Testosterone for Women in Menopause: What the Clinical Data Actually Shows

By Dr Joanne Hobson Chief Executive Officer · MBBS

19 January 2026 Updated 1 October 2026 23 min read

If you’ve been reading about menopause on social media, you’ve probably encountered claims that testosterone is the “missing third hormone” in HRT—a miracle solution for energy, brain fog, muscle loss, weight gain, joint pain, and low libido. Influencers and wellness websites often present testosterone as an essential part of every woman’s menopause treatment, suggesting that doctors who don’t prescribe it routinely are “behind the times.”

But here’s what the clinical evidence actually shows: testosterone has one evidence-based indication for women in menopause—hypoactive sexual desire disorder (HSDD). That’s persistent, distressing low sexual desire that causes personal distress, assessed after optimising other factors.

This doesn’t mean testosterone can’t be helpful. It means that prescribing it requires individualised assessment, proper context, and realistic expectations based on what the research actually demonstrates—not what’s trending online.

In this article, I’ll explain what the clinical data shows about testosterone in menopause, why prescribing requires looking at the whole person and hearing their story, and how evidence-based medicine approaches testosterone therapy with precision and individualised care.

1. What testosterone actually does in women’s bodies

Testosterone is often called a “male hormone,” but women produce it too—just in much smaller amounts. In women, testosterone is produced by:

The ovaries (approximately 25%)
The adrenal glands (approximately 25%)
Peripheral conversion from other hormones (approximately 50%)

Testosterone in women plays several physiological roles:

Sexual function: Contributes to libido, arousal, and sexual satisfaction in some women
Bone health: Supports bone density
Muscle mass and strength: Helps maintain lean body mass
Mood and wellbeing: May influence energy and mood (though evidence is limited)

However—and this is crucial—the relationship between testosterone levels and these functions is not straightforward. Higher testosterone doesn’t automatically mean better sexual function, more energy, or stronger muscles. Context matters enormously.

Normal testosterone ranges in women

Testosterone levels in women are:

Approximately 10-20 times lower than in men
Highly variable between individuals
Difficult to measure accurately (assays designed for male ranges often unreliable at female levels)
Not reliably correlated with symptoms

The International Menopause Society (IMS) notes that there is no validated “low testosterone” threshold for women that reliably predicts who will benefit from treatment.

2. The testosterone decline myth: what Professor Susan Davis’ research shows

One of the most common claims online is that “menopause causes testosterone to plummet” or that testosterone is the “third hormone lost at menopause” alongside oestrogen and progesterone.

The clinical data doesn’t support this.

What the research actually demonstrates

Professor Susan Davis, a leading researcher in women’s androgen physiology, and colleagues published a major analysis in 2025 examining testosterone patterns across women’s lifespans. Their findings:

Testosterone decline is primarily age-related, not menopause-related
Blood testosterone concentrations gradually decline from midlife
Levels reach their lowest point around ages 58-59
Then rise modestly again in later years
Natural menopause itself has no significant impact on testosterone levels

The authors conclude: “These data do not support menopause per se as an indication for testosterone supplementation.” (ScienceDirect)

Professor Davis has consistently emphasized in her public communications: menopause is not the biological “switch” that suddenly drops testosterone. (Monash University)

The exception: surgical menopause

There is one important exception: bilateral oophorectomy (removal of both ovaries) does cause an acute drop in testosterone because the ovaries contribute about 25% of testosterone production.

Women who have had both ovaries removed may experience:

More pronounced decline in testosterone
More severe sexual function changes
Potentially greater benefit from testosterone therapy

This is recognized in clinical guidelines, and we’ll discuss it further in Section 13.

Why this matters for prescribing

If testosterone naturally declines with age (not menopause), then:

Every postmenopausal woman doesn’t automatically need testosterone
“Replacing” testosterone to youthful levels isn’t evidence-based
Prescribing should be symptom-driven and individualized, not routine
The focus should be on who benefits, not blanket supplementation

3. The evidence-based indication: hypoactive sexual desire disorder (HSDD)

So when is testosterone indicated? The answer is clear across major international guidelines:

Testosterone therapy has one evidence-based indication in postmenopausal women: hypoactive sexual desire disorder (HSDD).

What is HSDD?

HSDD is defined as:

Persistent or recurrent deficiency or absence of sexual desire
Causes personal distress (not just partner distress)
Not better explained by relationship problems, medication side effects, mental health conditions, or other medical issues

Key point: This is not simply “I don’t feel like sex as often as I used to.”

