Testosterone Cream vs Gel for Perimenopause: AndroFeme vs Testogel Compared
Compare AndroFeme testosterone cream vs Testogel gel for perimenopause: absorption, dosing, UK availability, application sites, and what to expect from each product.
Why Testosterone Is Part of Perimenopausal Care
Testosterone is a hormone that many women associate only with men, but women produce it too, and perimenopausal decline in testosterone contributes to symptoms that oestrogen therapy alone does not always resolve. These include low libido, persistent fatigue not explained by sleep disruption or depression, reduced motivation, cognitive sluggishness, and in some cases a blunting of overall wellbeing. The NICE menopause guideline update in 2024 explicitly recommends considering testosterone supplementation for women with low sexual desire unresponsive to HRT alone. Interest in testosterone therapy for women has grown substantially, and with it the practical question of which formulation to use. In the UK and Australia, two preparations are most commonly discussed: AndroFeme cream, a product specifically licensed and dosed for women, and Testogel, a product licensed for men but used off-label for women at much lower doses. Each has distinct properties, and the choice between them depends on availability, cost, prescribing context, and individual preference.
AndroFeme Cream: The Female-Specific Licensed Product
AndroFeme 1% cream is a testosterone cream specifically developed and licensed for female use, originally in Australia through Lawley Pharmaceuticals. It delivers 1% testosterone concentration and is applied at a dose of 0.5 millilitres per day (providing 5 milligrams of testosterone), applied to the inner thigh or lower abdominal skin. The small volume and calibrated dosing pump make precise female-level dosing straightforward. AndroFeme received MHRA approval in the UK in 2024, making it the first licensed testosterone product for women in the UK. This is significant because it means prescribing is no longer off-label in the UK, which has historically been a barrier for some GPs. In Australia, AndroFeme has been available by prescription for longer and is relatively well established in menopause specialist practice. The cream formulation is absorbed through the skin and produces serum testosterone levels in the physiological female range when dosed appropriately. Transfer to partners or children via skin contact is a consideration, though the small dose volume and application to covered areas minimises this risk.
Testogel: Off-Label Male Formulation Used at Female Doses
Testogel is a 1.62% testosterone gel licensed for hypogonadism in men, supplied in sachets or pump dispensers providing 40 to 80 milligrams of testosterone per dose. For women, this is far too much. Off-label use in women involves using approximately one tenth or less of the male dose, typically around 0.5 to 1 milligram of testosterone daily, which requires either very small amounts from a sachet or careful use of a pump dispenser designed for much larger male doses. This makes dosing accuracy more challenging. Many menopause specialists who prescribe Testogel off-label for women advise applying a small amount (typically 0.5 to 1 cm of gel from the sachet) to the inner thigh or upper arm, rotating sites to prevent skin irritation. Testogel is more widely available in the UK on NHS prescription than AndroFeme currently is, simply because it has been on the formulary longer. The cost per male sachet is lower than AndroFeme per pack, making it appear economical, though the calculation depends on the dose used and the dispensing format.
Absorption, Application Sites, and Skin Transfer Considerations
Both products are transdermal, meaning testosterone is absorbed through the skin and enters the bloodstream gradually. Absorption varies between individuals based on skin type, body fat distribution, application site moisture, and other factors, which is why monitoring blood testosterone levels four to six weeks after starting treatment is recommended to confirm the dose is achieving physiological rather than supraphysiological levels. Preferred application sites for women are typically the inner thigh or inner upper arm. The vulval area is sometimes used but is associated with faster absorption and higher peak levels, which increases the risk of side effects. For both cream and gel formulations, allowing the product to dry fully before dressing and washing hands after application are standard precautions. Skin-to-skin transfer to partners or children is theoretically possible, and women who share a bed with young children may prefer to apply the product in a location that is not likely to be touched. Neither cream nor gel should be applied near breast tissue.
Comparing Availability, Cost, and Prescribing Practicalities in the UK
In the UK, Testogel has a longer NHS track record and is often more readily available from GPs who are comfortable prescribing testosterone for women off-label. Some GPs and menopause clinics have established protocols using Testogel at female doses. Since MHRA approval of AndroFeme in 2024, prescribing of the female-specific licensed product is expected to increase, but at the time of writing, NHS formulary inclusion varies by trust and CCG. Private menopause clinics are more likely to prescribe AndroFeme because the licensed female product aligns better with clinical governance standards. Cost-wise, AndroFeme tends to be slightly more expensive than the off-label Testogel approach per month, but the licensing and dosing accuracy advantages are meaningful. Women who have difficulty obtaining either through their GP can access both products through NHS or private menopause specialists, or through specialist telehealth menopause services. Blood monitoring of serum testosterone and SHBG is recommended with either preparation, typically at six weeks and then annually once stable.
Which to Choose and What to Expect
If you have access to a prescriber comfortable with AndroFeme, the licensed female formulation is the preferable starting point because dosing is more intuitive, the concentration is designed for female physiology, and it removes the off-label complexity. If AndroFeme is unavailable or unaffordable and your prescriber is experienced with Testogel at female doses, that is a reasonable alternative used successfully by many women under specialist guidance. In terms of what to expect: testosterone therapy for women tends to take three to six months to produce noticeable improvements in libido, energy, and wellbeing. It is not a rapid-acting treatment. Common early side effects at appropriate doses are minimal, but excessive doses cause acne, increased body or facial hair, and voice changes. These are avoidable with correct dosing and blood level monitoring. Testosterone is typically prescribed alongside oestrogen therapy rather than alone, because oestrogen provides the broader symptomatic coverage that testosterone does not address. Working with a menopause specialist rather than managing this through a GP with limited experience gives you the best chance of achieving a well-calibrated, effective regimen.
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