You used to want sex, and now you mostly don’t. You haven’t stopped caring, and you haven’t decided it doesn’t matter. The desire that used to turn up on its own has quietly gone missing. Perhaps you’ve started HRT, the hot flushes have settled and you’re sleeping better, but that part of you still hasn’t come back. Then you read online that testosterone for women is the answer to tiredness, brain fog, flat mood and low libido all at once, and you wonder whether it’s the missing piece.
These are questions I hear all the time from my patients, whether they have a partner or not. My view is that testosterone can do one thing well: help low sexual desire, in the right woman, prescribed and monitored properly. It isn’t the fix for everything else, and I’d rather you knew that before you start than found out six months in.
Your hormones have been changing for longer than you think
Testosterone is often called a male hormone, but women make it too, mainly in the ovaries and the adrenal glands. It plays a part in sexual desire and arousal, and it has roles in muscle, bone and brain tissue.
Levels fall gradually from a woman’s twenties onwards, then level off around the menopause. The exception is when the ovaries are removed: surgery causes a sharp drop, so women who have had this operation may notice the change much more suddenly. The average age of the menopause in the UK is 51, and by then testosterone has usually been drifting down for many years.
That slow change is part of why low desire can feel so confusing. There’s rarely a single day when it went, and it isn’t always easy to bring up, even with a doctor (I know this can be hard!). It’s still worth raising, because there is a lot that can be done.
Low desire almost always has more than one cause
Before testosterone comes into it, I want us to look at everything else. Low desire is usually multifactorial, and several causes are worth ruling out or treating first:
- vaginal dryness or pain during sex
- poor sleep
- low mood or strain in the relationship
- side effects of medication
- thyroid disease or anaemia
- ongoing stress
Treating vaginal dryness with local oestrogen, getting your HRT to an effective dose, reviewing antidepressants and improving sleep often make a meaningful difference before testosterone is considered at all.
Here’s the one thing I’d ask you to do before your appointment. For a week, jot down a couple of lines each day: when you first noticed your desire changing, whether sex has become uncomfortable, how you slept, and any medicines you’ve started in the past year. These small details are exactly what helps us find the real cause, and I promise they add up.
If testosterone turns out not to be suitable for you, or it simply isn’t something you want, this is still the work that matters most. Many of the causes on that list can be treated, and that is often where improvement begins.
What testosterone for women can do, and what it can't
For menopausal women with distressing low sexual desire, testosterone may improve:
- desire and arousal
- how often sex feels satisfying
- orgasm
- the distress that low desire causes
NICE guidance supports considering testosterone for menopausal women with low sexual desire when HRT alone hasn’t worked, recognising that this is an off-label use in the UK.
Now the other side. Many women ask me whether testosterone will lift their energy, sharpen their concentration, improve their mood, build muscle or protect their bones. Testosterone does act on these tissues, but current evidence doesn’t show a benefit for muscle strength, mood, general wellbeing or memory, and there isn’t enough data on bone I’d much rather you started with realistic expectations than felt let down later. If tiredness or low mood is what’s troubling you most, that deserves its own proper look. But having said that, many women do experience improvement in some of those symptoms mentioned above, so it’s always worth exploring testosterone as it’s one of your own body’s hormones and it deserves a discussion.
If we try it, we do it carefully
Testosterone is usually considered for women who are already on HRT, including those whose menopause was early or surgical, and whose low desire has continued despite enough oestrogen and after other causes have been addressed.
It may be less appropriate, or need particular caution, if:
- you’re pregnant, planning a pregnancy or breastfeeding
- you have untreated androgen-sensitive problems, such as significant acne or unwanted hair growth
- you’ve had a hormone-sensitive cancer, where decisions need specialist oncology input
- you have abnormal bleeding that hasn’t yet been investigated
- your low desire is clearly explained by something else that can be treated, such as painful sex, depression or medication effects
There is currently no testosterone product licensed for women in the UK. It’s prescribed off-label as a small, measured dose of a gel or cream applied to the skin, and this should be explained clearly and recorded as part of your consent. The British Menopause Society publishes practical guidance for clinicians on testosterone in menopausal women, and this is the approach I follow:
- A full assessment of your symptoms, menstrual and menopause history, sexual health, mood, sleep, relationships, medicines and risk factors.
- Getting the basics right: HRT at an effective dose and route, local treatment for vaginal dryness, and other reversible causes addressed.
- Baseline blood tests, usually testosterone and SHBG (the protein that carries it in the blood), plus thyroid or iron tests where needed. Blood tests support the clinical picture; on their own, they don’t diagnose low testosterone in women.
- An honest conversation and a trial of treatment, with the benefits, uncertainties, side effects and off-label status explained, and goals agreed.
- A repeat blood test at 6 to 12 weeks to check your level stays within the normal female range, a review at six months, then a yearly review if it’s helping.
- Stopping if it hasn’t helped. If there’s no meaningful improvement by six months, treatment should stop so we can look again at other causes.
Testosterone can be prescribed within NHS menopause services, though availability varies locally. Whichever route you take, it should never be used without this structure. Unmonitored use, high doses and products bought online carry a real risk of harm.
The side effects are usually mild, but take them seriously
At carefully monitored doses that keep your level within the normal female range, side effects are usually mild and reversible:
- acne or oilier skin
- extra hair growth, often where the gel or cream is applied
Higher doses can cause scalp hair thinning, a deeper voice, noticeable facial hair or enlargement of the clitoris. These are uncommon at correct doses, but they may not fully reverse, which is exactly why monitoring matters.
One safety point is easy to miss. Testosterone gel can pass to other people through skin contact, and children are particularly at risk: in children, exposure can cause genital enlargement and early puberty. Wash your hands after applying it, cover the area with clothing once it’s dry, and wash the area before close skin contact with anyone.
Long-term safety data on breast and heart health in women using low-dose testosterone are still limited. That uncertainty isn’t comfortable, I know, and it’s the reason treatment is reviewed regularly rather than carried on indefinitely without a check. Broader information about menopause symptoms and treatment options is available from the NHS menopause pages, and the Royal College of Obstetricians and Gynaecologists is another reliable UK source.
Testosterone is for desire, not for everything, and it deserves to be done properly
Losing your desire after the menopause is common, and you don’t have to simply live with it. Testosterone can be a real help when the basics are in place and HRT alone hasn’t been enough. Whether or not testosterone turns out to be right for you, you deserve an answer to why your desire has changed. Ask for that, and don’t settle for less.
In one unhurried 45-minute consultation at 10 Harley Street, Dr Katy Kasraie will look at your health history, your goals and every suitable option, including approaches that do not involve medication. No referral needed, and most major insurers are accepted. Click here to book your appointment.