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Do I need Testosterone

During the menopause transition, levels of the sex hormones estrogen and progesterone decrease, which can lead to a range of symptoms, such as hot flushes and night sweats, sleep problems, mood disturbance, fatigue, vaginal dryness, and urinary symptoms, among many others.

A significant number of menopausal women also suffer from sexual problems, such as low libido (sex drive). Although there are many reasons for this, including poor sleep, fatigue, stress, and relationship problems, low sex hormone levels also likely play a role.

While estrogen, prescribed as hormone replacement therapy (HRT), is usually enough to treat these symptoms, some women may also benefit from testosterone replacement. 

Testosterone, although more commonly known as a ‘male’ sex hormone, is also produced in women, and is a vital female sex hormone. It is important for sexual functioning, estrogen production (estrogen is actually derived from testosterone), and brain, bone, and muscle health.

Testosterone levels peak in a woman’s 20s, and then gradually decline with age, such that by menopause, levels are half to one-quarter of what they were at their peak. Some testosterone continues to be produced by the ovaries and the adrenal glands well beyond menopause.

Surgical removal of the ovaries results in a sudden, rather than gradual, fall in levels, so there is much less time for the body to adjust; in these women, as well as in younger women with early menopause, testosterone is particularly important.

As described earlier, HRT with estrogen and progesterone is sufficient to relieve most menopause symptoms, however, in a number of women, despite being on the right dose of HRT, low libido may remain a significant problem. Research shows that for many of these women, low dose transdermal testosterone (applied to the skin as a gel), if properly dosed and monitored, may be an important complement to HRT.

Although most transdermal testosterone preparations in the UK are licensed for men, there is a large body of research supporting its safety and effectiveness in women when used in lower, female physiological doses.

Testosterone replacement works best when given alongside standard HRT, so is generally not prescribed on its own. It is particularly important that any symptoms of vaginal dryness and discomfort are adequately treated with vaginal estrogen if testosterone is being considered. It may take 3-6 months to fully assess the benefit of treatment, and it may not be effective for all women.

Apart from an improvement in libido, some women also report improvements in mood and energy levels. However, there is not enough research data to conclude that testosterone replacement improves general well-being, cognitive health (brain functioning), or muscle and bone health, so guidelines recommend that it should not be prescribed for these reasons alone.


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      You are not alone. As a local example, in Manchester over 46% of council employees are female and over 40 years old. In a CIPD survey (2019) over 30% of women said they were unable to work because of menopausal symptoms.

      Only 25% said they could tell their manager the real reason for their absence. The Council account for nearly 7% of all employment in Manchester. They implemented a new Menopause policy in March 2022. CIPD survey | Manchester Council Menopause Policy | CIPD Manchester

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