HSDD is when low desire is:

Distressing to the woman herself
Persistent despite addressing other factors
Impacting quality of life or relationships in a meaningful way

What the evidence shows

Multiple randomized controlled trials demonstrate that testosterone can:

Increase the number of satisfying sexual events per month
Improve sexual desire and arousal
Reduce distress related to low desire
Improve overall sexual satisfaction

The International Menopause Society 2019 Global Consensus Position Statement concluded: “There is sufficient evidence to support the use of testosterone therapy for postmenopausal women with hypoactive sexual desire disorder.”

The British Menopause Society guidance aligns with this, emphasizing that testosterone should be considered after optimizing other factors (which we’ll discuss below).

What HSDD assessment involves

Proper assessment for HSDD includes:

Detailed sexual history
Understanding the whole context of the person’s life and relationships
Screening for depression, anxiety, relationship stress
Medication review (especially SSRIs/SNRIs which commonly reduce libido)
Assessment of genitourinary syndrome of menopause (GSM)
Evaluation of sleep, fatigue, chronic pain
Consideration of past sexual trauma or negative experiences

This is why individualised assessment is essential. HSDD cannot be diagnosed from a blood test or a single symptom—it requires understanding the person’s whole story.

4. Why “low testosterone = low libido” is too simple

One of the most persistent misconceptions is that low libido in menopause is simply caused by low testosterone, and that measuring testosterone levels will tell you who needs treatment.

The clinical reality is far more complex.

Testosterone levels don’t predict libido

Research consistently shows:

Women with higher testosterone can have low desire
Women with lower testosterone can have high desire
There is no reliable correlation between testosterone level and sexual desire in individual women
Testosterone levels do not predict who will respond to testosterone therapy

This is why guidelines state: Testosterone therapy should not be based on testosterone levels alone. (IMS)

Libido is biopsychosocial

Sexual desire in women is shaped by multiple interconnected factors:

Biological factors:

Hormone levels (oestrogen, testosterone, thyroid)
Physical health and chronic conditions
Medications (especially antidepressants, blood pressure medications)
Pain (especially GSM-related sexual pain)
Fatigue and sleep deprivation
Menopausal symptoms (hot flushes, night sweats)

Psychological factors:

Depression and anxiety
Stress and overwhelm
Body image and self-esteem
Past sexual trauma or negative experiences
Performance anxiety
Mental load and cognitive fatigue

Social and relational factors:

Relationship quality and communication
Partner’s sexual function and health
Life stage pressures (caring for parents, children at home, work demands)
Cultural and religious messages about sexuality
Privacy and opportunity
Emotional intimacy and connection

The responsive desire model

Research by Dr Emily Nagoski and others has shown that many women (particularly in long-term relationships) experience responsive desire rather than spontaneous desire:

Spontaneous desire: Feeling desire “out of the blue”
Responsive desire: Desire emerges in response to pleasurable stimulation and context

Responsive desire is completely normal, but if a woman expects spontaneous desire and doesn’t experience it, she may mistakenly believe something is “wrong” hormonally.

This is why hearing the whole story matters so much in assessment.

Clinical implications

Because libido is multifactorial:

Testosterone alone may not “fix” low desire if other factors aren’t addressed
Some women benefit enormously from testosterone; others don’t respond at all
Combination approaches (hormone + psychosexual + relationship work) often work best
Individualised assessment is essential

The British Menopause Society emphasizes: “Assessment should include biological, psychological, and relationship factors before considering testosterone therapy.”

5. What about energy, brain fog, weight, and joint pain?

This is where online claims diverge most sharply from clinical evidence.

Social media is full of testimonials about testosterone “curing” brain fog, restoring energy, helping with weight loss, relieving joint pain, building muscle, and improving mood.

Many women genuinely do report these benefits. But here’s the critical point: these claims are not supported by the evidence base used for prescribing.

What the guidelines say

Major international guidelines are clear:

There is insufficient evidence to recommend testosterone for:

Cognitive function or “brain fog”
Energy or fatigue
Mood or wellbeing (except as part of sexual function improvement)
Weight management or body composition
Muscle strength (in healthy women)
Joint pain or musculoskeletal symptoms
Cardiovascular disease prevention
Bone density (as first-line therapy)

The International Menopause Society states: “Current evidence does not support the use of testosterone to improve energy, cognition, musculoskeletal symptoms, or cardiovascular health in postmenopausal women.”

