Medical summary
In Great Britain, AndroFeme 10 mg/mL cream is licensed for hypoactive sexual desire dysfunction (HSDD) in postmenopausal women who are receiving optimised hormone replacement therapy (HRT). The MHRA product record is PLGB 57336/0002.[1]
NICE recommends considering testosterone for low sexual desire associated with menopause only when HRT alone is not effective.[2] The British Menopause Society (BMS) and international guidance emphasise a biopsychosocial assessment first: relationship factors, pain, vaginal symptoms, medicines, mental health and other treatable causes of low desire should be addressed.[3][4]
Testosterone is not an evidence-based treatment for general tiredness, low mood, brain fog, muscle loss or bone health in women. Total testosterone is measured before and during treatment mainly to prevent excessive exposure; there is no diagnostic blood cut-off for HSDD.[3][4][5]
What changed in the UK?
Older UK articles often stated that no testosterone product was licensed specifically for women. That is now out of date. The MHRA database lists AndroFeme 10 mg/mL cream as a prescription-only medicine authorised in Great Britain for HSDD in postmenopausal women on optimised HRT.[1]
The authorised indication is narrow. A licence does not mean that the medicine is appropriate for every woman with low desire, and it does not establish a condition called “female testosterone deficiency” based on a laboratory result.
Other testosterone gels manufactured for men may still be prescribed off-label in selected circumstances. Off-label prescribing places additional responsibility on the prescriber to explain the rationale, dosing, product handling and monitoring. Patients should not divide, transfer or substitute products without individual instructions.
Who may be considered for treatment?
Testosterone may be discussed when all of the following apply:
- low sexual desire is persistent and causes personal distress;
- menopause is relevant to the presentation;
- conventional HRT has been optimised but has not adequately improved the low desire;
- other contributors have been assessed and managed where possible; and
- a qualified prescriber judges that expected benefits outweigh individual risks.[1][2][3]
A detailed history matters more than one testosterone result. Pain during sex, vaginal dryness, relationship difficulties, depression, anxiety, sleep problems, medicines and other health conditions can all affect desire. Treatment decisions should be shared, realistic and based on the woman’s priorities.
What AndroFeme is licensed to do
The authorised starting dose in the AndroFeme Summary of Product Characteristics is 5 mg testosterone, equivalent to 0.5 mL of cream, once daily. The listed maximum is 10 mg daily.[1] This information describes the licence; it is not a personal dosing instruction.
The prescriber must provide the exact dose and application directions. Do not increase the amount because symptoms have not changed quickly. Excess exposure can cause acne, increased facial or body hair, scalp hair changes and other androgenic effects.
If there is no meaningful improvement after six months of optimised therapy, the authorised product information says treatment should be stopped.[1]
What about Testogel, Tostran and other male products?
Male testosterone gels contain much larger unit doses than women usually require. BMS guidance describes the cautious use of reduced quantities of male products when an appropriate female formulation is not used, but this remains product-specific and usually off-label.[3]
The exact quantity cannot safely be generalised across brands, pumps and sachets. Concentration, metering and excipients differ. A patient should receive written instructions naming the product, amount, frequency and application site. A change of brand needs a fresh dosing check rather than a simple like-for-like swap.
Compounded testosterone products are not recommended by international guidance when regulated products are available, because consistency, efficacy and safety data may be limited.[4]
How to apply testosterone safely
Follow the product leaflet and prescriber’s directions. The AndroFeme product information includes precautions intended to reduce accidental transfer to another person.[1]
General safeguards include:
- apply only to the site instructed by the prescriber;
- wash hands after application;
- allow the product to dry before covering the area;
- avoid skin-to-skin contact with the application area until the stated precautions have been followed;
- keep the medicine away from children and pets; and
- do not share the product.
If another person has direct contact with the application site, follow the product leaflet and seek professional advice if exposure is a concern.
Baseline assessment and blood tests
HSDD is not diagnosed by a low testosterone result. Total testosterone is measured before treatment to identify an unexpectedly high baseline and to provide a reference for safety monitoring.[3][4]
BMS guidance prefers total testosterone, ideally measured by a reliable assay, rather than using free testosterone or the free androgen index as a treatment target. Results should be interpreted against the reporting laboratory’s female physiological range.[3]
The assessment may also include SHBG and other tests when clinically indicated. The necessary tests depend on the person’s history, medicines, menopause care and possible alternative explanations for symptoms.
