Testosterone for Women in Menopause: Symptoms, Evidence and Treatment

Testosterone is often thought of as a "male" hormone, but women make it too. In women it is made by the ovaries and the adrenal glands, and it plays a part in sexual desire and general wellbeing. Levels fall gradually with age, and can drop sharply if both ovaries are removed. For some women with distressing low sexual desire after menopause, carefully prescribed testosterone may help.

This page explains what testosterone does, what the evidence does and does not show, and how it is used safely. You may also want to read our pages on estrogen, progesterone and hormone replacement therapy (HRT).

What testosterone does in a woman's body

Testosterone belongs to a group of hormones called androgens. The British Menopause Society (BMS) explains that androgens are essential for the development and maintenance of female sexual anatomy and function, and for sexual behaviour. Testosterone is also thought to play a part in:

• Sexual desire (libido), arousal and response
• Muscle and bone
• Energy, mood and concentration

It is important to say clearly that, apart from sexual desire, the research evidence that testosterone treatment improves these other areas in women is not strong enough to recommend it for them. More on this below.

What happens to testosterone in perimenopause and menopause

Unlike estrogen, testosterone does not drop suddenly at natural menopause. Levels fall gradually over many years. The BMS explains that this decline appears to be linked to age, at least partly because of the loss of ovarian function. The drop is more marked in women who have a surgical menopause (both ovaries removed) or a medical menopause (for example, from some cancer treatments).

The ovaries keep making some testosterone after natural menopause, so levels do not fall to zero.

Symptoms that can be linked to low testosterone

The main symptom that has been studied is low sexual desire that causes distress. Doctors call this hypoactive sexual desire disorder (HSDD). It means a lasting lack of interest in sex, or of sexual thoughts, that you find upsetting, and which is not better explained by another cause.

Women sometimes also report tiredness, low mood or poor concentration. However:

• The BMS notes that many women with low testosterone levels have no symptoms at all.
• Low desire at midlife has many possible causes, and they often overlap. These include vaginal dryness and pain during sex, poor sleep, low mood or anxiety, stress, relationship issues, tiredness, thyroid problems, anaemia, and some medicines, including certain antidepressants.
• Low estrogen itself can reduce desire, often through vaginal discomfort and hot flushes that disturb sleep.

This is why doctors look at the whole picture, physical, emotional and relationship factors, before thinking about testosterone. You can read more in our article on decreased libido in menopause.

Testing: what a testosterone blood test can and cannot tell you

This is an area where there is a lot of confusion. The 2019 Global Consensus Position Statement on testosterone for women, agreed by major menopause and endocrine societies worldwide, states that a blood testosterone level should not be used to diagnose HSDD. There is no testosterone level that reliably tells apart women who do and do not have low desire.

Blood tests do have a role, but in a different way:

• Before treatment: a total testosterone level is checked to give a starting point, and to make sure levels are not already high.
• During treatment: levels are re-checked a few weeks after starting, and then every 6 to 12 months, to make sure they stay within the normal range for women. This reduces the chance of side effects.

For menopause itself, NICE advises that women aged 45 or over can usually be diagnosed from their symptoms, without blood tests. The Indian Menopause Society also says menopause is diagnosed from your history.

Treatment options

Start with the basics

NICE and the BMS recommend that a trial of standard HRT is given first. NICE says testosterone can be considered for low sexual desire linked to menopause if HRT alone has not helped. Treating vaginal dryness (for example with vaginal estrogen or lubricants), improving sleep, and addressing mood, stress and relationship factors can make a real difference on their own.

What the evidence shows

A large review of 36 randomised trials, with over 8,000 women, found that testosterone improved sexual desire, arousal, orgasm and pleasure in postmenopausal women, and reduced sexual distress. The 2019 Global Consensus describes the benefit as moderate: on average, about one extra satisfying sexual event a month compared with a dummy treatment (placebo). For some women that is meaningful; for others it is not enough to be worth it.

The same Consensus found the evidence not sufficient to support testosterone for any other symptom or condition, including mood, energy, memory, bone or muscle health. The review also found no clear effect on thinking skills, bone or muscle, though few women were studied for these.

Forms of testosterone

• Through the skin (transdermal) creams and gels: non-oral products like these are preferred. Testosterone taken by mouth is not recommended, because it has harmful effects on cholesterol. Creams and gels applied to the skin at doses for women did not show these effects in trials.
• Products made for women: a 1% testosterone cream made for women is licensed in some countries, including Australia, New Zealand, South Africa and the UK. The Indian Menopause Society's 2020 guidelines state that testosterone formulations for women were not available in India at that time.
• Products made for men: where no women's product exists, the Global Consensus says a man's product may be used "off-label" at a much smaller, female dose, with careful monitoring. The Indian Menopause Society's 2020 guidelines advise that testosterone products meant for men should not be prescribed for women. Experts therefore differ, and this is a decision for your doctor.
• Not recommended: testosterone tablets, injections and pellets (implants under the skin), any treatment that pushes levels above the normal female range, and compounded "custom" testosterone products.