Why do women report these benefits?

If the evidence doesn’t support these uses, why do so many women report improvement? Several factors may be at play:

1. Placebo effect

In clinical trials, placebo response rates for symptoms like fatigue, mood, and wellbeing are high—often 30-40%. This doesn’t mean symptoms aren’t real; it means that expectation, attention, and context powerfully influence how we feel.

2. Concurrent optimization of oestrogen

Women often start or optimize oestrogen therapy around the same time as testosterone. Oestrogen has clear evidence for improving energy, mood, sleep, joint pain, and cognitive function. The benefits may be from oestrogen, but attributed to testosterone.

3. Treatment of GSM improving overall wellbeing

When painful sex improves, sleep improves (less night-time discomfort), mood improves (less distress), energy improves (better sleep), and relationship stress decreases. The indirect effects are substantial.

4. Attention to overall health

Women seeking menopause care often simultaneously address sleep, stress, exercise, nutrition, and mental health. These lifestyle factors profoundly affect energy, cognition, and mood.

5. Individual variation and anecdotal experience

Some women may genuinely benefit from testosterone for non-sexual symptoms, but we don’t yet have the evidence to predict who, why, or how safely in the long term.

Why evidence matters for prescribing

Clinicians prescribe based on evidence because:

We need to know which benefits are real vs. placebo
We need long-term safety data (testosterone has not been studied long-term for these broader indications)
We have a responsibility not to create dependence on treatments that may not be necessary
Resources and access to specialist care are limited; we must prioritize evidence-based indications

This doesn’t mean these experiences are “made up”—it means we need better research before we can confidently recommend testosterone for these purposes.

6. Why optimising oestrogen comes first

Before considering testosterone, it’s essential to ensure oestrogen therapy is optimized. Here’s why:

Oestrogen has the strongest evidence base

Unlike testosterone, oestrogen has robust evidence for:

Hot flushes and night sweats (most effective treatment)
Sleep quality (via reducing night sweats and direct effects on sleep architecture)
Mood stability and reduced depression risk in perimenopause
Cognitive function (particularly verbal memory)
Joint pain and musculoskeletal symptoms
Vaginal and vulvar health
Skin health and connective tissue
Bone density
Cardiovascular health (when started appropriately)

Many symptoms that women attribute to “low testosterone” may actually improve with properly dosed and delivered oestrogen.

Oestrogen affects libido too

Oestrogen contributes to sexual function by:

Maintaining vaginal and vulvar tissue health
Supporting natural lubrication
Reducing pain during sex
Improving sleep (fatigue kills libido)
Stabilizing mood (anxiety and depression reduce desire)
Enhancing overall wellbeing

The British Menopause Society guidance states: “Systemic menopausal hormone therapy (MHT/HRT) should be optimized before considering testosterone.”

What “optimizing oestrogen” means

Before adding testosterone, clinicians should ensure:

Adequate oestrogen dose: Some women need higher doses than standard starting doses
Appropriate delivery route: Transdermal (patch/gel) often preferred over oral
Consistent use: Giving oestrogen time to work (typically 3 months minimum)
Appropriate progesterone: Ensuring progesterone/progestogen isn’t causing side effects that worsen symptoms

Learn more about finding the right MHT regimen and managing progesterone intolerance.

7. The crucial role of treating genitourinary syndrome of menopause (GSM)

This is one of the most important—and most overlooked—factors in addressing low libido.

If sex hurts, desire switches off. This is a protective response, not a “hormone deficiency.”

What is GSM?

Genitourinary syndrome of menopause (GSM) includes:

Vaginal dryness, burning, irritation
Pain during or after sex (dyspareunia)
Difficulty with arousal and lubrication
Vulvar itching or soreness
Recurrent urinary tract infections (UTIs)
Urinary urgency and frequency
Urinary incontinence

GSM is caused by declining oestrogen affecting vaginal and vulvar tissue, leading to:

Thinning of tissue (atrophy)
Loss of elasticity
Reduced blood flow
Changed pH (increasing infection risk)
Reduced natural lubrication

How GSM kills libido

Even when emotional intimacy is present, if sex is painful:

Fear of pain overrides desire
Anticipatory anxiety before sex reduces arousal
Avoidance behaviors develop (avoiding intimacy entirely)
Relationship tension increases (partner feels rejected, woman feels guilty)
Body disconnection occurs (avoiding thinking about or touching the genital area)

Adding testosterone will not fix this. The pain must be addressed first.