Monitoring during treatment
The purpose of monitoring is to assess benefit and avoid excessive testosterone exposure. BMS guidance recommends reassessment after treatment begins and continued testing at intervals determined by the clinician; ongoing checks are commonly performed every 6–12 months once stable.[3]
A review should cover:
| Area | What the clinician assesses |
|---|---|
| Sexual-desire outcome | Whether distressing low desire has improved meaningfully for the patient. |
| Adverse effects | Acne, increased hair growth, scalp hair loss, voice change or other androgenic effects. |
| Total testosterone | Whether the result remains within the laboratory’s female physiological range. |
| Product use | Dose, application, transfer precautions and any brand change. |
| Ongoing need | Whether benefit still outweighs burden or risk. |
Routine monitoring should not use a male TRT target. Free testosterone and FAI should not be used as diagnostic cut-offs for HSDD.[3][4]
What benefits are supported?
The evidence-based indication is improvement of distressing low sexual desire in appropriately assessed women. International consensus does not support testosterone as a general treatment for cognition, mood, energy, bone or muscle outcomes.[5]
Some women may notice wider changes while their sexual wellbeing improves, but those observations must not be presented as proven treatment indications. Other symptoms should be assessed on their own merits rather than attributed automatically to testosterone.
Side effects and uncertainties
At physiological exposure, the more common androgenic effects include acne and increased facial or body hair. Voice deepening and clitoral enlargement are uncommon but require prompt review, particularly if exposure is excessive.[3][4]
Long-term breast and cardiovascular safety data are limited. The AndroFeme product information states that clinical-trial safety beyond 24 months is not established.[1] This uncertainty should form part of informed consent and ongoing review.
Testosterone is not appropriate during pregnancy or breastfeeding. Specialist advice is needed for women with hormone-sensitive cancer history, active liver disease, unexpectedly high testosterone or other significant risk factors.[1][3]
Questions to ask the prescriber
Before starting, ask:
- What is the precise treatment indication in my case?
- Is this product licensed for that use?
- What exact amount should I apply, and where?
- What should I do if I miss a dose or change brand?
- When will symptoms and total testosterone be reviewed?
- Which side effects should prompt an earlier appointment?
- When will treatment be stopped if it does not help?
Frequently asked questions
Is testosterone licensed for women in the UK?
AndroFeme 10 mg/mL cream is licensed in Great Britain for HSDD in postmenopausal women on optimised HRT. Other products may be used off-label under individual prescribing responsibility.[1]
Is a low testosterone result required?
No blood cut-off diagnoses HSDD or identifies who will respond. Total testosterone is used mainly as a baseline and safety-monitoring measure.[3][4]
What is the usual AndroFeme starting dose?
The authorised product information lists 5 mg, equivalent to 0.5 mL, once daily. Only the prescriber should set or change an individual dose.[1]
How long should a trial continue?
The MHRA product information says treatment should stop if there is no improvement after six months of optimised therapy.[1]
Does testosterone treat fatigue or brain fog?
Current randomised-trial evidence does not support testosterone as a treatment for cognition, mood or energy in women. Those symptoms need a broader assessment.[3][5]
How is treatment monitored?
Clinicians review symptom benefit, androgenic effects, product use and total testosterone. BMS guidance favours total testosterone over free testosterone or FAI for monitoring.[3]
References
[1] Medicines and Healthcare products Regulatory Agency. AndroFeme 10 mg/mL cream, PLGB 57336/0002: Summary of Product Characteristics. View source
[2] National Institute for Health and Care Excellence. Menopause: identification and management. Recommendation 1.5.32. View source
[3] British Menopause Society. Testosterone replacement in menopause. May 2026. View source
[4] Parish SJ, Simon JA, Davis SR, et al. ISSWSH Clinical Practice Guideline for the Use of Systemic Testosterone for HSDD in Women. *J Womens Health*. 2021;30(4):474–491. View source
[5] Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. *Climacteric*. 2019;22(5):429–434. View source
