Menopause Myth #12: Testosterone for Women: The Most Overlooked Piece of Menopause Care

“But testosterone is for men, right?”

A 48-year-old woman sits across from me, looking utterly exhausted. She had a total hysterectomy (uterus and both ovaries removed) eight months ago due to severe endometriosis. Her surgeon started her on oestrogen HRT immediately after surgery.

The good news: Her hot flushes are controlled. Her sleep has improved. The endometriosis pain that plagued her for years is gone.

The bad news: She feels profoundly, bone-deep exhausted. She used to be energetic, active, engaged. Now she can barely get through a workday. She has zero interest in sex — not reduced interest, but complete absence of libido. She’s tried to exercise but can’t seem to build any muscle despite consistent effort. She feels flat, unmotivated, like she’s just going through the motions of life.

“The oestrogen is helping,” she says, “but I still don’t feel like myself. My doctor says I just need to give it more time. It’s been eight months. How much more time?”

I look at her medication list. Transdermal oestrogen 100 mcg patch. That’s appropriate.

But something’s missing.

“Has anyone discussed testosterone with you?” I ask.

She looks confused. “Testosterone? Isn’t that a male hormone?”

This is the conversation that happens far too rarely in menopause care — and it’s leaving countless women suffering unnecessarily.

The Myth: Testosterone is a “Male” Hormone

The pervasive belief: Testosterone is a male hormone. Women don’t produce it, don’t need it, and shouldn’t take it.

The reality: Women produce testosterone throughout their lives. It’s essential for energy, libido, muscle mass, bone density, mood, motivation, and cognitive function.

When testosterone levels drop — particularly after surgical menopause (removal of ovaries) — women can experience devastating symptoms that oestrogen alone cannot resolve.

Yet testosterone replacement for women is vastly under-prescribed, under-discussed, and misunderstood — even by many healthcare professionals.

Testosterone in Women: The Basics

Where Do Women Get Testosterone?

Women produce testosterone from two main sources:

The ovaries (approximately 50%):

  • Theca cells in the ovaries directly produce testosterone
  • Ovaries also produce androstenedione (a precursor that converts to testosterone)

The adrenal glands (approximately 50%):

  • Sit on top of the kidneys
  • Produce DHEA and androstenedione (both convert to testosterone)
  • Also produce cortisol (stress hormone)

Total testosterone production in women:

  • Premenopausal women: Approximately 300 micrograms per day
  • This is about 1/10th the amount men produce (but still physiologically significant for women)

What Happens During Menopause?

Natural menopause (when ovaries gradually stop functioning):

  • Ovarian testosterone production decreases
  • BUT: Continues at reduced levels for years after periods stop
  • Adrenal production continues (though may decline with age)
  • Total testosterone gradually declines by about 50% from age 20 to menopause

The decline is gradual and partial — not sudden or complete.

Surgical menopause (bilateral oophorectomy — removal of both ovaries):

  • Immediate loss of 50% of testosterone production (the ovarian contribution)
  • Happens overnight
  • Only adrenal production remains
  • This is why surgical menopause often causes more severe symptoms — sudden, complete loss of ovarian hormones including testosterone

The woman I described earlier lost 50% of her testosterone production the day her ovaries were removed — and no one addressed it.

What Does Testosterone Do in Women?

Testosterone isn’t just about sex drive (though that’s often the most noticeable symptom when it’s deficient). It affects multiple body systems:

Libido and Sexual Function

Testosterone is essential for:

  • Sexual desire (libido)
  • Sexual arousal and response
  • Genital sensitivity
  • Orgasmic function

Low testosterone doesn’t just reduce libido — it can eliminate it entirely.

Women describe:

  • “I don’t just have less interest in sex; I have zero interest”
  • “I could happily never have sex again and not miss it”
  • “It’s not that I’m too tired or stressed — I genuinely don’t have any sexual feelings at all”
  • “I love my partner but feel absolutely nothing sexually”

This is profoundly distressing — not just for the woman, but often for relationships.

Energy and Vitality

Testosterone affects energy levels and overall vitality.