If testosterone is prescribed, it can take 3 to 6 months to judge whether it is helping. The Global Consensus advises stopping if there is no benefit by 6 months.

Tibolone

Tibolone is a tablet that acts a little like estrogen, progesterone and testosterone. The Indian Menopause Society notes that it can be used for libido problems. The BMS notes it is not sufficiently androgenic or estrogenic for many women. Your doctor can tell you whether it is suitable for you.

Side effects and safety

When levels are kept within the normal female range, side effects are uncommon. The most common are:

• Acne
• Extra hair growth on the face or body
• Some weight gain

These usually settle if the dose is lowered or treatment is stopped. Hair loss from the scalp, a deeper voice and enlargement of the clitoris are rare at female doses.

Long-term safety, especially for the heart and breasts, has not been fully established. The Global Consensus notes that safety beyond 24 months has not been confirmed, though short-term data are reassuring.

Who should avoid it or take extra care

• Women who are pregnant or breastfeeding
• Women with active liver disease
• Women who have had hormone-sensitive breast cancer (only in special cases, with specialist advice)
• Women whose testosterone levels are already in the upper range or high

One practical point: skin contact with partners or children should be avoided until the cream or gel has dried, and you should wash your hands straight after applying it.

Body-identical vs "bioidentical" compounded hormones

The BMS states that compounded bioidentical testosterone products are not recommended by regulators or menopause societies, and the Global Consensus also advises against them. More widely, the BMS says compounded "bioidentical" hormones are not evidence based for safety and effectiveness, and that regulated products should be used wherever possible. The North American Menopause Society raises similar concerns. Read more on our BHRT page.

Questions women often ask

Will testosterone give me more energy?

Some women report this, but current research does not show that testosterone improves energy, mood or memory in women. It is not recommended for these reasons alone. Tiredness is worth looking into for other causes, such as anaemia, thyroid problems or poor sleep.

Can I have a blood test to see if I need testosterone?

A blood test cannot tell whether low desire is caused by low testosterone. The decision is based on your symptoms and a full assessment. Blood tests are used to check your starting level and to keep your level safe during treatment.

Will it make me look masculine?

At the low doses used for women, and with regular blood tests, changes such as a deeper voice are rare. Acne and extra hair growth can happen and usually improve if the dose is reduced.

Do I need to take HRT as well?

Doctors usually try standard HRT first, as estrogen alone often improves desire, comfort and sleep. The BMS notes that testosterone without estrogen tends to cause more side effects such as acne and hair growth, so it is not usually used on its own in routine practice.

How long would I take it for?

If it helps, treatment is reviewed regularly. If there is no benefit after about 6 months, it should be stopped.

Talk to a NuHer doctor

Low sexual desire is common, and it is nothing to feel embarrassed about. A doctor can help you understand what may be behind it and what the options are. NuHer is a doctor-led menopause clinic. We see women in person at Nariman Point, Mumbai, and by video across India, Monday to Saturday, 10 am to 7 pm. A good first step is to take the free menopause assessment. You can also book a consultation with one of our doctors.

References

1. Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660–4666. https://pmc.ncbi.nlm.nih.gov/articles/PMC6821450/
2. Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754–766. https://research.monash.edu/en/publications/safety-and-efficacy-of-testosterone-for-women-a-systematic-review/
3. British Menopause Society. Tool for clinicians: Testosterone replacement in menopause (May 2026). https://thebms.org.uk/wp-content/uploads/2026/05/08-NEW-BMS-TfC-Testosterone-replacement-in-menopause-MAY2026-A.pdf
4. National Institute for Health and Care Excellence (NICE). Menopause: identification and management (NG23). Published 2015, updated 2024. https://www.nice.org.uk/guidance/ng23
5. Meeta M, Digumarti L, Agarwal N, Vaze N, Shah R, Malik S. Clinical practice guidelines on menopause: an executive summary and recommendations: Indian Menopause Society 2019–2020. J Midlife Health. 2020;11(2):55–95. https://pmc.ncbi.nlm.nih.gov/articles/PMC7688016/
6. British Menopause Society. Consensus statement: Bioidentical HRT. https://thebms.org.uk/publications/consensus-statements/bioidentical-hrt/
7. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. https://pubmed.ncbi.nlm.nih.gov/35797481/