Testosterone for low sex drive in the menopause
Testosterone is a sex hormone that both women and men produce. Many people think of it as the male sex hormone, but women also need testosterone.
In fact, women produce 3 times more testosterone than the female sex hormone oestrogen before menopause. Menopause is when a woman stops having periods and can no longer get pregnant naturally.
If you have a low sex drive during menopause, you can have testosterone as a treatment. We can give this to you as a gel or in sachets.
We usually give you testosterone at the same time as standard hormone replacement therapy (HRT). This replaces hormones that are at a lower level as you approach menopause. Testosterone works best when you are being given oestrogen as well.
Testosterone medicine can take several months to work. It's not effective for everyone.
Younger women who had early menopause often notice benefits from using testosterone.
Low testosterone levels
Your testosterone levels gradually reduce as you get older.
If you have surgery to remove your ovaries (an oophorectomy), your testosterone levels become lower quickly. This is because your ovaries produce most of the testosterone in your body.
The symptoms of low testosterone levels are:
- low sex drive (libido)
- less pleasurable sex (the ability to get aroused and have an orgasm)
- lack of energy
- finding it hard to concentrate
There is some evidence that lower testosterone levels can also affect your mood and increase your chance of being depressed.
The NHS website has information and support to help you deal with low mood or depression.
We can make a diagnosis based on your symptoms and medical history alone. You do not usually need a blood test, but it can be useful to confirm that your testosterone levels are low.
If you are on hormone replacement therapy (HRT) (especially after your ovaries have been removed), you might still have these symptoms.
Your body can use testosterone to increase your sex drive. It can turn some testosterone into oestrogen, which can help with your symptoms.
Important: Do not follow the manufacturer’s leaflet that comes with your medicine. It's important that you follow our instructions instead.
The medicine is labelled as hormonal replacement therapy for men and not testosterone replacement for women. This means the instructions in the manufacturers’ leaflet are different from the instructions that your medical team gives you. Our instructions and those on this page are for use in the menopause.
You usually have testosterone as a gel that you rub into the skin. There are 2 different products that you might use.
- Tostran® 2% is a gel in a pump dispenser. 1 pump has 10 milligrams (mg) of testosterone. You normally use this gel 3 times a week.
- Testogel® is a gel in a sachet. You normally use 1 sachet over 1 week. You use a small part of the sachet 1 time each day.
You need to put the gel onto clean, dry skin. Check with your medical team where to rub it on your body.
Let the gel dry before you get dressed. Wash your hands after rubbing it into the skin.
Do not have contact with any other person while the gel dries. This takes about 10 minutes.
Do not wash the area where you have put on the gel for 3 hours. This allows your skin to take in (absorb) the gel.
Tostran and Testogel are unlicensed (not officially approved) to treat low sex drive. The manufacturer of the medicine has not specified that it can be used in this way. However, there is evidence that the medicine works to treat this condition.
If you would like more information about unlicensed medicines, please speak to your medical team. You can also call the pharmacy medicines helpline.
Getting your prescription
At first, your doctor or nurse at the menopause clinic gives you your prescription.
When the amount (dose) of medicine that you take and your symptoms are stable, your GP can be responsible for the prescription. At this time, you can get your prescription from your GP and local pharmacy.
If you forget to take this medicine
- If you miss a dose, take it as soon as you remember.
- Do not take the missed dose if it is close to the time that your next dose is due (within a day). Continue with your normal schedule.
- Do not take 2 doses of the gel to make up for missing a dose.
Side effects of using testosterone
There are not usually any side effects from taking testosterone. Your medicine is intended to make testosterone return to levels that you had before the menopause.
However, there are some possible side effects. You usually only get these side effects if you have a large dose of testosterone. They include:
- more facial or body hair (hirsutism)
- pattern hair loss (hair loss that happens in a specific pattern or alopecia)
- acne and greasy skin
- a deeper voice
- an enlarged clitoris (a sexual organ above the vagina)
We have a lot of information about long-term side effects of oestogren and progesterone HRT in the menopause. However, there is less information on long-term side effects of testosterone replacement therapy.
Rarely, you may notice more hair growth or skin changes in the area where you put on the gel. You can avoid this by changing the area of skin where you rub the gel.
There is a concern about a possible higher risk of cancer and heart disease after testosterone treatment. However, there is no evidence to confirm if there is an actual risk.
The doctor or nurse looking after you can talk to you about any risks and benefits from using this medicine. Please speak to them if you have any questions or concerns.
Blood test monitoring
It can be useful to have blood tests to see how your testosterone treatment helps you. However, this is not essential.
The blood test is not very sensitive in women. Checking if your symptoms improve and if you have any side effects is a more helpful way to monitor your treatment.
If you find that testosterone helps, you will usually keep using this medicine while you take standard HRT.