Hormone therapy

Testosterone for low sex drive

UK guidance treats testosterone as an add-on for a low sex drive in menopause, used when standard HRT has not helped that problem. NICE NG23 classes the use as off-label, notes that the evidence is limited, and expects other causes of low desire to be ruled out first.

By Ines Kovac. Published 20 October 2026. 5 minute read.

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Low sex drive in menopause

A drop in desire can sit beside strain in a relationship, a changed feeling about your body, and sex that hurts. NICE Clinical Knowledge Summaries put those other causes ahead of a testosterone prescription.

HRT, anxiety and low mood sets out where hormone therapy fits for anxiety and depression in these years. The mood and mind hub gathers the guides on anxiety, memory and depression.

Pain during sex belongs in the same appointment. Vaginal dryness in menopause sets out local oestrogen for dryness and pain with sex, including when a patch or gel is already in use. On menopause forums, people say a treatment aimed at desire can feel beside the point while sex still hurts.

What NICE says about testosterone

NICE NG23 says to consider testosterone supplementation for people with low sexual desire associated with menopause if HRT alone is not effective. The same chapter names it among the sexual problems menopause can bring.

A note on that recommendation, dated November 2015, says this was an off-label use of testosterone. It points readers to NICE's information on prescribing medicines.

The British Menopause Society, in a July 2024 statement, names one evidence-based reason to add testosterone to standard HRT. That reason is persistent low libido in postmenopausal women, once other contributory factors have been addressed. The statement also says there is no evidence that testosterone helps other menopause symptoms, and no evidence that it prevents bone loss or dementia.

The appointment this guidance describes is about desire. Flushes, memory and bones are separate problems. Those guides sit on the HRT topic hub.

Hormone replacement therapy with testosterone for women

British Menopause Society clinician guidance says NICE NG23 and the Society recommend a trial of conventional HRT before testosterone is considered. What that first prescription contains is in the HRT guide linked above. How to start HRT and what to ask your GP covers the first visit. How long HRT takes to work covers the early months.

If the current HRT is a tablet, one step can come before a second hormone. NICE CKS says switching from oral HRT to transdermal oestrogen can raise free testosterone on its own.

How long you can stay on HRT covers the length of oestrogen and progestogen treatment, and how a later stop is planned.

Testosterone gel for women

No testosterone product is licensed in the UK for women. British Menopause Society practice standards say preparations made for men are commonly used. The NHS treatment page says a gel or cream can help a low libido in some people, and that a menopause specialist may prescribe it.

A Norfolk and Waveney patient leaflet from August 2025 gives a usual dose of about 5 mg a day, rubbed on the lower abdomen or the thighs. That dose is the one printed in that leaflet. Other areas publish their own.

Prescribing guidance from the same area names Testogel and Tostran for menopause-related low desire. It records MHRA approval for Androfeme in August 2025. At the time of that guidance, NHS prescribing of Androfeme was not advised, pending a formulary review.

How a prescription is monitored

Shared-care rules differ by area. CKS says topical testosterone follows local guidance. In some areas that guidance asks a specialist to advise the GP before the first prescription.

CKS asks for a total testosterone blood test before the first dose. The result is a baseline, and it shows whether the level is already high. The test is repeated 3 to 6 weeks after starting, then every 6 to 12 months.

Seeing whether desire has improved can take 3 to 6 months.

Common effects on the CKS list are extra hair growth, acne and weight gain, and they are usually reversible. Voice deepening and clitoral enlargement are described as rare when the level stays in the normal female range.

Whether to prescribe, change or stop treatment is a decision for the clinician in front of you.

Testosterone and low libido in menopause

A Menopause Society practice pearl cites guidelines that name hypoactive sexual desire disorder in postmenopausal women as the sole evidence-based indication for testosterone therapy.

Menopause forums describe a shift anywhere from about two weeks to many months. Some accounts describe no change after a long trial. A six-week mark is treated by some writers as the earliest point worth judging. The span to use with a clinician is the 3 to 6 month window above.

If you are in the US

In the United States, the Office on Women's Health says the FDA has not approved testosterone for women. It advises talking with a provider about possible benefits and risks. Does insurance cover HRT explains NHS prescription charges and how a US plan pays for standard hormone therapy.

What to ask at the appointment

Has this course of HRT had a fair trial, at a dose that controls the other symptoms?
Could painful sex or low mood be part of why desire has dropped?
If testosterone is discussed, ask for the baseline blood test, the review date, the dose planned, and which side effects to report.

Questions for a first HRT visit are in the starting guide linked above. When that early review usually falls is in the guide on how long HRT takes to work.

My take

I would start the conversation with a fair trial of standard HRT. Testosterone comes in if low desire is still the problem after that trial. The switch from tablets to a patch or gel, the one CKS describes, is the question I would ask before a second hormone. If sex hurts, I would want vaginal oestrogen discussed before anyone judges a gel aimed at desire. I would want the review booked inside the window above, with the blood tests already named, and I would keep flushes, memory and bones in their own visits.