Testosterone Gel for Women: Prescribing, Dosing and What to Expect

Medical Summary

Testosterone gel is increasingly prescribed for postmenopausal women experiencing hypoactive sexual desire dysfunction (HSDD) when hormone replacement therapy (HRT) alone is insufficient. Although testosterone is not currently licensed for female use in the UK, it is widely prescribed off-label by specialists following guidelines from the National Institute for Health and Care Excellence (NICE) and the British Menopause Society (BMS)^[1]. The typical female dose is approximately 5mg per day, which is roughly one-tenth of the standard male dose, and treatment requires regular monitoring of total testosterone and free androgen index to ensure levels remain within the physiological premenopausal range^[2]. While side effects are minimal at the correct dose, women with a history of hormone-sensitive cancers or those who are pregnant should avoid use.^[4][5][6]

Understanding Testosterone Gel for Women

When you think of testosterone, you might immediately associate it with men. However, women also produce testosterone in their ovaries and adrenal glands, and it plays a vital role in female health. As you approach the menopause, your natural production of oestrogen, progesterone, and testosterone begins to decline. For many women, this drop in testosterone can lead to a significant reduction in sexual desire, arousal, and satisfaction. This decline is not a sudden event but rather a gradual process that can begin years before your periods actually stop, often leaving women feeling confused about the changes in their bodies and their intimate relationships.^[3]

If you are experiencing a distressing lack of libido that does not improve with standard HRT, your doctor might suggest testosterone gel for women. This treatment aims to restore your testosterone to the levels you had before the menopause, helping to revive your sex drive and improve your overall sexual wellbeing. It is not about creating unnaturally high levels of the hormone, but rather replacing what your body has stopped producing in sufficient quantities. The goal is to help you feel like yourself again, restoring a part of your life that may have felt lost to the menopausal transition.

The conversation around women and testosterone is evolving rapidly. For decades, the focus of menopause treatment was almost exclusively on oestrogen and progesterone. While these hormones are undoubtedly critical for managing symptoms like hot flushes and protecting bone health, the role of testosterone was often overlooked. Today, medical professionals recognise that a comprehensive approach to menopause care must consider all the hormones that fluctuate during this time. By addressing testosterone deficiency, doctors can offer a more holistic treatment plan that addresses the full spectrum of menopausal symptoms, particularly those related to sexual function and overall vitality.

Why is it Prescribed?

The primary medical indication for prescribing testosterone gel to women is hypoactive sexual desire dysfunction (HSDD). This condition is characterised by a persistent lack of sexual thoughts, fantasies, and desire for sexual activity, which causes personal distress. It is not simply a case of occasionally not being in the mood; HSDD represents a profound and distressing shift in a woman’s sexual baseline. According to the latest guidance from NICE and the BMS, testosterone supplementation should be considered for postmenopausal women with low sexual desire if standard HRT has not been effective.

While some women report improvements in energy levels, mood, and cognitive function, the current clinical evidence and official guidelines focus specifically on its benefits for sexual function. The research supporting the use of testosterone for HSDD is robust, demonstrating that when used correctly, it can significantly increase the frequency of satisfying sexual events and reduce the distress associated with low libido. If you are struggling with low testosterone in women, discussing your symptoms with a specialist can help determine if this treatment is appropriate for you.

It is also worth noting that the diagnosis of HSDD involves ruling out other potential causes for low libido. Your doctor will want to ensure that your symptoms are not primarily due to relationship issues, depression, medications like antidepressants, or other medical conditions. A thorough evaluation is essential to ensure that testosterone therapy is the right approach for your specific situation. This comprehensive assessment ensures that you receive the most appropriate and effective care for your needs.

The Off-Label Status in the UK

One of the most common questions women have is why the medication they receive is often packaged for men. Currently, there are no testosterone products officially licensed for female use in the UK. Because of this, doctors prescribe testosterone gel for women “off-label.” This means they are using a medication licensed for one purpose (treating men with low testosterone) to treat another condition (HSDD in women) based on strong clinical evidence and expert consensus. This practice is entirely legal and very common in medicine, particularly when treating conditions where specific licensed products are not yet available.

When you receive a prescription for testosterone gel, you will likely be given a product like Testogel or Tostran, which are designed for men. The crucial difference lies in the dosage. Men typically use around 50mg of testosterone per day, whereas the female dose is much lower, usually around 5mg per day. This means you will need to carefully measure out a small portion of the gel or sachet, as directed by your doctor. The lack of a licensed female product can be frustrating, but it should not deter you from seeking treatment if you and your doctor believe it could be beneficial.

The off-label status also means that your GP might be hesitant to prescribe it initially. Many GPs prefer to refer women to a menopause specialist or an endocrinologist for the initiation of testosterone therapy. These specialists have the specific expertise required to assess your suitability for the treatment, determine the correct starting dose, and establish a monitoring plan. Once your dose is stable and your symptoms have improved, your GP may be willing to take over the prescribing under a shared care agreement.