Low testosterone causes:

  • Profound, unrelenting fatigue
  • Not the “I didn’t sleep well” tired
  • But bone-deep exhaustion that doesn’t improve with rest
  • Lack of physical stamina
  • Everything feels like an enormous effort

Women describe:

  • “I used to be energetic and active; now I can barely get through the day”
  • “I feel like I’m dragging myself through life”
  • “No matter how much I rest, I’m still exhausted”

Muscle Mass and Strength

Testosterone is anabolic — it promotes muscle protein synthesis and helps maintain muscle mass.

Low testosterone causes:

  • Difficulty building muscle despite training
  • Loss of existing muscle mass
  • Reduced strength
  • Decreased exercise capacity

Women describe:

  • “I strength train consistently but can’t seem to build any muscle”
  • “I’ve lost muscle tone despite exercising”
  • “I feel physically weak”

This matters beyond aesthetics:

  • Muscle mass crucial for metabolic health (muscle burns more calories than fat)
  • Muscle strength crucial for functional independence as we age
  • Loss of muscle accelerates during menopause — testosterone helps maintain it

Bone Density

Testosterone (along with oestrogen) helps maintain bone density.

This is particularly important after menopause when osteoporosis risk increases dramatically.

Studies show testosterone therapy:

  • Increases bone mineral density
  • Particularly in spine
  • May reduce fracture risk

For women who’ve had ovaries removed (especially if young), maintaining testosterone levels helps protect bones.

Mood and Motivation

Testosterone affects mood, drive, and motivation.

Low testosterone can cause:

  • Flat affect (feeling emotionally numb or blunted)
  • Reduced motivation and drive
  • Difficulty initiating tasks
  • Loss of competitive edge or ambition
  • Feeling like you’re “just going through the motions”

This is different from depression — it’s more about lack of drive and vitality rather than sadness.

Women describe:

  • “I don’t feel depressed, but I don’t feel anything”
  • “I used to be ambitious and driven; now I just don’t care”
  • “I have no motivation to do anything beyond the bare minimum”

Cognitive Function

Testosterone affects cognitive function, including:

  • Concentration and focus
  • Working memory
  • Mental stamina
  • Spatial reasoning

Some women report improved mental clarity with testosterone replacement — though research in this area is still evolving.

Body Composition

Testosterone helps maintain favorable body composition:

  • Maintains muscle mass (muscle increases metabolic rate)
  • May help reduce visceral (abdominal) fat
  • Improves insulin sensitivity

This is particularly relevant during menopause when metabolic changes favor fat accumulation (especially abdominal fat).

The Symptoms of Testosterone Deficiency

How do you know if testosterone deficiency might be an issue for you?

The classic symptom picture includes:

Profound, Unrelenting Fatigue

  • Not just “tired” — bone-deep exhaustion
  • Doesn’t improve with adequate sleep
  • Physical and mental exhaustion
  • Everything requires enormous effort
  • This is often the most disabling symptom

Complete Loss of Libido

  • Not reduced interest — complete absence
  • No sexual thoughts, fantasies, or desires
  • No response to sexual stimuli
  • Loss of genital sensitivity
  • Can’t even remember what it felt like to want sex
  • Distressing to women and their partners

Difficulty Building or Maintaining Muscle

  • Consistent strength training but no muscle gain
  • Loss of muscle tone despite exercise
  • Feeling physically weaker
  • Reduced exercise capacity

Mood Changes

  • Flat affect (emotionally numb, blunted)
  • Low motivation and drive
  • Loss of competitive edge
  • Difficulty initiating tasks
  • Lack of enthusiasm or engagement
  • Not the same as depression — more about lack of vitality

Cognitive Symptoms

  • Difficulty concentrating
  • Reduced mental stamina
  • Brain fog (though this can also be from oestrogen deficiency)

When to Strongly Suspect Testosterone Deficiency:

If you’ve had surgical menopause (ovaries removed) and experience:

  • Profound fatigue despite adequate oestrogen replacement
  • Complete loss of libido despite adequate oestrogen
  • Flat mood or lack of motivation despite adequate oestrogen

Testosterone deficiency should be top of the differential diagnosis.

Even if you’ve had natural menopause, if you’re experiencing these symptoms despite adequate oestrogen (and thyroid function is normal, B12 is adequate, etc.), testosterone deficiency may be contributing.

