Testosterone for women in menopause: what the guidelines actually support

Testosterone is often described online as the missing piece of menopause treatment, with claims about energy, mood, focus and muscle. The guidelines are much narrower. They support it for one thing, and say plainly that the evidence does not support the rest.

This article describes what that guidance says. It is not advice about your own treatment, which is a conversation for you and your clinician.

The short version

NICE recommends that clinicians consider testosterone for low sexual desire associated with menopause, if HRT alone has not been effective ¹. An international consensus statement, endorsed by menopause and endocrine societies including the Royal College of Obstetricians and Gynaecologists, says the only evidence-based use of testosterone for women is low sexual desire that causes distress, in postmenopausal women, after a proper assessment ².

What it is not recommended for

The consensus statement is explicit. It does not recommend testosterone for ²:

• mood or general wellbeing
• memory, thinking or preventing cognitive decline
• bone health, muscle strength or body composition
• preventing disease in general

It also makes no recommendation for women before menopause, because the evidence is not there ².

Why HRT comes first

NICE's wording is "if HRT alone is not effective" ¹. If pain with sex is part of the picture, the guide to vaginal dryness and painful sex on this site covers the treatments for that.

How it is given

The consensus statement recommends doses that bring testosterone into the normal range for premenopausal women, not above it, and prefers forms absorbed through the skin ². It does not recommend pellets or injections, because they can push levels too high, and it does not recommend compounded "bioidentical" testosterone, because its safety and effectiveness are unproven ².

In many countries there is no testosterone product licensed for women. The statement says using an approved male product off-label is reasonable as long as levels stay in the female range ². In the UK, the NHS says testosterone, as a gel or cream, may be available on prescription from a menopause specialist ³. NICE noted in 2015 that this was an off-label use ¹.

How it is monitored

The consensus statement sets out a monitoring pattern ²:

• a blood test for total testosterone before starting
• a repeat test 3 to 6 weeks after starting
• checks every 6 months to make sure levels are not too high
• stopping if there is no benefit by 6 months

Side effects

At doses in the normal female range, the statement reports mild increases in acne and body or facial hair in some women, and no association with hair loss, enlargement of the clitoris or voice change ².

Guidance in the US and Europe

The consensus statement this guide relies on is international. It was endorsed by societies in the US, Europe and beyond, including The North American Menopause Society, The Endocrine Society and the European Menopause and Andropause Society ².

In the US, there are no FDA-approved uses of testosterone for menopausal women, even though off-label use has grown ⁴. The FDA notes that testosterone is approved for low sexual desire in women in Australia, New Zealand, the UK and South Africa, and that long-term safety data beyond 24 months are limited, particularly on heart disease and breast cancer ⁴. It held a public workshop in September 2026 to look at the evidence and possible future products for women ⁴.

What is still uncertain

Long-term safety is not established. The consensus statement notes there is not enough data on safety beyond 24 months of use ².

Keeping a record

If you start testosterone, the question at six months is whether desire has changed. That is hard to judge from memory. A simple weekly note, kept alongside your other symptoms in a notebook or in Halcyon, gives the review something to work with.