Many women perceive testosterone as a hormone primarily associated with men. However, before menopause, women also naturally produce testosterone from their ovaries and adrenal glands, and it plays a crucial role in various aspects of female health, including sexual function, muscle and bone strength, cardiovascular health, cognitive function, and energy levels. Testosterone levels can decline gradually with age or drop suddenly if a woman undergoes surgical removal of her ovaries.

The 2015 NICE guideline NG23 supports the use of testosterone supplementation in women. Guidelines from the International Menopause Society endorse testosterone use in women who, despite adequate hormone replacement therapy (HRT), continue to experience symptoms of low libido, low sexual arousal, reduced desire, and decreased sexual satisfaction, causing distress (known as Hypoactive Sexual Desire Disorder).

It’s essential for all women to address symptoms of vaginal dryness before considering testosterone supplementation.


While current guidelines recommend testosterone supplementation primarily for persistent low libido in women, many users report more than just improved libido. They often experience enhanced muscle and bone strength, increased energy levels, improved cognitive function, mood, and concentration, reduced brain fog, and better sleep.

If you effectively manage other menopausal symptoms, have resolved issues related to vaginal dryness, but still suffer from low libido, low sexual arousal, diminished desire, and reduced sexual satisfaction, despite being in a supportive relationship, you may benefit from a trial of testosterone supplementation.

Libido can be influenced by various factors, including body image, partner relationship, work-related stress, and life events. Hypoactive Sexual Desire Disorder (HSDD) is diagnosed when a woman experiences a lack of interest in sex, absence of sexual thoughts, reluctance to initiate sex, reduced pleasure from sex, little interest in masturbation, and these symptoms persist for over six months. To evaluate your situation, consider the following:

Was your level of sexual desire or interest satisfying to you in the past?

  • Have you noticed a decrease in your level of sexual desire or interest?
  • Are you bothered by this decrease?
  • Would you like to increase your sexual desire or interest?

Could factors such as surgery, depression, medical conditions, medications, pregnancy, childbirth, menopausal symptoms, other sexual issues, partner’s sexual problems, dissatisfaction with your relationship, stress, or fatigue be contributing to your reduced sexual desire or interest?

HSDD can be addressed in various ways, including reducing drug and alcohol consumption, dedicating quality time to connect with your partner and discuss personal needs, trying consensual sexual experimentation, and planning intimate moments. Seeking the help of a psychosexual counsellor can also be beneficial if connection is an issue.

HRT can provide relief as well. For women experiencing discomfort during sex, vaginal estrogen can restore vaginal health, making intercourse pain-free. A trial of testosterone supplementation may be beneficial for women who continue to have symptoms of low sexual desire, low arousal, and poor sexual satisfaction despite adequate HRT and the resolution of vaginal dryness. The diagnosis of HSDD is based on symptoms.

A blood test is typically recommended before starting treatment to ensure that adding testosterone to your HRT regimen will not elevate your testosterone levels beyond the normal range for women. This test is not used to make the diagnosis but to confirm that treatment is safe.

Testosterone Medication in Women

Testosterone is usually administered as a cream or gel applied once daily to the outer thigh. In the UK, there are no licensed testosterone preparations for use in women, so products intended for men can be used at a reduced dose and are prescribed “off-label” for women. This does not imply that they are unsafe; it simply means that no company holds a license for their use in women. Some examples include Testim® and Testogel®, which come in gel form formulated for men. Dosage adjustments are necessary for use in women, and in some regions, these products can be prescribed by the NHS.

AndroFeme® 1 is a testosterone cream with a license for use in women in Australia. It is imported into the UK under special MHRA guidance. Since it is designed for women, no dosage adjustment is needed. AndroFeme®  is not currently available on the NHS and must be obtained through a private prescription. Testim® and Testogel® are generally less expensive than AndroFeme®.

It may take up to three months before women notice an improvement in symptoms. A trial of treatment for three to six months is standard. If there has been no improvement after six months, testosterone treatment is usually discontinued, and alternative causes for low libido are explored.

Women on testosterone treatment should have a repeat blood test after two to three months. If treatment continues, these tests should be repeated annually to ensure that testosterone levels remain within the normal female range. When testosterone levels are maintained within this range, side effects are rare. 

Side effects are uncommon when testosterone levels are monitored and kept within the normal female range.

Some women may notice slight hair growth at the application site, which can be minimised by varying the application site and using a thin layer of cream. Other side effects such as acne, oily skin, hair growth, hair loss, voice changes, clitoral enlargement, etc., are rare if normal female levels are maintained.

While there is limited long-term data on testosterone use in women, studies covering up to two years have not indicated any adverse effects in healthy postmenopausal women.

Note that AndroFeme® 1 contains almond oil and should be avoided by women with almond allergies.

Why is Testosterone important?

Testosterone helps to maintain normal metabolic function, muscle and bone strength, urogenital (bladder and vaginal) health, mood and cognitive (brain) function.  In the UK testosterone is currently indicated for low libido.

What happens when Testosterone levels are low?

Lowering testosterone can lead to several distressing sexual symptoms such as low sexual desire, arousal and orgasm. 


Testosterone deficiency can also contribute to a reduction in general quality of life, tiredness, depression, headaches, cognitive problems, loss of bone and muscle mass as well as function.

Are there Testosterone products?

There are no testosterone products for female use licensed in the UK. The licenses for patches and implants were both withdrawn for commercial reasons; however, the safety and efficacy data for these products remain valid. By extrapolation of these data, it is deemed acceptable for products licensed in men (mainly gels) to be prescribed off label in female doses. It is not uncommon in clinical practice to use medicines without their product licence or “off-licence”. This means there is evidence to support the prescribing of this medication, but the product has yet to be licensed in the UK for female use. 

Androfeme is designed for female usage. AndroFeme is not currently available in the NHS and is being imported from Western Australia by special license from the Medicines Health Regulatory Authority (MHRA). Androfeme is only available on special order and on a private prescription.

When would you prescribe testosterone?

Once your oestrogen has been optimised, we may offer to prescribe Androfeme testosterone. Usually, you will also be recommended HRT alongside testosterone as well as vaginal oestrogen if needed to treat vaginal dryness. It can sometimes take a few months for the full effects of testosterone to work; a 3–6-month trial is often recommended.

How does testosterone treatment work?

Testosterone is usually given as a cream (AndroFeme®) which you rub into your skin, so it goes directly into your bloodstream. It will restore your blood testosterone levels back into the normal range for women.

  • You should use 0.5ml (a edamame size amount) of AndroFeme® into your skin.
  • It should be applied to clean, dry skin on your lower abdomen or your outer thigh, and allowed to dry before dressing. 
  • You should wash your hands thoroughly after application.
  • Skin contact with other people should be avoided until the application site dry.
  • The area of application should not be washed for 2-3 hours after application.

Are there any side effects?

There are usually no side effects with testosterone treatment as it is given to replace the testosterone that you are otherwise lacking. If you use the recommended dose ie a small amount over a week or more, side effects are very few. Rotate the area of skin you apply it to and do not use more than suggested.

Very occasionally women notice some increased hair growth in the area in which they have rubbed the cream. This can be avoided by changing the area of skin on which you rub the cream. As the dose is so low, testosterone used in this way does not increase your risk of developing facial hair, voice deepening or skin changes.

It is important to have regular blood monitoring to reduce the risk of any side effects occurring.

AndroFeme contains almond oil so should not be used if you have an allergy to almonds.

Further Information & Useful Resources

Androfeme costs around £100-130 depending on the pharmacy and lasts for 3 months/ 100 days