The Evidence: Does Testosterone Replacement Help?

This isn’t alternative medicine or experimental treatment. There’s solid research evidence supporting testosterone therapy for specific indications in women.

NICE Guidelines (2015)

The National Institute for Health and Care Excellence states:

“Consider testosterone supplementation for menopausal women with low sexual desire if HRT alone is not effective,” after assessment and discussion of risks and benefits.

NICE recognizes testosterone therapy as an evidence-based treatment for low libido in menopausal women.

British Menopause Society Position

The British Menopause Society supports testosterone therapy for:

  • Low sexual desire in menopausal women (not adequately improved by oestrogen alone)
  • Women who have had surgical menopause (ovaries removed)
  • Women with persistent fatigue, low mood, or reduced wellbeing despite adequate oestrogen replacement

The British Menopause Society states that testosterone should be routinely considered for women after bilateral oophorectomy (removal of both ovaries).

Global Consensus Position Statement on Testosterone

An international consensus statement from leading menopause societies worldwide (2019) concluded:

Testosterone therapy is indicated for:

  • Postmenopausal women with hypoactive sexual desire disorder (low libido causing distress)
  • Not adequately improved by oestrogen therapy alone
  • Safe and effective when used appropriately

Research Evidence

Multiple randomized controlled trials show:

For libido:

  • Testosterone therapy significantly improves sexual desire, arousal, and satisfaction in postmenopausal women with low libido
  • Effect size is clinically meaningful (not just statistically significant)
  • Benefits maintained with ongoing treatment

For wellbeing and energy:

  • Studies show improvements in mood, energy, and quality of life
  • Particularly pronounced in women after surgical menopause
  • Women report feeling “more like themselves”

For muscle and bone:

  • Testosterone increases lean muscle mass
  • Increases bone mineral density (particularly spine)
  • Improves strength

Safety:

  • Short to medium-term studies (up to 2 years) show testosterone therapy is safe at appropriate doses
  • No increased cardiovascular risk
  • No increased breast cancer risk (though long-term data limited)
  • Side effects minimal at appropriate doses

Why Isn’t Testosterone Routinely Offered?

If the evidence supports testosterone therapy for specific indications, why isn’t it routinely discussed or offered?

Several factors contribute:

1. No Licensed Product for Women in the UK

This is the biggest barrier.

There is NO testosterone product licensed for use in women in the UK (or most other countries).

Testosterone products are licensed for men (testosterone deficiency in men is well-recognized and treated).

Why no licensed product for women?

  • Pharmaceutical companies haven’t pursued licensing (complex, expensive regulatory process)
  • Women’s health historically under-researched and under-prioritized
  • Market deemed too small

This doesn’t mean testosterone therapy for women is unsafe or inappropriate — it means prescribers must use products licensed for men at much lower doses (this is called “off-label” prescribing).

Off-label prescribing is common and legal — many medications are used off-label when evidence supports it. But it creates barriers:

  • Some prescribers uncomfortable with off-label prescribing
  • Requires informed consent discussion
  • May not be covered by some insurance (though NHS prescriptions are available)

2. Lack of Prescriber Awareness and Training

Most GPs have little training in testosterone therapy for women.

Many don’t know:

  • That women produce testosterone
  • The symptoms of testosterone deficiency
  • That testosterone therapy is evidence-based for specific indications
  • How to prescribe or monitor it

This isn’t deliberate neglect — it’s a knowledge gap resulting from minimal menopause training.

3. Outdated Attitudes About Women and Testosterone

Historical attitudes that “testosterone is a male hormone” persist.

Some healthcare providers (and society more broadly) are uncomfortable discussing:

  • Women’s sexual desire
  • Loss of libido as a legitimate medical issue deserving treatment
  • Women needing or wanting testosterone

These attitudes are changing — but slowly.

4. Concerns About Safety

Some prescribers worry about side effects — particularly masculinizing effects (deepened voice, excess body hair, etc.).

These concerns are valid if doses are too high — but at appropriate physiological doses (replacing what the ovaries would have produced), side effects are minimal.

The key is appropriate dosing and monitoring.

5. Lack of Specialist Clinics

Testosterone therapy for women is often only available through specialist menopause clinics — not routine GP care.

