Testosterone in women

Testosterone is not a male hormone that women happen to have traces of. Women produce it in the ovaries and adrenal glands throughout life, in smaller quantities than men but at levels well above oestrogen for much of the cycle. It declines gradually from the late twenties — roughly halving between 20 and 40 — with no sharp drop at menopause unless the ovaries are removed.

Where the evidence supports it

The evidence base is narrower than online discussion implies. What it supports reasonably well is a single indication: hypoactive sexual desire disorder in postmenopausal women, where HRT alone has not resolved it.

NICE says testosterone supplementation can be considered for menopausal women with low sexual desire where HRT alone has been ineffective. That is a specific, second-line recommendation, not a general endorsement.

The licensing position

There is no testosterone product licensed for women in the UK. Prescribing is therefore off-label, usually a fraction of a male testosterone gel dose. Some clinicians access AndroFeme, a cream licensed in Australia, on a named-patient basis.

Off-label is not the same as improper — it is common and legitimate across medicine — but it does mean the prescriber takes on additional responsibility, which is part of why some GPs decline and refer on.

Monitoring

The goal is to restore levels to the normal premenopausal female range, not to exceed it. Blood levels are checked at baseline and periodically. Excessive dosing causes androgenic effects — acne, unwanted hair growth, and less commonly voice deepening or clitoral enlargement, the last two of which may not reverse.