Interest in testosterone for women is growing. Here’s what the evidence actually shows.
“I’ve been on HRT for six months and I feel better, but my libido is still non-existent”.
“I’m so tired all the time. Could my hormones still be off”?
“I keep reading about testosterone for women. Is it actually safe”?
“My brain just doesn’t work the way it used to”.
These are the kinds of concerns we hear regularly in our clinic. Interest in testosterone therapy for women has grown significantly in recent years, driven partly by social media, partly by women sharing their experiences more publicly, and partly by a genuine gap in how menopause symptoms are addressed.
Testosterone is often framed as either a miracle fix or something to be wary of. The reality, as with most things in medicine, sits somewhere in between and depends a lot on the individual patient. For some women, testosterone can make a meaningful difference. For others, it may not be the right approach.
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What does testosterone do in the female body?
When most people hear “testosterone”, they think of it as a male hormone. In fact, testosterone is produced by all bodies, including yours.
In women, testosterone is made by the ovaries and adrenal glands. It plays a role in:
- Sexual desire and arousal
- Energy levels and motivation
- Mood regulation
- Muscle strength and bone density
- Cognitive function, including concentration and memory
Your body produces testosterone throughout your life, though levels are much lower than in men. Production peaks in your early twenties and declines gradually from there. By the time you reach menopause, levels may be around half what they were at their highest.
How do testosterone levels change during perimenopause?
Unlike oestrogen and progesterone, which fluctuate dramatically during perimenopause before dropping sharply after menopause, testosterone follows a slower and steadier decline. This means low testosterone isn’t unique to menopause; it’s been falling for years.
However, the impact of low testosterone often becomes more noticeable during perimenopause. This may be because:
- Falling oestrogen amplifies the effects of already-low testosterone.
- Symptoms overlap with other hormonal changes, making them harder to identify.
- Life demands (work, family, stress) compound physical changes.
Some women find that even after starting hormone replacement therapy (HRT), certain symptoms, particularly low libido, persistent fatigue or difficulty concentrating, don’t fully resolve. This is often when testosterone enters the conversation.
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What does the research say about testosterone for women?
The evidence base for testosterone therapy in women is strongest for postmenopausal women and limited for perimenopausal women specifically.
Most clinical trials have focused on women who are clearly postmenopausal (more than 12 months without a period) or surgically menopausal (following hysterectomy or oophorectomy). The research in these groups consistently shows that transdermal testosterone improves sexual desire, arousal and satisfaction when added to existing HRT.
For perimenopause, generally speaking, the transitional years when periods become irregular but haven’t stopped, the direct evidence is thinner. Only one study to date has explicitly included perimenopausal women as a distinct group. That 2024 study found that after four months of testosterone therapy, 52% of participants reported improvement in libido and 39% reported improvement in cognitive symptoms like memory and concentration.
These are encouraging findings, but they come from a single retrospective study without a control group. We can’t yet say with certainty how much of the improvement was due to testosterone versus other factors.
Low libido
This is where the evidence is strongest. Multiple systematic reviews confirm that testosterone improves sexual desire in postmenopausal women when added to oestrogen therapy. The British Menopause Society supports its use for this purpose.
For perimenopausal women, the evidence is extrapolated from postmenopausal data, but clinical experience suggests similar benefits, particularly when low libido persists despite adequate oestrogen replacement.
If you’re experiencing signs that your HRT isn’t working as well as you’d hoped, this is worth discussing with your GP.
Fatigue
The evidence here is more limited. Fatigue was measured in some studies but rarely reported as a standalone outcome. Clinical guidelines note that many women report improvements in energy levels with testosterone, but we don’t yet have robust trial data to confirm this.
What we do know is that fatigue during perimenopause has many potential causes, including disrupted sleep, iron deficiency, thyroid dysfunction, stress and low oestrogen. These should be investigated thoroughly by your GP before attributing tiredness to low testosterone.
If fatigue is your main concern, our post on crashing fatigue during menopause explores the full range of causes. A comprehensive blood test can also help rule out other contributors.
Brain fog and cognitive symptoms
The same 2024 study found modest improvements in concentration and memory (a 22% reduction in symptom scores), but no other trials have specifically measured this in perimenopausal women. The evidence for cognitive benefits is minimal.
Some reviews suggest testosterone may have favourable effects on cognition in postmenopausal women, but the data isn’t strong enough to recommend testosterone primarily for brain fog. It’s also worth noting that cognitive changes during perimenopause can have other explanations.
