“I want you to prescribe me testosterone, doctor; this woman I follow on Instagram says we should all have it!”
“My sex drive has gone out the window, doctor; can you let me have testosterone?”
I’ve been writing for West Cork People since September 2023 and those who read my articles may have noticed that I have left the topic of testosterone therapy for women until now.
Over the last year, I have seen a surge in demand for testosterone therapy, sometimes coming from women as young as 40-years. For a long time doctors have been concerned about the fear-mongering and damage wrought by certain health assertions on social media. Unfortunately, these days an opinion spouted by an influencer with 100,000 or more followers is taken as fact by some women.
Rather satisfyingly, this very phenomenon has recently been scrutinised scientifically.
A global University of Sydney-led study has been published in February 2025 in JAMA Network Open.
Researchers analysed almost 1000 posts about five controversial medical screening tests that had been promoted by social media influencers to almost 200 million followers. They found most posts had no reference to scientific evidence, were promotional, had explicit financial interests and failed to mention potential harms. One of the interventions looked at was testosterone blood tests. This article is worth a read: my favourite quote: “One of the underlying themes being used by influencers promoting these tests is that knowledge is power, but most information is cherry-picked. When it comes to health, getting the full picture is so important, and half-truths are often lies.”
Get your information from credible sources like the website menopause matters.co.uk or www.womens-health-concern.org.
So, let’s look at the facts about testosterone therapy for women.
Is testosterone a female
hormone?
Yes, premenopausal women produce both testosterone and oestrogen. The main sources are ovaries and adrenal glands, small glands located near the kidneys. The amount of testosterone produced in a woman’s body is less than in a man’s.
What happens my testosterone levels with age?
Testosterone levels in women fall a little between ages of 20 and 40 and reach a steady level at menopause.
There is no dramatic cliff face fall-off in testosterone through the menopause as happens with oestrogen. A dramatic fall-off will occur, however, if a woman’s ovaries are removed surgically. What a lot of people are unaware of is that our testosterone levels start to rise again a little over the age of 60.
Mythbusting
I need my testosterone blood test done; Testosterone will help my fatigue and brain fog; I don’t want HRT, doc, I just want to have testosterone.
All of the above statements are not true or are flawed.
So, what will it do for me, doctor?
Testosterone use in the postmenopausal woman has been studied extensively. There s no evidence that it helps with brain fog or improves cognition. Similarly, studies have not shown it to be helpful for fatigue or aches and pains in this group. The only symptoms that have been repeatedly shown to be improved by testosterone is low sexual desire or libido; defined as a loss of interest in sex, and/or inability to become aroused and attain orgasm that is impacting on a woman’s psychological wellbeing or impacting her life in some way such as causing issues with her relationship.
The level of your testosterone in the blood does not tell us anything, as studies again have failed to show any links between testosterone levels and symptoms. Put simply; a woman’s testosterone can be lower than the usual female range and she may feel absolutely fine.
We also lack data on the possible negative effects of long-term testosterone use on increasing cardiovascular risks such as heart attacks and strokes as it is known that oral testosterone increases our blood lipids. There is also concern that longer term use may increase risk of breast or other cancers.
Evidence based guidelines on testosterone use in post-menopausal women have been published by the British Menopause Society( BMS) and National Institute for Clinical Excellence ( NICE) UK.
There is very little information and practically no studies done looking at testosterone use in women before the menopause so we just do not know if it is safe.
When can I have it?
The place of testosterone is as an add-on to hormone replacement therapy, HRT. Patients come with multiple menopause symptoms; low libido is only one of them.
For women, libido is a complex and multifactorial issue and therefore the approach needs to be holistic. You are going to have a rubbish sex drive if you are worried sick about one/all of the kids, your mum has recently passed away, there are money problems in the household, your husband is ill, you are exhausted as not sleeping for the hot flushes and everything down below is dry/itchy/burning/on fire; all of the above.
The initial approach is to deal with all the menopause symptoms and, unless contraindicated, start systemic HRT in the form of patches or tablets. It is vital to identify and treat vulval and vaginal symptoms of soreness, itching and dryness. This will require oestrogen as a cream and or pessary, in addition to HRT.
I see the patient three months later for a review. Depending on her symptoms, a slight increase in her oestrogen dose might be needed. In that case, I will see her again after another three months.
Only once I have established that her oestrogen deficiency symptoms have resolved do we talk about testosterone gel. In other words; the hot flushes are gone, she has seen improvement in mood and brain fog, sleep is better and her vulvo-vaginal symptoms have completely settled; specifically that sex is no longer painful or uncomfortable.
Then we talk about sex and what else can be done do to improve her libido and sexual enjoyment.
If libido is low and sex is not happening; is that a problem for her? I have met women who told me it’s not something they want any treatment for. Other women are distraught that they used to feel sexy and have regular sex with their partner and want to get that intimacy back.
What first?
Now we do a blood test; not because the result will influence my treatment plan but in order to ensure that her baseline level is low or within normal female range.
Three months after starting testosterone gel we do another blood test to ensure the level remains within the female range; we are not aiming for high levels.
How do I take it?
Testosterone for women comes as a gel but there are currently no licensed formulations for women outside of Australia.
This is mainly because Big Pharma do not see this as a therapeutic area worth investing in.
The dose is 0.5mg per day for a post-menopausal woman. Because these products have been manufactured and licensed for men who need higher doses, the dosing for women is fiddly: Testogel comes in a sachet that should last eight days. Testim gel comes in a sachet that should last 10 days so about half pea size blob per day. Tostran is a pump canister slightly easier to use; one pump equals 10mg alternate days.
Side effects?
Even at normal female testosterone levels, some women experience excessive hair growth, in particular on the face, acne, and sometimes weight gain. These side effects are reversible and subside on stopping therapy. Other side effects, more commonly associated with testosterone levels outside the female range but not exclusively, are male pattern baldness, deepening of voice and enlargement of the clitoris. Unfortunately, these side effects can be irreversible.
Monitoring
After your three-month blood test you should see your doctor to ensure your testosterone level remains in the female range and to review your symptoms. If you feel your libido and sexual enjoyment are benefitting from the testosterone you can continue but must have a blood tests, to keep an eye on testosterone levels, every six to 12 months. Importantly if I see a woman on testosterone gel for six months who feels it is doing absolutely nothing for her, I would recommend she stops.
Who should never have
testosterone therapy?
If you are pregnant or breastfeeding, have active liver disease or a history of breast cancer, or if your baseline testosterone level is elevated, testosterone therapy is not for you.
I finish this article as I always do by recommending that anyone experiencing symptoms related to menopause, perimenopause, or indeed issues with sex drive and enjoyment at any age, book an appointment to talk to your GP.
I emphasise again that doing blood tests for any female hormones, including testosterone under the age of 45 is rarely of any clinical use.
