Testosterone and Menopause : What Women Need to Know
Article written by Dr Mari Walling, British Menopause Society Registered Specialist, GP, Co-founder of Lemala Health, November 2025 This information is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personal guidance.
As women age, testosterone levels naturally decline. Many women will not notice these changes, while others may experience symptoms that affect daily life.
Testosterone can be the final missing piece of the jigsaw in menopause management for some and appears to be especially important in women with premature ovarian insufficiency (POI), early menopause and/or surgical (removal of ovaries).
This guide explains what testosterone does, who may benefit, how testosterone therapy in menopause works, and what to expect.
Symptoms of low Testosterone in Menopause:
Low testosterone levels can lead to a variety of symptoms including:
Low sex drive
Decreased sexual satisfaction
A lack of energy or feeling tired
Vaginal dryness
Mood changes, including depression and anxiety
Hair thinning
Loss of muscle strength and tone
Sleep issues, such as insomnia and disrupted sleep
Should you take Testosterone for Menopause?
Many women with low testosterone do not experience symptoms, and treatment is usually not needed unless symptoms are affecting quality of life.
It’s also not usually recommended in routine clinical practice for testosterone to be used on its own to treat menopausal symptoms.
The British Menopause Society advises that testosterone replacement in menopause can be considered should oestrogen alone fail to improve low libido. It can be used safely alongside hormone replacement therapy (HRT) and vaginal oestrogen.
Some women may also gain improvement in mental sharpness, energy levels, musculoskeletal strength and joie de vivre, but there is not enough evidence for testosterone to be formally recommended for these reasons in current guidelines.
Note: Oral oestrogen can increase sex hormone binding globulin (SHBG), lowering free testosterone and potentially worsening symptoms. Switching to transdermal oestrogen may resolve this issue.
Do I need a blood test?
Prior to starting testosterone replacement, levels should be confirmed with a blood test.
Blood levels will then need to be monitored at 3-6 months and then yearly after this. This is to ensure that testosterone levels stay within the normal female physiological range and reduce the risk of side effects.
Types of testosterone replacement for menopause:
Most testosterone products come as a cream or gel that is rubbed into the skin daily (transdermal preparations).
The common preparations used are Testogel and Androfeme - they are both body-identical, containing testosterone with the same chemical structure as testosterone naturally produced by the body.
In August 2025, Androfeme, a testosterone cream, formulated specifically for women, was approved by the UK regulator, the Medicines and Healthcare products Regulator (MHRA).
Until now, Androfeme has only been available through private clinics, under a special import licence. This approval means a UK-licensed version is expected to be available in 2026. NHS availability will depend on a future NICE appraisal, so for now women can still access AndroFeme privately with a prescription. AndroFeme must not be used by anyone with an almond allergy.
Testogel and other male-licensed testosterone gels can still be used off label for women in line with British Menopause Society guidance, and these remain commonly prescribed options.
How do I use Testosterone Cream or Gel ?
Apply to clean, dry skin on the upper outer thigh, buttock, lower tummy or inner forearm.
Rotate application sites regularly to minimise hair growth.
Rub in the gel thoroughly and wash hands immediately.
Allow 30 seconds to dry before dressing
Wait 30 minutes before bathing, or applying other creams
Apply at the same time each day for best results.
How long before I see any improvement ?
Response to testosterone treatments differs in each person.
Some women notice improvement immediately, some report a few months for the full effects. When we monitor your blood levels, your dose can be adjusted if needed.
Testosterone does not work in everybody. If you show no response by 3 months, we may recommend you stop treatment, and we explore other causes for your symptoms.
What are the side effects of testosterone ?
Side effects are rarely seen with testosterone treatment in women, as doses are low, and levels are monitored regularly.
Some women may notice increased hair growth at the site of application, greasy skin, and acne. Other rarer side effects include facial hair, voice deepening, weight gain and clitoral enlargement.
What are the risks of testosterone ?
Short-term studies up to five years show no increased risk of breast cancer, heart disease, or stroke in healthy postmenopausal women.
Long-term data are limited, so ongoing monitoring is important.
Summary
Testosterone can be a safe and helpful treatment for some women, especially for persistent low sexual desire during or after menopause. Treatment is low dose, monitored carefully, and usually well tolerated.
A specialist consultation ensures treatment is suitable, safe, and tailored to your individual needs.
If this article was helpful, explore our full library of menopause resources at Lemala Health