Access to specialists is limited:

  • Long NHS waiting lists
  • Private care expensive
  • Not available in all areas

Women who might benefit often don’t get access.

How Testosterone is Prescribed for Women

If testosterone therapy is appropriate, how is it prescribed and what does treatment look like?

Formulations Available

Because there’s no product licensed for women, prescribers use:

Testosterone gel (licensed for men):

  • Most common approach in UK
  • Brands: Testogel, Tostran, Testavan
  • Men’s dose is 50-100 mg daily
  • Women use approximately 1/10th the male dose — typically 5-10 mg daily
  • Applied to skin (usually abdomen, inner thighs, or upper arms)
  • Absorbed transdermally

Testosterone cream (compounded):

  • Made by specialist compounding pharmacies
  • Can be formulated in appropriate doses for women (e.g., 1-2%)
  • Applied to vulva or skin
  • Not widely available on NHS (usually private)

Testosterone implants:

  • Pellets inserted under the skin
  • Release testosterone slowly over 3-6 months
  • Used in some specialist clinics
  • Not widely available

Intramuscular injections:

  • Sometimes used
  • Less common for women (causes more peaks and troughs)
  • Usually reserved for specific situations

In the UK, testosterone gel (licensed for men, used at low dose for women) is most common.

Dosing

The goal is to restore testosterone to mid-normal range for premenopausal women — not supraphysiological levels.

Typical starting dose:

  • Testosterone gel: 5-10 mg daily (approximately 1/10th the male dose)
  • Applied once daily, usually in morning
  • Applied to skin, allowed to dry, area covered with clothing

Dose is adjusted based on:

  • Symptom response (are symptoms improving?)
  • Blood testosterone levels (monitored at 6-12 weeks after starting, then periodically)
  • Side effects (if any)

Target testosterone levels:

  • Total testosterone: 0.8-1.5 nmol/L (mid-normal range for premenopausal women)
  • Some women need levels toward upper end of this range; others respond well at lower levels
  • Individual variation

Monitoring

Testosterone therapy requires monitoring:

Before starting:

  • Baseline blood tests: testosterone, SHBG, lipids, liver function
  • Assess symptoms (use validated questionnaire or systematic assessment)

6-12 weeks after starting:

  • Blood testosterone level (check level 3-4 hours after applying gel)
  • Assess symptom response
  • Check for side effects
  • Adjust dose if needed

Ongoing:

  • Blood tests every 6-12 months (testosterone, lipids, liver function, HbA1c)
  • Clinical review (symptoms, side effects)
  • Breast examination and mammography as per standard screening
  • Dose adjustment if needed based on symptoms and levels

Testosterone therapy is not “set and forget” — it requires ongoing monitoring by a knowledgeable prescriber.

Side Effects (at Appropriate Doses)

At appropriate physiological doses (replacing what ovaries would produce), side effects are minimal.

Possible side effects if dose too high:

  • Acne
  • Excess hair growth (hirsutism) — particularly face
  • Hair loss/thinning (male pattern)
  • Voice deepening (rare, usually only at very high doses; may be irreversible)
  • Clitoral enlargement (usually mild if occurs)
  • Changes in lipid profile

Most of these are dose-dependent — reducing dose resolves the issue.

Voice deepening is the most concerning side effect because it may be irreversible. This is why monitoring is essential — if voice changes occur, stop testosterone immediately.

At appropriate doses (5-10 mg daily for most women), side effects are uncommon.

What women more commonly report:

  • Slight increase in body hair (manageable)
  • Occasional acne (usually mild)
  • Increased libido (this is the desired effect!)
  • Increased energy (also desired)

Benefits typically outweigh minimal side effects for women who need testosterone.

Contraindications

When should testosterone NOT be used in women?

Absolute contraindications:

  • Pregnancy or breastfeeding (though most women considering testosterone are post-menopausal)
  • Breast cancer (testosterone can be converted to oestrogen; caution needed)
  • Androgen-dependent cancers

Relative contraindications (require careful assessment):

  • Severe acne or hirsutism (may worsen)
  • Polycystic ovary syndrome (PCOS) — many women with PCOS already have elevated androgens
  • Cardiovascular disease (though evidence doesn’t show increased risk at physiological doses)
  • Liver disease

Most postmenopausal women considering testosterone don’t have contraindications — but thorough assessment is essential.

