Written by Dr Rinku Ratti, GP & Hormone Specialist
When women think about menopause treatment, they usually think about oestrogen and progesterone. But few realise that testosterone — traditionally seen as a “male hormone” — also plays a vital role in female health.
Women produce testosterone naturally in the ovaries and adrenal glands, and levels start declining as early as their thirties, often falling by more than 50% by the time of menopause.
For many women, this hormonal shift can lead to subtle yet life-changing symptoms.
Recognising Low Testosterone in Women
I see many women who come to me saying, “I’m on HRT, but I still don’t feel like myself.”
They may have balanced oestrogen and progesterone, yet still experience:
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Low libido or reduced sexual satisfaction
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Loss of drive and motivation
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Difficulty building or maintaining muscle
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Weight gain despite healthy habits
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Emotional flatness or loss of confidence
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Fatigue, “burnout” and mental fog
These symptoms are often attributed to stress, mood, or ageing — but research shows androgen deficiency may be an underlying cause.
The Evidence Behind Testosterone Therapy in Women
Contrary to popular belief, testosterone therapy for women is not new — it has been studied for over 70 years.
The Global Consensus Position Statement (JCEM, 2019) — endorsed by leading menopause societies worldwide — confirms that testosterone can safely and effectively treat low sexual desire (HSDD) in postmenopausal women when prescribed correctly.
Key research findings include:
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Improved sexual function:
Women given physiological doses of testosterone experienced significant improvement in sexual desire, arousal, and satisfaction compared with placebo (Parish et al., JAMA Internal Medicine, 2020).
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Enhanced mood and wellbeing:
Low testosterone correlates with lower quality-of-life scores, poorer mood, and reduced cognitive function in menopausal women (Islam et al., The Lancet Diabetes & Endocrinology, 2022).
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Physical benefits:
Physiological testosterone can improve lean muscle mass and bone density, reducing frailty risk in later life (Kingsberg et al., Climacteric, 2021).
However, this therapy is not a cosmetic fix or a shortcut for energy or weight loss. It must only be prescribed when clinically appropriate — in low doses, by trained clinicians, and with close monitoring.
When Testosterone Therapy May Be Considered
According to international guidelines, testosterone may be prescribed for women who have:
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Persistent loss of libido causing distress
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Exclusion of other medical causes (thyroid, depression, anaemia, etc.)
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Low or low-normal testosterone on testing
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No contraindications, such as active hormone-sensitive cancers
Before treatment, I carry out a comprehensive evaluation including:
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Full hormone profile (oestrogen, progesterone, testosterone, SHBG)
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Thyroid and adrenal function
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Vitamin D, B12, and ferritin levels
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Blood sugar and lipid profile
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Liver and kidney function
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Lifestyle factors, sleep, and stress levels
Only if all other potential causes are addressed and symptoms persist do we consider testosterone replacement therapy (TRT).
How We Treat Safely
When TRT is appropriate, the goal is to restore physiological balance — not to reach male levels.
Women typically require tiny doses (around one-tenth of male TRT levels), delivered as a transdermal cream or gel compounded specifically for female use.
Follow-up blood tests are performed at 8–12 weeks and periodically thereafter to ensure safety and efficacy.
Common monitoring includes:
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Serum testosterone (total & free)
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SHBG
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Liver enzymes and lipids
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Clinical response and side-effects
When prescribed responsibly, the risk of virilisation (e.g. acne, hair growth, deepened voice) is very low and usually reversible upon dose adjustment.
Who Should Avoid TRT
Testosterone therapy should not be used in women who are:
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Pregnant or breastfeeding
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Have active breast or uterine cancer
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Have severe liver or cardiac disease
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Using unregulated or online testosterone without supervision
It should always be prescribed and monitored by a qualified hormone specialist — never purchased online or from non-medical sources.
Real Case Example
One of my patients, a 52-year-old executive, came to me after two years on standard HRT.
Her hot flushes had settled, but she felt “emotionally flat” and had no libido. Blood tests revealed low testosterone and low vitamin D.
After starting low-dose transdermal testosterone and optimising her nutrition, she noticed improvements within weeks — her motivation returned, her workouts became more effective, and intimacy in her marriage improved.
At three months, follow-up tests showed her hormone levels had normalised, and she described feeling “alive again, not like a shadow of who I was.”
Another patient, aged 48, had ongoing fatigue and loss of drive despite balanced oestrogen therapy. Investigation showed elevated SHBG and very low free testosterone. Adjusting her thyroid medication, adding magnesium, and introducing physiological testosterone brought marked improvement in energy and cognitive focus — all within three months.
These results are consistent with published evidence showing that restoring androgen balance can improve sexual function, mood, and quality of life.
A Note from Dr Rinku
Many women tell me they feel “switched off” — as if their spark and confidence have faded.
When clinically indicated, testosterone therapy can be transformative:
✅ More energy and motivation
✅ Restored libido and intimacy
✅ Improved muscle tone and bone strength
✅ Renewed confidence and wellbeing
But not every woman needs testosterone — and it should never be prescribed blindly.
Every woman deserves a comprehensive hormonal evaluation, not just oestrogen and progesterone replacement. Not every woman needs testosterone — but every woman deserves a full hormone evaluation, not just oestrogen and progesterone.
References
- Davis, S. et al. “Global Consensus Position Statement on Testosterone Therapy in Women.” Journal of Clinical Endocrinology & Metabolism (2019).
🔗 https://academic.oup.com/jcem/article/104/10/4660/5556103 - Islam, R. et al. “Testosterone therapy and women’s health: benefits and risks.” The Lancet Diabetes & Endocrinology (2022).
🔗 https://www.thelancet.com/journals/landia - Parish, S. et al. “Testosterone for hypoactive sexual desire disorder in postmenopausal women.” JAMA Internal Medicine (2020).
🔗 https://jamanetwork.com/journals/jamainternalmedicine - Kingsberg, S. et al. “Clinical use of androgens in perimenopausal and menopausal women.” Climacteric (2021).
🔗 https://www.tandfonline.com/toc/iclm20/current - Reviews by the British Menopause Society
🔗 https://thebms.org.uk
Great Post.