Treating GSM

First-line treatment for GSM is vaginal oestrogen:

Pessaries, cream, or vaginal ring
Used regularly (typically 2-3 times weekly long-term)
Minimal systemic absorption (safe even in women with breast cancer history, in most cases)
Dramatically improves tissue health, comfort, and lubrication

Learn more in our comprehensive guide: Vaginal Dryness: The So-Often Overlooked Symptom During Menopause

Additional treatments may include:

Vaginal moisturizers (used regularly, not just before sex)
Lubricants (water or silicone-based)
Pelvic floor physiotherapy (if muscle tension or vaginismus present)
Dilators (for gradual tissue stretching if penetration is very painful)
Psychosexual therapy (addressing fear, anxiety, and re-learning pleasure without pain)

The timeline matters

GSM treatment takes time:

Tissue improvement: 4-12 weeks with vaginal oestrogen
Pain reduction: gradual over weeks to months
Desire returning: often follows pain resolution by several months

This is why rushing to testosterone without addressing GSM doesn’t work.

The NICE Menopause Guidelines (NG23) emphasize: “Vaginal oestrogen should be offered as first-line treatment for genitourinary symptoms, and its use should not be limited by duration.”

8. Psychosexual factors: not optional extras

Low sexual desire is rarely “just hormones.” Psychological and relational factors are central—not peripheral—to assessment and treatment.

Common psychological contributors

Depression and anxiety:

Directly reduce libido via neurotransmitter changes
Perimenopausal depression is common (2-4x increased risk)
Antidepressants (especially SSRIs/SNRIs) frequently reduce libido

Learn more: Depression in Menopause

Stress and overwhelm:

Chronic stress elevates cortisol, suppressing sex hormones
Mental load (managing household, family, work) leaves no “space” for desire
Survival mode prioritizes safety over pleasure

Learn more: Managing Stress and Understanding Cortisol

Body image and self-esteem:

Midlife body changes (weight redistribution, skin changes) affect confidence
Feeling “not attractive” reduces willingness to be vulnerable sexually
Societal messages about aging and desirability compound this

Past sexual trauma:

Trauma history can cause protective “shutdown” of desire
May not be disclosed initially (requires safe, trusting therapeutic relationship)
Requires trauma-informed psychosexual or psychological support
Hormone therapy alone won’t address this

Relational factors

Relationship quality:

Unresolved conflict, resentment, or emotional disconnection reduce desire
Lack of emotional intimacy makes physical intimacy feel hollow
Communication about sex may be poor or absent

Partner factors:

Partner’s sexual function issues (erectile dysfunction, premature ejaculation)
Partner’s health problems or chronic illness
Mismatched libido (one partner wants sex more often than the other)
Lack of partner interest in foreplay or pleasure beyond penetration

Life stage pressures:

Caring for aging parents
Children still at home or boomerang children returning
Career demands
Financial stress
Lack of privacy or time alone

Why this matters for testosterone prescribing

If low desire is driven by:

Untreated depression
SSRI side effects
Chronic relationship conflict
Past trauma
Overwhelming stress

…then testosterone will not be the solution.

This is why guidelines emphasize: Psychological and relational assessment must precede testosterone therapy. (BMS)

Learn more about holistic support: Psychosexual Medicine: Understanding How Life, Hormones, and Emotions Affect Intimacy

9. Individualised assessment: hearing your whole story

This is where evidence-based prescribing becomes truly person-centered.

Testosterone prescribing is not about ticking boxes or meeting a threshold on a blood test. It’s about understanding the whole person, hearing their story, and determining what will actually help.

What a comprehensive assessment involves

A thorough evaluation for low desire and consideration of testosterone includes:

1. Sexual history

When did desire change? Was it sudden or gradual?
What was desire like before? (Establish baseline)
Is arousal affected? Can you become aroused if stimulation occurs?
Is orgasm affected?
Is sex painful? (Screen for GSM)
How does low desire make you feel? (Distress assessment)
How does it affect your relationship?

2. Relationship context

How is your relationship overall?
Do you feel emotionally connected to your partner?
Is there unresolved conflict or resentment?
How is your partner’s sexual function?
Do you feel desired by your partner?
Is there time and privacy for intimacy?

