Testosterone therapy for women – everything you need to know

Testosterone replacement therapy for women remains a hot topic, with Kate Winslet the latest celebrity adding her voice to a raft of women who say they are benefitting from it. “Women have testosterone in their bodies but it runs out and you have to replace it; once you do, you’ll feel sexy again,” she said on the American Failing with Friends podcast, hinting that she uses testosterone to rev up a flagging libido.

Should you, like Winslet and other prominent menopause campaigners such as Davina McCall and Gabby Logan, ask your doctor to prescribe testosterone for you? What are the options, product choices and side effects? And how long does it take to kick in?

We spoke to GP and British Menopause Society-accredited menopause specialist Dr Fionnuala Barton, one doctor who treats many women with testosterone therapy.

How does testosterone therapy help with menopause symptoms?

A flagging libido can be one of the many symptoms of menopause and perimenopause, and testosterone is clinically proven to help with this when you take it with ‘regular’ HRT (oestrogen and progesterone replacement). More than half (50-60 per cent) of women see their sex drive come back.

But the hormone appears to have a number of additional benefits. If you experience brain fog, lack of energy and strength despite being on HRT you may, says Dr Barton, “experience a serious improvement in these symptoms too”.

Other reported benefits are improved hair growth, less vaginal dryness and discomfort, and even weight management. We all have testosterone receptors in most of our cells, not just in our reproductive organs. So when levels fluctuate wildly, as they do, throughout life and significantly after menopause, it stands to reason you notice it on multiple physical and mental levels.

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Can you get testosterone for menopause on the NHS?

You certainly can, if you are in late perimenopause or menopause and already on HRT, and are distressed by a loss of sex drive.

A low libido or HSDD (hypo-active sexual desire disorder) is currently the only NHS-approved symptom for prescribing testosterone therapy in menopause and the only issue for which the hormone is clinically proven to provide relief.

If you tell your GP you have no issues with your libido and want it for support with other issues such as fatigue and strength, the answer will probably be no, says Barton.

Because testosterone is only licensed for women with low libido when conventional HRT hasn’t helped, NHS doctors will not be keen to prescribe it if you don’t fit this category.

If you do fit the bill and you are nearing the end of perimenopause, approaching the menopause proper (which, says Barton, is when big changes in your testosterone levels happen), there are two brands of testosterone available on the NHS – and they are covered by your pre-pay HRT certificate. They are Testogel and Tostran. Both are designed for men but can be dosed specifically for women. For all the details, see our list of testosterone options below.

What about testosterone for the ‘off-label’ benefits?

While there is plenty of circumstantial evidence for the ‘off-label’ benefits of testosterone therapy, the long-term clinical evidence just isn’t (yet) there, says Barton, who also consults patients privately (in-person and online) as The Menopause Medic. Her convo on the topic with Get The Gloss Editorial Director Victoria Woodhall on Instagram live is above.

The field is woefully under-studied, so it could partly be a case of simply not having enough clinical data on anything other than the link between HSDD and testosterone. But there’s also a chance that a very strong placebo effect may be at work: “So we do need to be very careful to not jump to conclusions prematurely,” she says.

Is testosterone therapy safe for women?

Appropriately dosed testosterone therapy is proven to be very safe and well-tolerated by women, with no long-term or irreversible side effects – no, you’re not going to bulk up or grow a beard. So if you feel like you want to give it a try, you can do so largely risk-free. There can be temporary side effects, however, and Dr Barton outlines them below.

When should you go private for testosterone therapy?

You can do this when your GP is hesitant to give you a prescription. Private menopause specialists like Dr Barton will be able to prescribe bespoke daily doses of testosterone, and they will also investigate prescribing it for reasons other than a flagging sex drive – if the circumstances are right.

The first thing your private doctor will do, says Barton, is ensure the balance of oestrogen and progesterone you are taking is right for you before adding testosterone. “The three hormones will work best when in the right synergistic equilibrium,” she says. “We would not normally use testosterone without oestrogen and progesterone because testosterone is converted – or ‘aromatised’ – into oestrogen.” So if you take it when oestrogen is low, she says, you might get very little benefit.

What is the standard dose of testosterone for (peri)menopausal women?

The guideline standard dose is 5mg, which is what you’ll get from your NHS-prescribed testosterone. But, says Barton, “in women for whom this is too high and who experience side-effects [see below], or for those in perimenopause with ongoing ovarian testosterone-producing capacity, or for post-menopausal women who are starting out or are concerned about side effects, I will often use 2.5mg and adjust from there if necessary.”

This is a fine balance, dependent on your individual response and blood levels.

