Still Feeling Flat on HRT? Could Testosterone Be the Missing Piece?

Many women start HRT for menopause expecting to feel fully like themselves again with improved energy, better mood, clearer thinking, and a return to normal wellbeing.

For many women, Hormone Replacement Therapy (HRT) works extremely well. However, some women continue to experience symptoms such as low libido, fatigue, brain fog, poor concentration, reduced motivation, and low mood, even when their oestrogen treatment is working effectively.

If this sounds familiar, testosterone for menopause may be worth considering.

At the Bristol Menopause Clinic, we often see women who feel their HRT has helped, but they still do not feel fully themselves. In some cases, testosterone can be an important part of completing their menopause treatment plan.

What Does Testosterone Do in Women?

Although testosterone is often thought of as a male hormone, women naturally produce testosterone too, and it plays an important role in physical, emotional, and sexual wellbeing.

Testosterone can help support:

• Libido and sexual desire

• Energy and motivation

• Mood and emotional wellbeing

• Confidence and resilience

• Focus and concentration

• Muscle strength and body composition

• General vitality and quality of life

  
  

During perimenopause and menopause, testosterone levels naturally decline. This reduction can be more significant after surgical menopause, particularly if the ovaries have been removed.

Symptoms of Low Testosterone in Menopause

Low testosterone in women can contribute to symptoms such as:

• Low libido

• Ongoing fatigue

• Brain fog

• Poor memory and concentration

• Reduced confidence

• Low motivation

• Feeling emotionally flat

• Loss of enjoyment or drive

• Feeling unlike yourself despite being on HRT

  
  

These symptoms can overlap with other aspects of menopause, which is why specialist assessment is important.

When Is Testosterone Prescribed for Menopause?

Testosterone replacement for women is not usually the first step in treatment.

Before considering testosterone, it is important to ensure that standard menopause HRT is fully optimised, including:

• Oestrogen replacement

• Progesterone where required

• Lifestyle factors such as sleep, stress, nutrition, and exercise

  
  

Testosterone may be considered when a woman is already using appropriate HRT but symptoms still persist. This should always be assessed by a qualified menopause specialist.

Do You Need a Blood Test Before Testosterone?

Yes and it must be a venous blood test, not a finger-prick test.

Before prescribing testosterone, we assess:

• Baseline testosterone levels

• Sex Hormone Binding Globulin (SHBG)

• Free Androgen Index (FAI)

  
  

Finger-prick tests are not accurate enough for assessing testosterone and should not be used for prescribing decisions.

Is Testosterone Licensed for Women in the UK?

Currently, there is no female-specific licensed testosterone product for menopause treatment in the UK.

This means specialist menopause clinics prescribe carefully adjusted low doses of testosterone gel or cream originally licensed for men, following guidance from the British Menopause Society.

This is known as off-licence prescribing, but it is common, safe, and evidence-based when managed correctly by an experienced clinician.

Is Testosterone Safe for Women?

When prescribed at female physiological doses and monitored correctly, testosterone is generally very safe. The goal is not to create “high testosterone” levels, but to restore levels within the normal female range to improve symptoms safely. Monitoring is essential to reduce the risk of side effects and ensure the treatment remains appropriate.

How Long Does Testosterone Take to Work?

Some women notice improvement within 6 to 8 weeks, particularly in libido, energy, and mental clarity. However, we usually allow 3 to 6 months to properly assess the full benefit of treatment.

Regular follow-up appointments are an important part of safe testosterone prescribing.

What If My GP Will Not Prescribe Testosterone?

Many NHS GPs do not routinely prescribe testosterone for menopause, mainly because it is an off-licence treatment.

This can leave many women feeling frustrated when symptoms continue despite being on HRT.

As a specialist menopause clinic, we can:

• Assess whether testosterone is clinically appropriate

• Arrange the correct blood tests

• Prescribe safely where suitable

• Monitor treatment and blood levels

• Communicate with your GP for continuity of care

Could Testosterone Be the Missing Piece?

For the right patient, testosterone can make a significant difference to quality of life. It is not suitable for everyone, but for women experiencing persistent symptoms despite optimised HRT, it can be an important part of effective menopause treatment.

If you are still feeling flat on HRT and wondering whether there is more that could help, a specialist menopause review may help determine whether testosterone therapy for women could be the next step.

At Bristol Menopause Clinic, we provide expert assessment, evidence-based prescribing, and ongoing support to help women feel well, confident, and fully supported through menopause.

Find out more information about our testsoterone packages here