3. Psychological health

Are you experiencing depression or anxiety?
How is your mood day-to-day?
What is your stress level?
How are you sleeping?
Have you experienced sexual trauma (past or recent)?
How do you feel about your body?

4. Medical and medication review

What medications are you taking? (Especially SSRIs, SNRIs, beta-blockers)
Any chronic health conditions?
Thyroid function checked recently?
Are you on MHT? If so, is it optimized?
GSM symptoms assessed and treated?

5. Life context

What else is happening in your life right now?
Work stress? Family responsibilities?
How much time do you have for yourself?
What brings you joy and pleasure outside of sex?

Why this comprehensive approach matters

Two women might both say “I have no libido” but have completely different underlying drivers:

Woman A:

Optimized on MHT
GSM treated, no pain
Strong relationship, emotionally connected
Good mental health
Still has persistent, distressing low desire
→ May benefit from testosterone trial

Woman B:

Untreated GSM, sex is painful
Taking sertraline (SSRI) for anxiety
Relationship conflict, feeling disconnected
Exhausted from caregiving responsibilities
→ Testosterone will not help; needs GSM treatment, medication review, possibly couples therapy, stress management

This is why “hearing your whole story” isn’t a nice-to-have—it’s essential for good prescribing.

At TMC Health, we take time to understand:

Your unique symptom pattern
Your relationship and life context
Your medical and psychological history
Your goals and what matters most to you
What you’ve already tried and how it’s worked

Only then can we make truly individualized recommendations about whether testosterone is likely to help—or whether other interventions should come first.

10. When testosterone can be genuinely helpful

After everything we’ve discussed, let’s be clear: testosterone can be transformative for the right person, at the right time, for the right indication.

The evidence-based scenario

Testosterone is most likely to help when:

1. HSDD is present

Persistent, distressing low sexual desire
Causing personal distress (not just partner frustration)
Affecting quality of life or relationship satisfaction

2. Other factors have been optimized

MHT (oestrogen ± progesterone) optimized for at least 3 months
GSM treated if present (vaginal oestrogen, lubricants, pain addressed)
Medications reviewed (SSRI switched if possible, or dose adjusted)
Sleep, stress, and overall health addressed

3. Psychological and relational factors have been considered

Depression/anxiety treated if present
Relationship issues acknowledged and being addressed (therapy if needed)
Trauma history disclosed and appropriate support in place

4. Expectations are realistic

Testosterone may help desire; it won’t fix relationship problems
Response is gradual (typically 3-6 months to assess benefit)
Not everyone responds
Benefit may be modest (e.g., 1-2 more satisfying sexual events per month)

The surgical menopause exception

Women who have had bilateral oophorectomy (both ovaries removed) may benefit more from testosterone because:

Acute drop in testosterone from ovarian loss
Often more severe sexual function changes post-surgery
May benefit from earlier consideration of testosterone (alongside estrogen)

The IMS acknowledges this, noting testosterone may be particularly beneficial in this population.

Real-world benefits

When testosterone is appropriately prescribed, women may experience:

Increased spontaneous sexual thoughts or desire
Increased receptiveness to partner’s initiation
Enhanced arousal during sexual activity
Increased pleasure and satisfaction during sex
Reduced distress about low desire
Improved relationship satisfaction (secondary to sexual function improvement)

Some women also report:

Increased energy (though not evidence-based)
Improved mood (though may be related to improved sexual satisfaction)
Better sense of wellbeing

These anecdotal benefits are real for many women—but we prescribe based on the evidence-based indication (HSDD) while acknowledging that broader benefits may occur.

What testosterone won’t do

Testosterone will not:

Fix relationship problems
Overcome past trauma (therapy needed)
Compensate for inadequate sleep or overwhelming stress
Make painful sex pleasant (GSM treatment needed first)
Work if SSRI/SNRI is blocking desire (medication review needed)
Guarantee response (some women don’t respond even when appropriately prescribed)

11. How testosterone is prescribed safely

When testosterone is indicated, it must be prescribed carefully to maintain levels within the female physiological range and minimize side effects.