Will a private doctor prescribe testosterone ‘just’ for low energy and mood?

They may well. “If a woman is happy to do a trial of treatment on this basis, knowing that the research base doesn’t yet officially support the use of testosterone for these issues, then I think it’s worth a go,” says Barton.

You can have insufficient testosterone without it impacting libido, and vice versa. “Some women have low libido without testosterone insufficiency,” says Dr Barton. So if other elements of your health (including your HRT) are optimised, you can try testosterone for energy, strength, motivation and mood. “Three to six months will provide helpful personal insight into what benefits it may provide; if it does, we may continue its use,” she advises.

Which testosterone therapies are available in the UK for women?

Testogel

Comes in gel sachets containing 40.5mg of testosterone – a product and dosage officially developed for men. Because women need a lower dose, you need to apply only one eighth of a sachet daily, to get the recommended 5mg in 0.5ml of gel.

Availability: via your GP on the NHS, and privately.

Dr Barton says: “This is great for women who want to apply a moderate dose every day (to minimise the risk of side effects) and who aren’t put off by having to ‘guesstimate’ what an eighth of sachet is.” The similar Testim gel has now been discontinued in the UK.

Tostran gel

Comes in a pump bottle designed for men that delivers an exact dose of 10mg per pump. To get your 5mg daily dose, you apply one pump every other day.

Availability: via your GP on the NHS, and privately.

Dr Barton says: “If a woman finds it easy enough to remember to take this every second day, the precision of the dosage is great. This is also the most cost-effective option if you buy it privately, as a bottle can last you a year. But for some women the dose, even when taken on alternate days, is too much. It can, for example, cause your libido to fluctuate.

You should also be careful to alternate where you apply it on your body to avoid sensitising the androgen receptors in your skin and cause localised oiliness or hair growth.”

Androfeme

A 50ml tube of cream that’s the only testosterone therapy designed and clinically proven for women. It comes with a syringe applicator that lets you measure out 5mg in 0.5ml of daily testosterone, so one tube lasts 100 days.

Availability: imported from Australia and currently only available privately in the UK.

Dr Barton says: “It’s great to have a product designed specifically for women that works very well for many of them, and to have a cream format that’s better absorbed by some than a gel. But I also see women who do much better on the men’s gels, which are more cost-effective. Also, Androfeme’s syringe applicator can be fiddly. It’s still pending MRHA [Medicines and Healthcare Products Regulatory Agency] licence in the UK but I’m optimistic this will happen soon.”

Bespoke or ‘compounded’ testosterone creams

Tubes of cream containing the daily dosage of testosterone prescribed for you by your private menopause or hormone specialist and made by a private pharmacy.

Availability: privately.

Dr Barton says: “These are great if you don’t want to ‘guesstimate’ your doses, don’t want to take a double dose on alternate days, and/or need a smaller dose of testosterone than the regular 5mg. They come with the personal guidance of a private doctor, although this also applies when I prescribe one of the men’s gels for a patient, and with an elevated price tag due to the bespoke nature of the cream.”

TEPI Testosterone Patch

A global-first, UK-developed testosterone patch for women is awaiting completion of trials and regulatory approval. Read Testosterone replacement in menopause – should you consider it?

Availability: not available yet.

Dr Barton says: “I am excited about this as it would give women more choice and move the discussion about female testosterone forward, but things are moving slower than expected. The TEPI patch was due to complete phase 1 trials by the end of 2023 but there have been no results published yet. It will be a great alternative to Androfeme, but given how long these drugs take to get MHRA approval, I do not anticipate it will be available for a long time yet.”

What results can you expect from testosterone therapy?

Barton is upfront about results: “they are very variable. But many women call it the ‘missing piece of the puzzle’; it gives them their spark, edge and lustre back.”

Most (but not all) women find it helpful for improving libido, while many note they feel calmer and more at ease. They also report being more positive in their outlook, mood and ability to motivate, thinking more clearly and often sleeping better. Some see improvements in energy and strength with fewer aches and pains and faster recovery after exercise, says Barton, “and occasionally women find their weight easier to manage with the addition of testosterone, as it may help with fat distribution”.

She also sees a reduction in vaginal dryness and discomfort in patients taking testosterone. This is because our genitourinary tract and mucosa (wet tissues) are badly affected by low testosterone.

However, Barton has also treated women who’ve seen little, if any, benefit at all.

How long does testosterone therapy take to work?

Unlike regular HRT, testosterone will take a good while to kick in, but if there’s no benefit after six months, you’re better off stopping treatment, says Dr Barton.

What are the side effects of testosterone therapy?