For some women, difficulties with focus, organisation or emotional regulation that become harder to manage at midlife turn out to reflect underlying neurodivergent traits that hormonal shifts have unmasked. If this resonates, it may be worth exploring.
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Is testosterone safe for women?
We understand that safety is a key concern. The good news is that when testosterone is used at appropriate doses, and levels are kept within the normal female physiological range, side effects are generally mild.
The most common include:
- Acne (usually mild and manageable)
- Increased hair growth at the application site
- Oily skin
More significant androgenic effects, such as facial hair growth, deepening voice or hair loss, are rare and typically only occur if testosterone levels rise too high. This is why monitoring matters.
Studies have not found increased risk of breast or endometrial cancer with short-term use (up to two years). Transdermal testosterone does not appear to adversely affect cholesterol levels or blood pressure. However, long-term safety data beyond two years is limited, and this is something to factor into any treatment decision.
How is testosterone prescribed in the UK?
There is currently no testosterone product licensed specifically for women in the UK. This means testosterone is prescribed off-label, a common and legitimate practice when evidence supports use but licensing hasn’t caught up.
Most commonly, women are prescribed:
- transdermal testosterone gel or cream (applied to the skin daily)
- at doses much lower than those used for men, typically a fraction of a male sachet
Testosterone is usually prescribed as an adjunct to HRT, not as a standalone treatment. Guidelines recommend ensuring you’re adequately “oestrogenised” before adding testosterone, meaning your oestrogen replacement should be optimised first.
If you’re considering testosterone, your GP should:
- Review your symptoms and current HRT regimen.
- Check baseline blood tests, including testosterone levels.
- Discuss the evidence, benefits and limitations honestly.
- Prescribe an appropriate formulation and dose.
- Monitor your response and testosterone levels at follow-up (usually around three to six months).
If there’s no noticeable benefit after six months, guidelines suggest discontinuing treatment.
If you’re unsure whether your current HRT needs adjusting before considering testosterone, our guide to adjusting your HRT dose may help.
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When might testosterone be worth considering?
Testosterone may be worth exploring if:
- You’re experiencing persistent low libido that’s affecting your quality of life or relationships.
- You’ve been on HRT for several months, but certain symptoms haven’t improved.
- You’ve ruled out other causes of fatigue or cognitive symptoms.
- You understand that the evidence, while promising, is still developing, particularly for perimenopause.
It’s less likely to be appropriate if:
- You haven’t yet optimised your oestrogen and progesterone replacement.
- Your main concerns are symptoms like hot flushes or night sweats (testosterone doesn’t address these).
- You’re looking for a quick fix rather than a carefully monitored treatment.
How can Summerhill Health help?
Testosterone isn’t a miracle hormone, but it’s also not something to dismiss. Based on our clinical experience, for some patients, typically women with a persistent low libido despite adequate oestrogen replacement, it can make a meaningful difference.
The evidence is strongest for sexual desire, limited for fatigue, and minimal for cognitive symptoms. And importantly, most research has focused on postmenopausal rather than perimenopausal women. Being honest about these gaps doesn’t diminish testosterone’s potential value; it simply means treatment decisions should be made carefully, with realistic expectations.
At Summerhill Health, testosterone prescribing sits within our broader approach to menopause care, always individualised, evidence-based, and focused on how you feel rather than chasing numbers on a blood test.
“Dr Summerhill has always resolved every issue I have had seamlessly. She takes the time to listen and to explain what is happening and how it can be treated. Her knowledge is absolutely phenomenal and she has a lovely ‘bedside manner’, combining a kind and gentle approach while remaining consummately professional at all times”.
— Andi L.
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References
Glynne, S., Kamal, A., Kamel, A. M., et al. (2024). Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study. Archives of Women’s Mental Health.
Somboonporn, W., Davis, S., Seif, M., & Bell, R. (2005). Testosterone for peri- and postmenopausal women. Cochrane Database of Systematic Reviews.
Davis, S. (2013). Androgen therapy in women, beyond libido. Climacteric.
Scott, A., & Newson, L. R. (2020). Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care. British Journal of General Practice.
Reed, B., Bou Nemer, L., & Carr, B. (2016). Has testosterone passed the test in premenopausal women with low libido? A systematic review. International Journal of Women’s Health.
