Low Testosterone in Women: What Happens Next?

Many women come to clinic having already done their research. They have read about testosterone, recognised symptoms in themselves, and often spent months or years wondering whether it might help.

Yet when they speak to their GP, they are frequently told their blood tests are “normal,” or that testosterone is not something that can be prescribed. In some cases, treatment is started without clear guidance or follow-up.

If this feels familiar, it is worth understanding what good testosterone care should look like and why the answer is not always straightforward.

Can Women Have Low Testosterone?

Yes. Testosterone is often thought of as a “male hormone,” but it plays an important role in women’s health.

In women, testosterone contributes to:

• Libido and sexual function

• Motivation and drive

• Energy levels

• Mood and emotional resilience

• Muscle strength and maintenance

Levels naturally decline with age, particularly during perimenopause and menopause.

Symptoms of Low Testosterone in Women

Low testosterone can present in a number of ways. Common symptoms include:

• Reduced libido

• Low motivation or drive

• Persistent fatigue

• Emotional flatness or reduced enjoyment

• Brain fog or poor concentration

• Reduced muscle strength

These symptoms often overlap with other hormonal changes, particularly oestrogen decline, which is why a full assessment is essential.

Why “Normal” Blood Tests Do Not Always Mean Normal

One of the most common frustrations is being told that testosterone levels are “normal.”

However, testosterone testing in women is complex:

• There is no universally agreed diagnostic threshold for low testosterone in women

• Reference ranges vary between laboratories

• Results do not account for individual baseline levels

• Hormone levels fluctuate with age, cycle, and medication

A level that is technically “normal” may still be too low for a particular individual.

The Importance of SHBG and Free Testosterone

A key factor often overlooked is Sex Hormone Binding Globulin (SHBG).

SHBG is a protein that binds testosterone in the bloodstream. When testosterone is bound, it is not biologically active.

This means:

• Total testosterone may appear normal

• But free (active) testosterone may be low

SHBG levels can be raised by:

• Oral oestrogen (including some HRT)

• The combined contraceptive pill

• Certain metabolic factors

For this reason, a proper assessment should include:

• Total testosterone

• SHBG

• Calculated free testosterone

  
  

Do You Need a Blood Test for Low Testosterone?

Blood tests can be helpful, but they are only one part of the picture.

A diagnosis is based on:

• Clinical symptoms

• Hormonal context (including oestrogen status)

• Blood results (interpreted appropriately)

Focusing on numbers alone can miss the underlying issue.

Why Oestrogen Matters First

Before considering testosterone, it is important to ensure that oestrogen levels are adequately supported.

Testosterone therapy tends to be more effective when:

• Oestrogen deficiency has already been addressed

• Symptoms have partially improved but not fully resolved

For example, a woman on HRT who feels significantly better overall but still experiences low libido or reduced motivation may benefit from testosterone.

Testosterone Treatment for Women in the UK

Is testosterone safe for women?

When prescribed at physiological (female) doses, testosterone has a well-established safety profile.

Treatment aims to:

• Restore levels within the normal female range

• Improve symptoms not exceed normal hormone levels

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How is testosterone prescribed?

In the UK, testosterone for women is prescribed off-licence, which is standard practice in specialist menopause care.

Treatment usually involves:

• A transdermal gel or cream

• Applied daily to the skin

• Careful dose titration over time

Common options include:

• Low doses of male formulations (e.g. Testogel, Tostran)

• Androfeme 1% (licensed in Australia)

  
  

How long does testosterone take to work?

Testosterone is not a quick treatment.

• Effects develop gradually

• Improvements are often seen over several weeks to months

• Consistency is essential

Women who understand this tend to achieve the best outcomes.

Monitoring and Follow-Up

Safe testosterone prescribing requires structured follow-up.

Typical monitoring includes:

• Blood test at 3 months

• Ongoing testing every 6 months

• Clinical review of symptoms

The goal is:

• Symptom improvement

• Safe hormone levels

• The lowest effective dose

  
  

Side Effects of Testosterone in Women

At appropriate doses, side effects are uncommon.

Potential side effects may include:

• Acne

• Increased facial or body hair

• Oily skin

These are:

• Dose-dependent

• Usually mild

• Reversible with dose adjustment

More significant side effects are rare when treatment is properly supervised.

Why Testosterone Care Often Falls Short

Despite strong evidence, many women struggle to access appropriate care.

This is largely due to:

• Limited training in testosterone prescribing

• Variability in clinical confidence

• Lack of structured follow-up in some settings

As a result, women may experience:

• Underdiagnosis

• Undertreatment

• Inadequate support

  
  

When to Seek Specialist Advice

You may benefit from specialist input if:

• You have persistent symptoms despite “normal” blood tests

• You are on HRT but still feel something is missing

• You have tried testosterone without clear benefit

• You have not had structured follow-up

In many cases, the issue is not that testosterone “doesn’t work,” but that:

• Dosing is suboptimal

• Treatment is stopped too early

• Monitoring is insufficient

  
  

Testosterone Treatment at Bristol Menopause Clinic

At Bristol Menopause Clinic, testosterone assessment includes:

• A full clinical history

• Detailed hormone review

• Appropriate blood testing

• Personalised treatment planning

We also offer structured follow-up and support packages to ensure:

• Safe prescribing

• Ongoing monitoring

• Continuity of care

  
  

Book a Consultation

If you are concerned about low testosterone or ongoing menopausal symptoms, we are here to help.

hello@bristolmenopause.com

Low testosterone in women is often overlooked, misunderstood, or inadequately managed.

A “normal” blood test does not always mean optimal health. The key is a symptom-led, clinically informed approach, supported by appropriate testing and follow-up.

With the right care, testosterone can play a valuable role in helping women feel more like themselves again.