Formulations available in the UK

1. Testosterone cream or gel (compounded)

Applied to skin (inner thigh, lower abdomen, upper arm)
Typical dose: 5-10mg daily
Absorbed through skin
Requires compounding pharmacy (not available as licensed product for women in UK)

2. Testogel/Tostran (licensed for men, used off-label for women)

Testosterone gel in sachets or pump
Used at much lower dose for women (typically 1/10th male dose)
Applied daily to skin
Most commonly used in UK practice

3. Testosterone implants

Subcutaneous pellet inserted under skin
Lasts 4-6 months
Less commonly used now (due to risk of supra-physiological levels)

Note: There is currently no licensed testosterone product for women in the UK. All prescribing is off-label using male products at lower doses or compounded preparations.

Starting dose and titration

The goal is to achieve testosterone levels in the upper half of the premenopausal female range, not male range.

Typical approach:

Start low (e.g., 5mg daily of compounded cream, or small amount of Testogel)
Assess response at 3-6 months (symptom improvement, side effects)
Check testosterone level at 3-6 months
Adjust dose if needed to optimize benefit and minimize side effects
Continue monitoring long-term

Application technique matters

For gels/creams:

Apply to clean, dry skin
Rotate application sites
Allow to dry before dressing
Wash hands after application
Avoid transfer to partner or children (this is critical)
Avoid application before swimming or bathing

What about testosterone levels?

Despite what you may read online:

Baseline testosterone levels don’t predict who will benefit
Treatment is not based on achieving a specific level
Monitoring levels helps ensure we’re in a safe range (not too high)
Levels are checked at 3-6 months, then periodically

Target: upper half of female premenopausal range (approximately 0.3-1.5 nmol/L, though assays vary)

12. Monitoring and side effects

Testosterone therapy requires ongoing monitoring to ensure safety and efficacy.

What we monitor

Clinical response (most important):

Has sexual desire improved?
Is sex more satisfying?
Has distress reduced?
Any side effects?

Blood tests:

Testosterone level (at 3-6 months, then 6-12 monthly)
SHBG (sex hormone-binding globulin)
Liver function tests (if indicated)
Lipid profile (testosterone can affect cholesterol)
Fasting glucose/HbA1c (if risk factors for diabetes)

Clinical examination:

Blood pressure
Weight
Signs of androgenization (see below)

Potential side effects

At appropriate doses, side effects are usually mild, but can include:

Androgenic effects (dose-related):

Acne (most common side effect)
Oily skin
Unwanted hair growth (face, chest, abdomen)
Male-pattern hair loss (rare at female doses)
Voice deepening (rare, but can be irreversible)
Clitoral enlargement (rare at appropriate doses)

Metabolic effects:

Weight gain (though often related to increased appetite and muscle gain)
Fluid retention
Changes in lipid profile (can increase LDL, decrease HDL)
Insulin resistance (rare, theoretical)

Other:

Mood changes (irritability, aggression—rare at female doses)
Headaches
Local skin reaction at application site

When to reduce dose or stop

Testosterone should be stopped or dose reduced if:

Significant androgenic side effects (acne, hair growth, voice changes)
Testosterone level consistently supra-physiological
No benefit after 6-month trial
Adverse effects on lipids or liver function
Woman no longer wishes to continue

Long-term safety

This is where we have limited data:

What we know:

Short-term use (up to 2 years) appears safe when dosed appropriately
Does not increase breast cancer risk (based on available data)
Does not appear to increase cardiovascular risk (limited data)

What we don’t know:

Safety beyond 2 years (most studies are shorter)
Long-term effects on cardiovascular health, bone density, cognition
Optimal duration of use

This is why ongoing monitoring and individualised risk-benefit assessment are essential.

The IMS recommends: “Women using testosterone therapy should have regular follow-up to assess benefit, monitor for side effects, and periodically review the need for continued treatment.”

13. What about surgical menopause or premature ovarian insufficiency?

These situations deserve special consideration.

Bilateral oophorectomy (surgical menopause)

Women who have had both ovaries removed experience:

Sudden, profound drop in oestrogen (if premenopausal at time of surgery)
Acute drop in testosterone (ovaries produce ~25% of testosterone)
Often more severe menopausal symptoms
Frequently report significant impact on sexual function

Evidence and guidelines:

May experience more severe HSDD
May benefit from testosterone alongside oestrogen replacement
Some guidelines suggest considering testosterone earlier in this population
Still requires proper assessment (GSM, psychological factors, relationship context)

However, testosterone is still not automatically indicated—assessment for HSDD and optimization of oestrogen remain essential.

