Introduction

Testosterone is often overlooked in women’s health, but it plays a valuable role in libido, energy, mood, muscle strength, bone health, and cognition. As women enter perimenopause and menopause, testosterone levels may start to decline. For some women, adding testosterone to standard hormone therapy (HRT or MHT) may help when symptoms persist. That said, this approach must be used cautiously, in evidence-informed specialist settings.

What Do Guidelines Permit (and Not)?

In the UK, NICE guidelines (NG23) permit consideration of testosterone supplementation only for women with hypoactive sexual desire disorder (HSDD) whose symptoms persist despite optimised HRT/MHT [1]. It is not broadly endorsed for other symptoms such as fatigue, mood or cognition in guidelines.

That said, clinical practice and smaller studies report benefits beyond sexual desire, including increased energy, improved mood, better cognition, and support for musculoskeletal health, but these are not formally approved indications [2][3].

Recent Advance: AndroFeme® Cream Licensed in the UK

A major development is that AndroFeme®, a testosterone cream designed for women, has now been licensed in the UK for postmenopausal women with HSDD [4]. Unlike off-label use of male testosterone products, AndroFeme includes a dosing syringe to deliver precise low doses suited for women, reducing guesswork and risk.

As clinicians, this gives us a more standardised option for prescribing testosterone in women (where appropriate), rather than adapting male preparations.

Potential Benefits of Testosterone Therapy

When used correctly in suitable patients, testosterone therapy may offer:

• Improved sexual desire, arousal and satisfaction, particularly in cases of HSDD
• Enhanced energy, vitality and mood
• Support for cognitive clarity and focus
• Contribution to muscle mass, strength, and bone health, especially when paired with resistance training
• Possible improvements in sleep and recovery

It’s crucial to emphasise this is supportive therapy, not a cure, and should be part of a holistic menopause plan.

Safety, Monitoring & Side Effects

Testosterone must always be prescribed in low, carefully monitored doses. Possible side effects include:

• Skin irritation or sensitivity at the application site
• Mild acne or increased hair growth (in the area of application)
• Changes in lipid profiles (rare)
• Voice changes are unlikely at low doses but should be monitored

Importantly, at recommended low doses, current evidence does not suggest a clear increase in breast cancer, cardiovascular disease, or clotting risk when used appropriately in women, but large long-term trials are lacking [2][5].

Regular monitoring is essential—every 3 to 6 months initially—for blood lipids, liver function, testosterone levels, symptoms, and side effects.

How It’s Used in Practice

• Administered as a low-dose transdermal cream or gel (e.g. AndroFeme)
• A trial period of 3–6 months helps evaluate response
• If benefits are seen and side effects minimal, therapy may continue, often with the GP prescribing under oversight
• Adjustments are made based on symptom response, lab results, and tolerability

It is not recommended to start with high doses—starting low and going slow is the safest approach.

When to Discuss Testosterone Therapy

You may explore this option if:

• You have persisting low sexual desire (HSDD) despite optimised HRT
• You experience residual fatigue, low mood or cognitive fog after other therapies
• You want to support musculoskeletal strength and recovery
• You understand the risks, benefits, monitoring and are under specialist care

It’s not appropriate for everyone, especially those with active hormone-responsive cancers, untreated cardiovascular disease, or contraindications to testosterone.

Local and Remote Support

At The Menopause Medic, specialist testosterone consultations are offered by accredited clinicians. You can attend in person in Berkhamsted or St Albans, or remotely across Hertfordshire, Watford, Hemel Hempstead, Tring, Harpenden, Welwyn Garden City, and beyond.

References

[1] NICE NG23 – Menopause: Diagnosis and Management: https://www.nice.org.uk/guidance/ng23
[2] British Menopause Society – Testosterone use in women (clinical guidance)
[3] Health in Menopause – Testosterone cream for postmenopausal women UK: https://healthinmenopause.co.uk/testosterone-cream-for-postmenopausal-women-uk/
[4] Lawley Pharma – MHRA approves AndroFeme for UK postmenopausal women: https://www.lawleypharm.com.au/news/mhra-approves-testosterone-cream-for-uk-postmenopausal-women/
[5] Clinical reviews and small trials on low-dose testosterone safety in women