Testosterone for Women During Perimenopause: A Practical Guide
Everything women need to know about testosterone during perimenopause: how it affects libido, energy and mood, and how to access it on the NHS or privately.
Testosterone Is a Women's Hormone Too
Testosterone is usually associated with men, but it is a key female hormone throughout a woman's life. In fact, women produce more testosterone than oestradiol at certain points in their cycle. During perimenopause, testosterone levels decline alongside oestrogen and progesterone, though the decline tends to be more gradual. Even so, by the time a woman reaches her mid-forties she may have significantly less testosterone than she did a decade earlier. The symptoms of low testosterone in women are distinct from low oestrogen, which is why they are often missed or misattributed. Understanding what testosterone does and how its decline affects you is the first step toward addressing it.
What Low Testosterone Feels Like
The most commonly reported symptom of low testosterone in perimenopausal women is a significant loss of libido, not just reduced desire but a complete absence of spontaneous sexual thoughts or interest. This is different from the pain during sex caused by low oestrogen, though the two often co-occur. Other common symptoms include persistent fatigue that does not improve with rest, reduced motivation and drive, difficulty concentrating, a flat or blunted mood that does not meet the threshold for depression but feels like a loss of spark, and loss of muscle mass and strength despite regular exercise. Some women describe feeling like they have lost confidence or assertiveness that used to feel natural. These symptoms are often gradual and easy to dismiss.
How to Get Tested
Testosterone testing in women requires a specific approach. The standard NHS testosterone test measures total testosterone and is calibrated for male ranges, making it unreliable for detecting low testosterone in women. A more useful measurement is free androgen index (FAI) or free testosterone, which accounts for the fact that most testosterone is bound to a protein called SHBG and therefore unavailable for use by the body. High SHBG levels, common with oestrogen use or naturally in some women, can result in low free testosterone even when total testosterone appears normal. A full blood count and SHBG measurement alongside total testosterone gives a much clearer picture. Ask your GP or menopause specialist to request these alongside your standard hormone panel.
The Evidence on Testosterone Therapy for Women
The evidence for testosterone therapy in perimenopausal women is strongest for hypoactive sexual desire disorder (HSDD), the clinical term for significant loss of sexual desire. Multiple systematic reviews and the 2019 Global Consensus Statement on Testosterone for Women concluded that testosterone therapy at physiological doses improves sexual desire, arousal, pleasure, and orgasm. Evidence is also building for benefits to energy, mood, cognitive function, and muscle preservation, though these outcomes are less firmly established. Testosterone does not replace oestrogen therapy for symptoms like hot flashes or vaginal dryness. It works best as part of a broader hormone management strategy rather than as a standalone fix for all perimenopausal symptoms.
How Testosterone Is Prescribed for Women
In the UK, testosterone is not licensed specifically for women but can be prescribed off-label by GPs and menopause specialists. The most common form is a gel applied in a very small daily dose to the inner thigh or lower abdomen. Testogel and AndroFeme are the products most frequently used, though AndroFeme is a women's-specific formulation that is increasingly available. Doses are significantly lower than those used in men, typically 5 to 10% of a male dose. Blood levels are monitored after three to six months to ensure they remain in the normal physiological range for women. Patches and implants are also available through specialist clinics. Treatment response is usually assessed at three to six months and may take that long to notice full effects.
NHS Access vs Private Care
Accessing testosterone on the NHS can be frustrating. Many GPs are unfamiliar with prescribing it for women, and some CCGs (now Integrated Care Boards) do not support it on the NHS formulary. The most straightforward route is a referral to an NHS menopause clinic where a specialist can assess, prescribe, and monitor. Some GP practices with a menopause-trained partner will also prescribe it. Private menopause clinics can prescribe testosterone with less friction, and the cost of a gel prescription is generally manageable, though clinic fees vary. Organisations like the British Menopause Society and Menopause Support provide directories of trained practitioners. Bringing the Global Consensus Statement to your GP appointment can help support a prescription request if you face initial resistance.
Safety Considerations and Monitoring
At physiological doses, testosterone therapy for women is considered safe based on current evidence. The main risks associated with testosterone are linked to excessive doses: acne, unwanted hair growth, voice changes, and elevated red blood cell count. These side effects are generally avoidable with appropriate dosing and monitoring. Blood levels should be tested after starting treatment and every six to twelve months thereafter to ensure levels remain within the normal female range. Avoid applying gel to skin that will be in contact with children or male partners, as accidental transfer can have effects on them. If you are pregnant or breastfeeding, testosterone therapy is contraindicated. Women with hormone-sensitive cancers should discuss the risks carefully with their oncologist before considering testosterone.
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