How testosterone cream could boost your libido and lift your brain fog

For Andrea Shaw, the perimenopause came with a portfolio of symptoms, from urinary tract infections to heart palpitations. Hormone replacement therapy (HRT) helped, but not entirely. She says she was left with a long list of symptoms, including “brain fog, concentration, energy levels and low libido”. She adds: “The low mood, crying episodes, wanting to stay in my bedroom and not wanting to go out were crippling. I had turned into a person I no longer recognised and felt extremely lonely and sad.” In April 2020, she saw a doctor who prescribed something new: a small tube of testosterone cream. 

Testosterone is often associated with bulking up. But a growing body of research suggests that testosterone cream, gel and injections could be even more beneficial for the 13 million perimenopausal and menopausal women in the UK than was previously thought, as well as the one in 10 men aged 40 to 60 who are suffering the symptoms of low testosterone. 

For Shaw, the effects were startling. “My energy levels and low libido improved quite quickly, perhaps within a few weeks. The low mood, brain fog and other symptoms took slightly longer.”

She says: “Testosterone was the missing link for me. It helped me to find my old self again and go back to living my life to the full.”

What is testosterone cream?

Women make testosterone naturally in their ovaries and adrenal glands, but production drops sharply during the menopause. The hormone influences libido and arousal, but also bone strength, cardiovascular health, cognition, energy and more. 

In men, testosterone is produced in the testes and controls – among other things – sperm production and sex drive. Yet 2-5 per cent of men suffer from a shortage, a proportion that rises to eight per cent among the over-50s, and half of men over 80. The medical term for this deficiency is hypogonadism.

In both men and women, this diminishment in testosterone can be redressed using a gel or cream that is absorbed through the skin or, more unusually, an injection.

Is testosterone cream considered a steroid?

Anabolic steroids (that’s synthetic derivatives of testosterone) get a bad rap, of course. Most of us only hear of them when a sports star is caught misusing them. So, are the creams, gels and jabs themselves steroids? Well, yes, says Dr Robert Stevens. He is the founder of The Men’s Health Clinic in Dorset, a private medical practice that specialises in treating men with testosterone deficiency. However, he says: “We need to draw a clear distinction between anabolic steroid abuse and restoring your normal testosterone level and physiological function under careful medical supervision. It is 100 per cent beneficial to have a healthy testosterone level for life, but 100 per cent unhealthy to abuse it.”

What is it prescribed for? 

About 25 per cent of menopausal women will suffer from hypoactive sexual desire disorder (HSDD), explains Dr Louise Newson, a GP, leading menopause expert and the founder of Newson Health. “Basically it means they’ll get a really low libido. Testosterone has been shown to help significantly with that.” 

NHS data suggests that 4,675 women aged 50 and over obtained testosterone gel using an NHS prescription in November 2022, a sharp increase from 429 women in November 2015, and largely attributed to a rise in demand from female patients. Guidelines by Nice (The National Institute for Health and Care Excellence) allow it to be prescribed to women who have tried HRT but still suffer symptoms. Yet while private practices such as Newson’s can prescribe a testosterone cream designed for women called AndroFeme, it has yet to be licensed in the UK. “On the NHS, the only option is male testosterone products prescribed off-licence, at lower doses than would be prescribed for men,” Newson explains. 

A similarly complex situation currently exists for men. Testosterone replacement therapy is known to improve sexual function for men with pathological hypogonadism, so the NHS will prescribe it if a blood test shows a man’s levels to be low. Doctors will also look for symptoms of hypogonadism, but many of these – low libido, for example, or fatigue and anxiety – overlap with those of depression, meaning that sufferers are often prescribed antidepressants instead, says Stevens. 

There has also been debate over whether testosterone can alleviate sexual dysfunction in older men and those with obesity. However, in October 2023, a landmark analysis in The Lancet revealed that “age, BMI, and diabetes status do not significantly alter the short-to-medium-term effectiveness of testosterone replacement therapy in improving sexual function or quality of life”. For many, one of the authors commented, it may be more suitable than Viagra.  

Testosterone cream for men and women – the benefits

Fascinatingly, The Lancet analysis not only shed light on testosterone’s impact on libido and erections. Testosterone treatment, they found, also improved key quality-of-life indicators such as social functioning and energy levels. In fact, when it comes to diagnosing low testosterone, the biggest red flag is not low libido but mood dysregulation, says Stevens, “be that anxiety, low mood or depersonalisation. The second biggest red flag is fatigue and the third is brain fog.” Though there is no guarantee, all these symptoms can be alleviated with a well-designed testosterone replacement therapy protocol, he explains. Low testosterone can also reduce your bone density, and treatment can redress this. 

Newson also finds that many female patients seek out testosterone cream for low libido, then see other symptoms improving alongside it. In May 2023, Newson Health published the results of a study involving 905 women aged 45 and over, all of whom were given testosterone in addition to HRT. “Unsurprisingly, libido improved. But more significantly, there were improvements in mental health,” says Newson. Treatment was associated with a 37 per cent improvement in sexual function, and a 47 per cent improvement in mood-related symptoms. Anxiety, memory and sleep improved dramatically too. This, she explains, is because testosterone is a neurotransmitter, altering the levels of other hormones such as dopamine and serotonin in our brain. 

