When we think about menopause and hormones, oestrogen and progesterone usually take centre stage. But there's another crucial hormone that's often overlooked in women's health: testosterone.
Testosterone Isn't Just a Male Hormone
Many women are surprised to learn that their bodies produce testosterone throughout their lives. While women produce far less than men, testosterone plays vital roles in female health, affecting energy levels, mood, motivation, muscle mass, bone density, and sexual function.
During the menopausal transition, testosterone levels can decline by up to 50%, contributing to symptoms that oestrogen replacement alone may not fully address.
The Symptoms of Low Testosterone
If you're taking HRT but still experiencing certain symptoms, low testosterone might be the missing piece of your menopause management puzzle.
Common signs include:
Persistent fatigue and low energy - Not the tiredness that improves with a good night's sleep, but a pervasive lack of energy that makes even simple tasks feel exhausting.
Reduced motivation and drive - That "get up and go" feeling has got up and gone. You might feel unusually apathetic or struggle to find enthusiasm for activities you once enjoyed.
Loss of muscle mass and strength - Despite regular exercise, you notice decreased muscle tone and find it harder to build or maintain strength.
Low libido - Reduced sexual desire that doesn't improve with oestrogen replacement. This is one of the most common reasons women seek testosterone therapy.
Brain fog and poor concentration - Difficulty focusing, processing information, or making decisions that persists despite oestrogen treatment.
Mood changes - Feeling flat, lacking confidence, or experiencing low mood that doesn't fully respond to oestrogen therapy.
Why Isn't Testosterone Routinely Offered?
Despite growing evidence supporting its use, testosterone therapy for women remains underutilised in the UK. Several factors contribute to this:
There's no licensed testosterone product specifically for women in the UK, though this is gradually changing. Clinicians use male preparations at much lower doses, which requires specialised knowledge and experience.
Many healthcare providers lack training in prescribing testosterone for women, and some remain unaware of the evidence supporting its use.
Historical misconceptions about side effects persist, despite studies showing that testosterone therapy is safe and well-tolerated at appropriate doses for women.
The Evidence
The 2019 Global Consensus Position Statement on testosterone therapy for women, endorsed by major international menopause societies, confirms that testosterone effectively improves sexual function in postmenopausal women and is likely beneficial for mood, energy, and bone health.
Research shows that testosterone therapy can significantly improve low sexual desire, arousal, pleasure, orgasm, and sexual satisfaction. Many women also report improvements in energy, motivation, and overall wellbeing.
What About Side Effects?
At appropriate doses, testosterone therapy for women is generally well-tolerated with minimal side effects. Most women notice positive changes without any adverse effects.
Potential side effects at higher doses might include:
Mild acne (usually manageable)
Increased facial or body hair (rare at appropriate doses)
Voice deepening (very rare and usually reversible if caught early)
Changes in cholesterol levels (monitored through blood tests)
These side effects are dose-dependent and monitored through regular follow-up. The key is working with a specialist who understands appropriate dosing and monitoring for women.
How Is It Given?
Testosterone for women is typically administered as a cream or gel applied daily to the skin. This provides steady hormone levels and allows for easy dose adjustment.
Some women prefer testosterone implants, which are inserted under the skin and last several months. The choice depends on individual preference, lifestyle, and response to treatment.
Who Might Benefit?
Testosterone therapy is particularly worth considering if you:
Have persistent low libido despite oestrogen replacement
Experience ongoing fatigue and low motivation on HRT
Had your ovaries removed surgically (which causes a sudden drop in testosterone)
Feel you're not quite yourself despite being on HRT
Have symptoms of low testosterone confirmed by blood tests
It's important to note that testosterone is used in addition to, not instead of, oestrogen and progesterone for most women.
Monitoring and Safety
Testosterone therapy requires proper assessment before starting and regular monitoring during treatment. This includes:
Baseline blood tests to measure current testosterone levels
Assessment of symptoms and health history
Blood tests at three months and then annually
Regular review of symptoms and any side effects
Dose adjustment as needed based on your response
The Bottom Line
Testosterone is an important hormone for women's health that deserves more attention in menopause management. If you're taking HRT but still struggling with low energy, motivation, or libido, testosterone therapy might be the missing piece.
At Bristol Menopause Clinic, we have extensive experience in testosterone therapy for women and can provide comprehensive assessment, prescribing, and monitoring. Our approach is evidence-based, individualised, and focused on helping you achieve optimal wellbeing through every stage of menopause.
You don't have to settle for feeling "okay" when you could feel genuinely well. Book your consultation today and take the first step towards feeling like yourself again HERE