While the therapy is considered very safe and no irreversible side effects have been reported, there can be temporary side effects. Barton says a small number of patients experience these, and that they resolve completely when stopping treatment or reducing doses.

Skin changes: Higher levels of testosterone can mean your skin produces more sebum, which may mean increased oiliness or spots. This can be a boon if you suffer from dry skin, says Dr Barton, as the androgens can restore the skin’s lipids and barrier protection.

Anger, rage and restlessness: If your dosage is too high for you, testosterone can make you feel antsy, angry, aggressive or argumentative.

Sleep issues: By the same token, too much testosterone can interrupt a good night’s sleep. “Like oestrogen, it can be a stimulatory hormone, so I advise using both in the morning,” says Barton. Adjusting the dosage may also be necessary.

Hair changes: Testosterone is stimulatory to hair follicles, which have lots of androgen receptors – which means, says Barton, it may help thinning hair grow back, but at high doses may also stimulate systemic hair growth – think unwanted facial hair, etc. “For the vast majority of women, hair loss in menopause is not due to their testosterone levels but to overall hormone flux,” she says. “However, if you have a strong family history of androgenetic hair loss, you should be very cautious taking it.”

Weight gain: “Despite what some people say, testosterone therapy is definitely not a good strategy for weight loss; in fact, weight gain is a side effect for some,” says Barton. It’s true that it can in some women help support healthy metabolism and promote muscle, but this is a very personal thing that should be carefully trialled.

Other side effects: Lower mood, abnormal bleeding and a theoretical risk of your voice getting hoarse or deeper can possibly result from taking testosterone as well, says Barton. “And I have encountered one case of clitoral enlargement with testosterone which was distressing for my patient.” However, recent research confirms it doesn’t increase risk of blood pressure or heart disease.

Do you need a blood test to measure your testosterone levels?

“Fingerprick tests are contentious,” says Barton. DIY testosterone fingerprick test kits are available online and from pharmacies like Superdrug but, says Barton, the methodology and the validity of the results is questionable; the samples can be easily contaminated and give rise to falsely elevated readings. You also risk a spuriously high reading if you’re on any supplement containing biotin.

On top of that, there is a lack of consensus as to what ‘normal’ women’s ranges are in these testosterone tests, warns Barton.”I guess it can be a useful and cheap first “screening tool” for women wondering if their symptoms such as low libido are due to low testosterone or not: if the test comes back normal then it may save you the complex journey of seeking a prescription,” she says.

However, if your levels are low, this will not mean your GP will give you a testosterone prescription. “They are unlikely to accept it and will want to do their own venous blood test [using a syringe], which is more accurate,” she says. She adds that this so-called ‘baseline total testosterone blood test’ is especially important to make sure you aren’t already at high levels, as supplementation on top of that can lead to masculinisation symptoms. Only if you’re in the lower or normal range is a prescription appropriate.

If your fingerprick test results show a low level of testosterone, you will likely be able to use them to purchase testosterone privately from Superdrug through their online doctor service. As Dr Barton explains above, this would involve a level of throwing caution to the wind (she does not recommend it), but it will avoid the high cost of a private specialist and prescription.

What is a normal testosterone level for women?

While there is no standardised ‘normal’ testosterone range for women, experts reckon anything between 0.3 and 1.4 (nmol/L) is normal. However, cautions Barton, this partly depends on symptoms and can also be influenced by your level of SHBG (sex hormone-binding globulin), which makes testosterone less bio-available if at high levels and needs to be separately measured.

She adds that regular monitoring via venous blood tests when you’re on testosterone therapy is important but quite hard to get from the NHS. “In a private capacity, apart from doing a baseline total testosterone test before prescribing, I would check blood levels at between six to twelve weeks,” she says. “From your GP, I would at least ask for a clinical review at three months, and then on a six- to 12-month basis to make sure you don’t end up with supra-levels of testosterone.”

She adds that in the case of these regular screenings, it’s even more essential that fingerprick blood tests are avoided in the name of accuracy and safety – so do not try to self-screen with a kit!

Can women with oestrogen-positive breast cancer take testosterone?

“In theory, we should not be treating hormone-positive breast cancers with testosterone, because it is aromatised [converted] to oestrogen which may affect the breast cancer,” says Barton.

But, she says, testosterone itself does not worsen these breast cancers. If someone uses aromatase inhibitors for their breast cancer, she explains, those will block the conversion of testosterone into oestrogen, at which point the patient could really benefit from testosterone’s menopause-supporting symptoms.

“However, this is experimental; if it’s something a patient wants to consider, I would advise her to speak to her oncologist,” says Barton.