Who Should Consider Testosterone Therapy?

Based on current evidence and guidelines, testosterone therapy should be considered for:

1. Women After Surgical Menopause (Bilateral Oophorectomy)

If you’ve had both ovaries removed, you’ve lost 50% of your testosterone production immediately.

Testosterone replacement should be routinely discussed — ideally at the time of surgery or shortly after.

Particularly if you experience:

  • Profound fatigue despite adequate oestrogen
  • Complete loss of libido despite adequate oestrogen
  • Difficulty building muscle
  • Flat mood or lack of motivation

Women after surgical menopause often need BOTH oestrogen AND testosterone to feel well.

2. Women with Persistent Low Libido Despite Adequate Oestrogen

If you’re postmenopausal and:

  • Experiencing distressing loss of libido
  • On adequate oestrogen HRT (symptoms like hot flushes, sleep, vaginal dryness controlled)
  • But libido hasn’t improved with oestrogen alone
  • Causing personal distress or relationship difficulties

Testosterone therapy is evidence-based and may help.

Important: Other causes of low libido should be addressed first:

  • Relationship issues
  • Stress, fatigue, poor sleep
  • Depression or anxiety
  • Medications (antidepressants, beta-blockers reduce libido)
  • Vaginal dryness/painful sex (treatable with topical oestrogen)

But if these are addressed and libido remains absent, testosterone is worth considering.

3. Women with Persistent Fatigue or Low Mood Despite Adequate Oestrogen

If you’re postmenopausal and:

  • Experiencing profound fatigue or flat mood
  • On adequate oestrogen HRT
  • Other causes ruled out (thyroid function normal, B12 adequate, not depressed, sleep adequate)
  • Symptoms persist despite optimal oestrogen dose

Testosterone deficiency may be contributing.

This is less well-established than the libido indication — but clinical experience and some research support it, particularly for women after surgical menopause.

How to Discuss Testosterone with Your Healthcare Provider

If you think testosterone deficiency might be contributing to your symptoms, how do you raise it with your GP or prescriber?

Step 1: Prepare for the Conversation

Before your appointment:

Assess your symptoms systematically:

  • Do you have profound, unrelenting fatigue (not explained by other causes)?
  • Have you lost all libido (not just reduced, but absent)?
  • Are you struggling to build muscle despite consistent training?
  • Do you feel flat, unmotivated, lacking drive?

Consider your menopause type:

  • Did you have surgical menopause (ovaries removed)?
  • If so, when? (If within last 1-2 years, testosterone loss is most acute)

Document what you’ve already tried:

  • Are you on HRT? What type and dose?
  • Have other causes been ruled out? (Thyroid checked? B12 adequate? Not depressed?)
  • Is your oestrogen dose optimal? (Hot flushes controlled, sleep improved, vaginal symptoms resolved?)

Be clear about impact:

  • How are symptoms affecting your quality of life?
  • Relationships? Work? Physical function? Mental wellbeing?

Step 2: Frame the Request Clearly

What to say:

“I’ve been on oestrogen HRT for [X months] and some symptoms have improved — my hot flushes are controlled and I’m sleeping better. But I’m still experiencing [profound fatigue / complete loss of libido / inability to build muscle / flat mood]. I’ve had my thyroid checked and it’s normal. I’ve read that testosterone deficiency can cause these symptoms, particularly after [surgical menopause / natural menopause]. I’d like to discuss whether testosterone therapy might be appropriate for me.”

Being specific and informed:

  • Shows you’re not asking on a whim
  • Directs the conversation productively
  • Makes it harder for GP to dismiss outright

Step 3: Reference Evidence and Guidelines

If your GP seems uncertain or dismissive:

“I understand that NICE guidelines support testosterone therapy for postmenopausal women with low libido if HRT alone isn’t effective. The British Menopause Society also recommends considering testosterone for women after surgical menopause. Would you be willing to discuss this further or refer me to a specialist who could assess whether it’s appropriate for me?”