Available Products and Dosing

Because you are using a fraction of the male dose, understanding how to measure your medication is essential. Your doctor will provide specific instructions, but here is a general overview of how common products are used in clinical practice:

• Testogel (50mg sachets): You will typically use one-tenth of a sachet per day, meaning one sachet should last you about 10 days. This requires careful visual estimation, which can be challenging at first but becomes easier with practice. You will need to fold the sachet and seal it with a clip to keep the remaining gel fresh for the next days.
• Tostran (2% gel): This comes in a pump dispenser. One full pump delivers 10mg of testosterone, so women are usually advised to use half a pump per day, or one full pump every other day. The pump mechanism makes it slightly easier to measure than the sachets, but you still need to be precise.
• AndroFors (5mg sachets): This is a newer product that provides exactly 5mg of testosterone per sachet, making it much easier for women to apply the correct daily dose without needing to estimate fractions of a larger packet. This development represents a significant step forward in making testosterone therapy more user-friendly for women.

Always follow your prescribing doctor’s exact instructions, as your dose may be adjusted based on your blood test results and symptom response. Never alter your dose without consulting your healthcare provider, as taking too much can lead to unwanted side effects, while taking too little may render the treatment ineffective.

How to Apply Testosterone Gel

Applying the gel correctly ensures that the hormone is absorbed effectively and reduces the risk of transferring it to others. You should apply the gel once a day, ideally at the same time each morning. The best areas for application are the lower abdomen or the inner thighs. These areas have a good blood supply and are usually covered by clothing, which helps prevent accidental transfer to your partner, children, or pets.

Before applying, ensure your skin is clean, dry, and free from any lotions or moisturisers. Rub the gel gently into the skin and allow it to dry completely before getting dressed; this usually takes just a few minutes. Wash your hands thoroughly with soap and water immediately after application. You should avoid showering, bathing, or swimming for at least two to four hours after applying the gel to give it time to absorb fully into your bloodstream.

It is also important to rotate your application sites. For example, if you apply the gel to your left inner thigh one day, use your right inner thigh the next day. This helps prevent skin irritation and ensures consistent absorption. If you accidentally miss a dose, do not double up the next day. Simply apply your normal dose at the usual time and continue with your regular schedule.

What to Expect: Timeline and Monitoring

Patience is key when starting testosterone therapy. Unlike some medications that work immediately, hormones take time to build up in your system and produce noticeable effects. Most women begin to see an improvement in their sexual desire and arousal after 8 to 12 weeks of consistent use. If you do not notice any benefits after six months, your doctor will likely recommend stopping the treatment, as it may not be effective for you. It is crucial to manage your expectations and understand that this is not a quick fix, but rather a gradual restoration of your hormonal balance.

To ensure your safety and the effectiveness of the treatment, regular monitoring is essential. Before starting, you will need a baseline blood test to check your total testosterone and sex hormone-binding globulin (SHBG) levels, which allows your doctor to calculate your free androgen index (FAI). The FAI provides a more accurate picture of how much active testosterone is available in your body. Once treatment begins, you should have follow-up blood tests every 3 to 6 months.

The goal of monitoring is to keep your testosterone levels in women within the normal physiological range for a premenopausal woman. This ensures you get the benefits of the hormone without the risks associated with excessively high levels. Your doctor will review your blood test results alongside your symptom diary to determine if your current dose is optimal or if adjustments are needed.

Side Effects and Safety Considerations

When used at the correct, low dose, testosterone gel for women is generally very safe and well-tolerated. The most common side effects are mild and often occur at the application site, such as slight skin irritation or a small increase in fine hair growth where the gel is rubbed in. These local reactions are usually temporary and can often be managed by rotating the application site more frequently or ensuring the skin is completely dry before applying the gel.

However, if your dose is too high or your levels exceed the normal female range, you may experience signs of overdosing, also known as virilisation. These symptoms occur because the body is being exposed to levels of testosterone that are more typical of a male physiology. They can include:

• Increased facial or body hair (hirsutism), particularly on the chin, upper lip, or chest
• Acne or unusually oily skin, often resembling the breakouts experienced during puberty
• Deepening of the voice, which may start as a slight hoarseness or a feeling of a “frog in the throat”
• Enlargement of the clitoris, which can sometimes be uncomfortable or sensitive
• Hair thinning or male-pattern balding, particularly at the temples or the crown of the head

If you notice any of these signs, you must contact your doctor immediately. These side effects are usually reversible if caught early and the dose is reduced or stopped. This highlights exactly why regular blood monitoring is so critical. By keeping a close eye on your hormone levels, your doctor can intervene before these side effects become problematic or permanent.

