Testosterone and the Menopause: What Women Need to Know

2 Feb

For most of us, testosterone is still filed mentally under “men’s hormones”. The word conjures images of muscle bulk and macho energy, not midlife women juggling work, sleep deprivation and menopausal symptoms. And yet, women produce testosterone throughout their lives, and over time, levels can fall in ways that genuinely affect quality of life.

So why is testosterone suddenly part of the menopause conversation? When is it helpful and when is it not. Let’s break it down.

First things first: women have testosterone too

Before the menopause, women produce testosterone in their ovaries and adrenal glands. Levels decline gradually with age, but for some women the drop feels anything but subtle, particularly during perimenopause and after menopause.

Testosterone doesn’t work alone. It interacts closely with oestrogen, which means that when oestrogen levels fall, the effects of lower testosterone can become more noticeable too.

Still, testosterone is not a routine menopause treatment. In the UK, it is only recommended in specific circumstances and understanding those boundaries matters.

What are the signs of low testosterone in women?

Low testosterone doesn’t announce itself loudly. There’s no single symptom that screams “this is hormonal”, which is partly why it’s so often missed.

Women may notice:

A persistent low libido, particularly reduced sexual desire
A lack of sexual responsiveness or pleasure
Ongoing fatigue that doesn’t improve with rest
Reduced motivation or drive
Lower mood or confidence
Difficulty building or maintaining muscle despite exercise

Crucially, these symptoms overlap with menopause itself, stress, depression, poor sleep, and thyroid problems. Which is why testosterone is never a first-line treatment.

Does low testosterone affect long-term health?

This is where things get nuanced. There is no strong evidence that low testosterone in women leads to serious long-term health problems such as heart disease or dementia. Unlike oestrogen, testosterone is not prescribed to protect bones, the heart or cognition.

The main recognised impact is on sexual wellbeing and quality of life. And that matters.

Loss of sexual desire can affect relationships, self-esteem, identity and mental health, especially at a life stage already full of change. The NHS recognises this, which is why testosterone may be considered in very specific cases.

When might testosterone be appropriate?

According to NHS and NICE-aligned guidance, testosterone may be considered only for women who:

Are peri- or post-menopausal
Have persistent low sexual desire (hypoactive sexual desire disorder)
Have already tried adequate oestrogen-based HRT (where appropriate)
Reviewed and treated treatment of vulval and vaginal symptoms (GSM)
Have no other identifiable cause for their symptoms
In other words: testosterone is not often a standalone fix, and usually prescribed alongside oestrogen (and progesterone). If oestrogen levels are low or fluctuating, these must be addressed as well.

What form does testosterone come in?

In the UK, testosterone for women is usually prescribed off-licence, meaning the products are licensed for men but used at much lower doses for women. It’s typically given as a gel, applied to the skin daily. Tablets and injections are not recommended for women, as they can cause hormone levels to spike. The aim is not to “boost” testosterone, but to restore levels to the female physiological range. There is a cream as well, called Anrdofeme, comes in a tube containing a 1% testosterone cream and is easy to apply. It is body identical, meaning it is identical to the testosterone produced your ovaries. Androfeme has now been approved by MHRA and licensed from 2026 and is the only female specific testosterone available in the UK.

Does it work?

For the right women, yes. Evidence suggests testosterone can improve sexual desire and satisfaction. Effects are usually felt within 3–6 months. If there’s no clear benefit by six months, treatment should be stopped.

What about side effects?

When prescribed and monitored correctly, side effects are uncommon, but they do matter.

Possible side effects include acne or oily skin, increased facial or body hair, scalp hair thinning, voice deepening (rare but potentially irreversible). These effects are more likely if doses are too high or treatment continues without monitoring. This is why testosterone should never be sourced online or taken without medical supervision.

What precautions are needed?

Good menopause care is not just about prescriptions, it’s about follow-up. If you’re prescribed testosterone, you should expect a review at 2- 3 months and again at 6-12 months, monitoring of symptoms, not just blood levels, and dose adjustment.

Routine blood testing is always required at follow up and once a year. If you notice unwanted hair growth, voice changes or acne, you should report this promptly and stop your treatment until review.

Testosterone should be stopped if there’s no improvement after six months, side effects outweigh benefits, your circumstances or health change, or you no longer feel it’s helping your quality of life.

Determining what’s right for you

At Jaya Life, the focus is on individualised, evidence-based care, and grounded in real life. That means starting with the basics, listening properly, and only adding treatments when they’re genuinely appropriate.

Testosterone can be transformative for the right woman, at the right time, for the right reason.

It’s not a cure-all. But when sexual wellbeing has quietly slipped away, and oestrogen alone hasn’t helped, testosterone may offer a way back to feeling more like yourself again, with care, caution and proper support.

If you’re wondering whether it’s relevant for you, please book a consultation, where your symptoms, history and priorities can be explored, helping to decide what support is right for you.