How should it be used?

Women are most commonly offered testosterone as a gel, cream or implant. In the first two instances, it is prescribed for daily use, explains Newson. Your doctor should monitor your response carefully through regular blood tests and discussion of your symptoms, adjusting your dosage accordingly. It can take around six months to have an effect, and if it works for you, you are likely to take it indefinitely, says Newson.

Men, on the other hand, are likely to be offered either three-monthly injections of a long-acting formulation of testosterone called Nebido. Sustanon – a combination of four forms of testosterone – is also commonly prescribed and requires an injection every two to four weeks. In both cases, the injections will be done by a doctor or nurse. Gels such as Tostran and Testogel are available too, and these are rubbed in at home daily, with the aim of creating more stable blood levels of testosterone. 

Injections, however, can offer better and faster absorption into the bloodstream, so Stevens prefers a different protocol. His clinic prescribes daily injections, which patients can give themselves at home. This allows for much smaller “microdoses” to be administered regularly, “mimicking the body’s physiology as closely as possible” and creating stable levels. This protocol is, he suggests, attracting growing recognition. In 2022, the Society for Endocrinology added more frequent injections to their treatment guidelines. 

Where do you put testosterone cream on your body?

Women usually rub testosterone cream or gel onto their thigh, says Newson, making sure the skin is clean and dry. Things are a little more variable for men. Tostran is rubbed into the abdomen or both inner thighs, while Testogel is often applied to the shoulders. Different studies show different absorption rates when the medication is applied to various parts of the body, which means the products have different application instructions. 

And when it comes to injections, “The vast majority of my patients inject into the subcutaneous tissue, which is essentially the space between the skin and the muscle, in the belly or love handles,” says Stevens. “It’s painless – much like being a diabetic.” Plus, subcutaneous jabs have a slower rate of absorption. 

What should I do if I forget a dose?

If you are on a daily treatment regime, don’t panic, says Stevens. “One of the beauties of microdosing is that you won’t end up feeling close to how you felt before you began your protocol, unless you miss multiple injections.” 

Newson agrees. “It doesn’t really matter what time of day you apply it,” she says. “So if you forget, just take it as soon as you remember.” 

Testosterone cream side effects

“When it’s prescribed properly, side effects are vanishingly rare,” says Newson. Mild acne is occasionally reported. “Some women find hair grows at the spot where they rub it in, as testosterone stimulates the hair follicles. Others, rarely, say they feel a bit agitated and wired right at the start, as their bodies adjust to the presence of a hormone that has been missing in these quantities for a while. If that’s the case, we can reduce the dose, then very gradually increase it,” she says. 

“In a well-balanced protocol, there should be no side effects since all we are doing is normalising your physiology,” agrees Stevens. Cardiovascular complications have traditionally been the biggest worry due to associations between testosterone replacement treatment (TRT) and haematocrit which, he explains, “is essentially a rise in red blood cell count, thickening the blood and putting a strain on your cardiovascular system”. This may be associated with an increased risk of heart attack, stroke and blood clots. But, says Stevens, “There’s likely to be an underlying reason – either a bad protocol or sleep apnoea, dehydration or kidney disease.” In fact, in 2023, a major study of more than 5,000 men, published in The New England Journal of Medicine, found that the risk of “major adverse cardiac events” was not raised by the use of TRT.

Fertility is another common concern since, Stevens explains, your natural production of testosterone may be reduced as a result of ongoing testosterone replacement, leading to a reduction in sperm. Alongside testosterone, his clinic administers hCG or human chorionic gonadotropin – a female pregnancy hormone that (counterintuitively) helps preserve testicular size, function and fertility when given to men undergoing TRT. 

For those who are using a testosterone cream or gel, it is important to wait for the gel to dry, cover the site where it’s been applied and make sure you have thoroughly washed your hands before touching other people, particularly children. “Otherwise there’s a small risk of transference,” says Stevens. “If it happens once or twice, and you’re touching your partner, it’s not going to be that much of an issue. But you don’t want to rub it on and then be in contact with young kids immediately.”

Things to consider before using testosterone cream

It might sound like a miracle cure, and for some it is. However, it’s not a guaranteed silver bullet. “There are lots of reasons why people have reduced libido and mood, so testosterone is not going to be a cure for everyone,” says Newson. Whatever you do, both she and Stevens agree that you should not consider taking testosterone without proper medical supervision. 

“I have read about lots of people buying it online and that really fills me with horror,” she says. “We all respond differently to hormones, and in our clinic we’re very careful to give individualised doses.”

Stevens warns that while TRT can be transformative, “patients should only go on it if they can’t correct their problems by addressing their sleep, stress, nutrition and exercise”. Three common causes of low testosterone are obesity, diabetes and stress. 

“We need to think about testosterone as a foundation hormone – it’s the foundation allowing you to do what you need to do to be a healthy human being: pursue a healthy lifestyle, healthy nutrition and healthy exercise,” says Stevens. The treatment, he suggests, often works like a catalyst, giving you the boost required to make these fundamental changes to your lifestyle. Then it’s up to you. “To continue feeling great, you need to put the work in.”