Learn more: Unveiling Premature Ovarian Insufficiency

Premature ovarian insufficiency (POI)

Women with POI (menopause before age 40) have different considerations:

Often younger, with higher expectations for sexual function
May have additional psychological burden (grief about early menopause, fertility loss)
Require long-term hormone therapy for bone and cardiovascular protection

Testosterone in POI:

Same evidence-based indication applies (HSDD)
Must optimize oestrogen replacement first (often need higher doses than older women)
Psychosexual support particularly important (grief, identity, relationship impact)
May benefit from testosterone if HSDD persists after oestrogen optimization

Cancer survivors

Women who have had oophorectomy as part of cancer treatment (e.g., ovarian, breast, endometrial cancer) require specialist input:

For hormone-receptor-positive breast cancer:

Oestrogen therapy contraindicated
Testosterone’s safety profile unclear
Some specialists prescribe cautiously for severe HSDD with extensive counselling
Requires oncology input and shared decision-making

For other cancers:

Individualized assessment required
Consider cancer type, time since treatment, prognosis
Requires multidisciplinary discussion

14. Key take-home messages

Testosterone has one evidence-based indication for postmenopausal women: hypoactive sexual desire disorder (HSDD). It is not a routine “third hormone” that every woman needs.
Testosterone decline is primarily age-related, not caused by menopause itself. Natural menopause does not cause a sudden drop in testosterone (though surgical removal of ovaries does).
“Low testosterone = low libido” is too simple. Libido is biopsychosocial—shaped by hormones, psychological factors, relationship context, physical health, and life circumstances.
Claims about brain fog, energy, mood, weight loss, and joint pain are not supported by the evidence base used for prescribing. Many women report these benefits anecdotally, but we don’t yet have the data to recommend testosterone for these indications.
Optimizing oestrogen comes first. Oestrogen has robust evidence for multiple menopause symptoms and affects sexual function indirectly through mood, sleep, and tissue health.
Treating GSM is crucial. If sex hurts, desire switches off. Vaginal oestrogen and addressing pain must come before testosterone.
Psychosexual factors are not optional. Depression, anxiety, relationship issues, stress, trauma, and medication side effects all profoundly affect desire and must be addressed.
Individualised assessment is essential. Prescribing testosterone requires hearing your whole story—understanding your symptoms, context, relationships, psychological health, and what you’ve already tried.
When appropriately prescribed, testosterone can be genuinely helpful for women with persistent, distressing low desire after other factors are optimized.
Testosterone requires careful dosing, monitoring, and ongoing assessment. The goal is female physiological levels, not male levels, and we monitor for both benefit and side effects.
Long-term safety data beyond 2 years are limited. This is why ongoing monitoring and periodic reassessment are essential.
Evidence-based prescribing is person-centered prescribing. We use the clinical data to guide us, but we tailor recommendations to each individual woman’s unique situation, goals, and values.

Clinical guidance and expert voices

To ensure your care is grounded in robust evidence, your clinician may refer to:

International Menopause Society Global Consensus Position Statement on Testosterone Therapy for Women (2019) – comprehensive evidence review and recommendations
British Menopause Society guidance on testosterone – UK-specific recommendations emphasizing biopsychosocial assessment
Professor Susan Davis’ research on testosterone patterns across the lifespan (2025) – clarifying that menopause itself doesn’t cause testosterone decline
NICE Menopause Guidelines (NG23) – UK evidence-based recommendations including sexual function
Endocrine Society guidelines on androgen therapy in women
Research on biopsychosocial factors in female sexual dysfunction

Disclaimer

Disclaimer: This article is for general information about testosterone therapy and menopause care. It does not replace personalised medical advice. Testosterone prescribing requires comprehensive assessment by a qualified healthcare professional. Always discuss your symptoms, medical history, and treatment options with a clinician familiar with your individual circumstances.

If you’re experiencing distressing low sexual desire or other menopausal symptoms, please book a consultation with a menopause specialist who can provide individualised assessment and evidence-based care.

About TMC Health

TMC Health provides specialist, evidence-based menopause care across multiple UK clinics and online. Our menopause-trained clinicians offer:

Comprehensive biopsychosocial assessment
Individualised MHT prescribing
Testosterone therapy when clinically indicated
Psychosexual medicine support
Complex case management
Holistic, person-centered care

We believe in hearing your whole story, understanding your unique context, and tailoring treatment to what will actually help you—not following trends or one-size-fits-all protocols.

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