proper monitoring, it is a safe and often transformative addition to HRT. Used carelessly, without baseline levels or monitoring, it causes side effects and disappointment.

Who it may help

Women already on optimised oestrogen replacement (and progesterone if needed) who still have low libido, low energy, poor motivation or persistent brain fog.
Women with surgical menopause (both ovaries removed) — testosterone falls sharply and is often worth replacing from the start.
Women with hypoactive sexual desire disorder (HSDD) causing personal distress.

What UK guidance says

The British Menopause Society supports testosterone use for HSDD in menopausal women where oestrogen alone has not helped.
There is currently no UK-licensed female testosterone product — specialists prescribe male gels (Testogel, Tostran) at a reduced female dose, or import AndroFeme (licensed in Australia specifically for women).
Blood levels must be kept within the female physiological range.
Testosterone is prescribed 'off-label' for women in the UK — this is normal, safe practice under specialist care.

A tube of testosterone gel with a measuring applicator — UK specialists prescribe reduced doses of male gels or import AndroFeme, monitored with 3-monthly bloods.

How it is monitored

Baseline blood test before starting: total testosterone, SHBG and a calculated free androgen index.
Repeat at 3 months to confirm levels are in the female physiological range and check symptom response.
Annual review thereafter to confirm continued benefit and check levels remain in range.

What to watch for

Localised skin acne, oily skin or increased facial or body hair — usually dose-related and reversible on dose reduction.
Voice changes and scalp hair loss are rare at correctly prescribed female doses and warrant stopping and reassessing.
Testosterone is not a quick fix for tiredness or low mood on its own — those symptoms usually need oestrogen, sleep and lifestyle addressed first.

Realistic expectations

Most women notice benefit at 8–12 weeks, not immediately.
The strongest evidence is for libido; energy, mood and cognition are secondary benefits that vary between women.
Around a third of women will not notice enough benefit to continue — stopping is straightforward.

Key takeaway

Testosterone deserves a fair hearing, but it also deserves proper prescribing: baseline bloods, physiological doses, follow-up at 3 months and honest conversation about what it can and cannot do.

How Dr Awal approaches this in clinic

Every consultation starts with your full story — symptoms, cycle, medical history, family history and what you've already tried. From there we look at whether hormonal treatment, non-hormonal options, lifestyle changes or a combination will give you the best result, and we tailor the plan to your age, risk factors and preferences.

A detailed 60 minute first appointment — no rushed 10-minute slots.
Evidence-based recommendations aligned with NICE NG23 and BMS guidance.
Body-identical HRT considered first-line where appropriate.
Shared-care letters sent to your NHS GP so treatment can continue affordably.
Follow-up at 3 months to fine-tune your regimen and address side effects.
Ongoing annual reviews so your plan evolves with you.

Common questions we hear about this

Do I need to be at a certain age to be seen?

No. We see women in early perimenopause (often late 30s and 40s), through post-menopause and beyond. Age alone doesn't decide whether treatment is right — symptoms, health history and goals do.

Will my GP continue the prescription?

In most cases yes. After your consultation we send a detailed shared-care letter with the diagnosis, treatment plan and rationale so your NHS GP can prescribe on the NHS. Not every practice accepts shared care — we'll discuss this in your appointment.

What if I've tried HRT before and it didn't suit me?

Very common — often the type, dose or route wasn't right rather than HRT itself. We review what you've tried, why it didn't work, and adjust accordingly. Many women who thought HRT wasn't for them do well on a different preparation.

How long will I need to stay on treatment?

There is no set upper time limit for HRT. Current BMS and NICE guidance supports continuing HRT for as long as the benefits outweigh the risks for you personally. We review this together every year so you stay in control of the decision.

Where do you see patients?

All consultations at Pause and Co Healthcare are conducted securely via video, allowing us to support patients anywhere in the UK. Prescriptions and shared care arrangements are managed in the same way, regardless of your location.

About the author

Dr Nadira Awal is a British Menopause Society Advanced Menopause Specialist with 15+ years' NHS and private experience. She holds the BMS Advanced Certificate in Menopause Care, sits on the BMS Programme Planning Group, and advises the UK Government Menopause Strategy Group. Read her full profile.

Sources & further reading

General information only — not a substitute for personalised medical advice. Always speak to your GP or a menopause specialist about your own situation.

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