Referencing guidelines:

  • Demonstrates this is evidence-based, not fringe
  • Puts GP on notice that you’re informed
  • Makes blanket dismissal more difficult

Step 4: If Your GP Is Uncomfortable Prescribing

Many GPs will not feel comfortable initiating testosterone therapy — it’s not routine practice and requires specialist knowledge.

This is reasonable.

What to request:

“I understand this may be outside your usual practice. Would you be willing to refer me to a menopause specialist or consultant who could assess whether testosterone therapy is appropriate?”

Most areas have NHS menopause clinics. Your GP should be willing to refer.

If private care is an option for you, seek a specialist menopause clinic with experience prescribing testosterone for women.

Step 5: If You’re Dismissed Without Consideration

If your GP dismisses the idea without consideration:

  • “Testosterone is for men”
  • “We don’t prescribe that”
  • “That’s not evidence-based”

These responses are incorrect and demonstrate lack of current knowledge.

Your options:

  • Request second opinion from another GP in practice
  • File complaint (care should align with current guidelines)
  • Seek private specialist assessment if financially possible
  • Change GP practices if pattern of dismissive care

You have a right to have legitimate treatment options discussed, particularly when evidence-based guidelines support them.

What About “Natural” Ways to Boost Testosterone?

Can lifestyle factors increase testosterone naturally without medication?

Honestly: Not significantly.

Some factors may have modest effects:

Strength training:

  • Resistance exercise acutely increases testosterone slightly
  • Building muscle may improve overall hormonal milieu
  • Won’t restore levels after surgical menopause

Adequate sleep:

  • Sleep deprivation suppresses testosterone production
  • Optimizing sleep supports normal production
  • But won’t overcome surgical menopause deficit

Healthy weight:

  • Obesity can lower testosterone (fat cells convert testosterone to oestrogen)
  • Maintaining healthy weight may help preserve levels
  • But won’t restore significant deficiency

Stress management:

  • Chronic stress increases cortisol, which can suppress testosterone production
  • Managing stress may help
  • But limited impact on surgical menopause

Supplements:

  • Various supplements marketed to “boost testosterone” (DHEA, tribulus, etc.)
  • Evidence is weak for most
  • DHEA is a testosterone precursor and may have modest effect in some women
  • Should only be used under medical supervision

The reality: If you have genuine testosterone deficiency — particularly after surgical menopause — lifestyle interventions alone won’t be sufficient.

They’re worth doing (for overall health and wellbeing), but they don’t replace testosterone therapy if you need it.

The Bottom Line

Testosterone is NOT just a “male hormone.”

Women produce testosterone throughout their lives. It’s essential for:

  • Libido and sexual function
  • Energy and vitality
  • Muscle mass and strength
  • Bone density
  • Mood and motivation
  • Overall sense of wellbeing

When testosterone levels drop — particularly after surgical menopause — women can experience devastating symptoms:

  • Profound fatigue
  • Complete loss of libido
  • Inability to build muscle
  • Flat mood and lack of motivation

Oestrogen alone doesn’t address testosterone deficiency. Many women need BOTH oestrogen AND testosterone to feel well.

Testosterone therapy for women is evidence-based:

  • NICE Guidelines support it for low libido in postmenopausal women
  • British Menopause Society recommends considering it after surgical menopause
  • Multiple randomized controlled trials show efficacy and safety at appropriate doses

Yet testosterone remains vastly under-prescribed due to:

  • No licensed product for women in UK
  • Lack of prescriber awareness and training
  • Outdated attitudes about women and testosterone
  • Limited access to specialist clinics

If you’ve had surgical menopause or are experiencing symptoms suggestive of testosterone deficiency despite adequate oestrogen, testosterone therapy deserves discussion.

Don’t accept profound fatigue, complete loss of libido, or inability to feel like yourself as inevitable. These may be symptoms of testosterone deficiency — a treatable condition.

Advocate for comprehensive menopause care that includes consideration of ALL hormones — not just oestrogen.

You deserve to feel like yourself again.

Need Support?

If you’re experiencing symptoms of testosterone deficiency and want to explore whether testosterone therapy might be appropriate, I can help.

As a registered nurse and prescriber specializing in menopause care, I provide comprehensive assessment including testosterone therapy for appropriate candidates.

Book a consultation to discuss your symptoms and treatment options.

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