Who Should Not Use Testosterone Gel?

Testosterone therapy is not suitable for everyone. There are certain medical conditions and circumstances where the risks of using testosterone outweigh the potential benefits. You should not use testosterone gel if you:

• Have a history of hormone-sensitive cancers, such as breast cancer or endometrial cancer, as the impact of exogenous testosterone on these conditions is not fully understood
• Are pregnant or breastfeeding, as testosterone can cause severe developmental abnormalities in a female foetus
• Have active liver disease, as the liver is responsible for metabolising hormones
• Have polycystic ovary syndrome (PCOS) with already elevated androgen levels, as adding more testosterone could exacerbate your symptoms
• Have severe acne or significant unwanted facial hair before starting treatment, as testosterone is likely to make these conditions worse

Always provide your doctor with a complete and accurate medical history so they can safely assess whether this treatment is right for you. Honesty about your past and current health conditions is the best way to ensure you receive safe and effective care.

The Psychological Impact of HSDD

It is impossible to discuss testosterone therapy without acknowledging the profound psychological impact of hypoactive sexual desire dysfunction. For many women, the loss of libido is not just a physical symptom; it is a deeply emotional experience that can affect their self-esteem, their body image, and their intimate relationships. Feeling disconnected from your own sexuality can lead to feelings of guilt, inadequacy, and frustration.

When a woman seeks treatment for HSDD, she is often looking for more than just a physical response; she is seeking a return to a part of herself that feels lost. The validation that comes from a healthcare professional acknowledging her distress and offering a viable treatment option can be incredibly empowering. It shifts the narrative from “this is just a normal part of ageing” to “this is a recognised medical condition with available treatments.”

Furthermore, the improvement in sexual desire that often accompanies successful testosterone therapy can have a ripple effect on a woman’s overall wellbeing. A satisfying sex life is associated with better mood, reduced stress, and stronger relationship bonds. By addressing the hormonal imbalance at the root of HSDD, testosterone gel can help women reclaim their vitality and improve their quality of life in ways that extend far beyond the bedroom.

Combining Testosterone with Other HRT

Testosterone gel is rarely prescribed in isolation. In most cases, it is used as an add-on therapy for women who are already taking standard hormone replacement therapy (HRT) consisting of oestrogen and, if they still have a womb, progesterone. This combined approach is essential because oestrogen provides the foundation for treating the majority of menopausal symptoms, such as hot flushes, night sweats, and vaginal dryness.

In fact, current guidelines recommend that testosterone should only be considered after a woman has been on a stable dose of systemic HRT for several months without seeing an improvement in her libido. This ensures that the low sexual desire is not simply a secondary effect of other menopausal symptoms, such as exhaustion from night sweats or discomfort from vaginal atrophy, which oestrogen alone can often resolve.

When you add testosterone to your HRT regimen, your doctor will carefully monitor how the hormones interact. Sometimes, adjusting the dose of oestrogen can affect how your body binds and uses testosterone. This delicate balancing act requires the expertise of a specialist who understands the complex interplay of female hormones. The goal is to find the precise combination and dosage that provides maximum symptom relief with minimal side effects.

The Future of Female Testosterone Treatments

The area of women’s health is slowly changing. While the UK currently relies heavily on off-label prescribing of male products, there is growing recognition of the need for female-specific formulations. Products like AndroFeme, a 1% testosterone cream designed specifically for women, have been approved by the MHRA and are expected to become more widely available in the coming years. This approval marks a significant milestone in acknowledging and addressing the specific hormonal needs of women.

Until female-specific products are universally accessible on the NHS, the careful use of low-dose gel remains the gold standard for treating HSDD in postmenopausal women. Advocacy groups and medical professionals continue to campaign for better access to these treatments, arguing that women should not have to rely on off-label prescribing or private clinics to receive evidence-based care for a recognised medical condition.

If you are wondering do women have testosterone, the answer is a resounding yes. It is a vital hormone that contributes significantly to your quality of life. If you feel that a lack of libido is affecting your wellbeing, do not hesitate to seek professional medical advice. There are effective, evidence-based treatments available that can help you feel like yourself again. You do not have to accept a diminished quality of life as an inevitable consequence of the menopause.

References

1. National Institute for Health and Care Excellence (NICE). Menopause: diagnosis and management. NICE guideline NG73. 2015 (updated 2024). View
2. Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660–4666. View
3. British Menopause Society. Testosterone replacement in menopause. BMS consensus statement. 2022. View
4. Islam RM, et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2019;7(10):754–766. View
5. Achilli C, et al. Efficacy and safety of transdermal testosterone in postmenopausal women with hypoactive sexual desire disorder. Fertil Steril. 2017;107(2):475–482. View
6. National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summaries: Menopause. View