How testosterone could boost your sex drive in midlife

Menopause is a time when empty nests and freedom from unwanted pregnancies could lead to a newfound liberation in the bedroom. But all too often, menopausal symptoms get in the way. One survey found that while 84 per cent of perimenopausal and menopausal women thought an active sex life was important, more than 50 per cent reported that their sex drive had nosedived, and fewer than a third sought help for it. But today women are increasingly refusing to allow menopause to sabotage their sex lives.  

The number of women using hormone replacement therapy (HRT), which can ease libido-sapping hot flushes, anxiety, poor sleep and vaginal dryness, doubled between 2015 and 2023. NHS figures reveal that in England, from 2022 to 2023, women were prescribed nearly 11 million separate HRT medications, a rise of 47 per cent on the previous year. And a growing number of them were for testosterone – a hormone more often associated with men. NHS prescriptions for testosterone for menopause have increased tenfold in less than a decade, and it’s thought that these numbers are dwarfed by prescriptions from private doctors. Why? Because for some women, testosterone can boost their elusive sex drive.  

Trish Halpin, 56, a journalist and podcaster, is one of them. After Halpin started experiencing menopausal symptoms a decade ago, her sex drive became “non-existent”, even though she was otherwise happy in her relationship with her photographer husband Neil, 58. She says: “I’d think, please God, don’t let my husband try to have sex with me tonight – I really can’t face the look of hope turning to disappointment when I reject his advances once again.” 

This all changed when Halpin interviewed menopause specialist Dr Shahzadi Harper in 2019 for an episode of her podcast Postcards from Midlife. Halpin says: “I’d never given much thought to testosterone, believing it to be primarily a male hormone, but it’s an important sex hormone for women too.” Harper subsequently prescribed Halpin HRT in the form of oestrogen and progesterone, plus a testosterone cream. After just a few weeks of applying a pea-sized amount of the cream on her thigh every day, Halpin says: “I felt desire again, which my husband and I were very happy about. And today, after three years of HRT and testosterone, I feel fitter, stronger, happier – and, yes, sexier – than I ever did in my 40s.”

So could testosterone work for you? Here’s everything you need to know.

What happens to testosterone in menopause?

Dr Juliet Balfour is a GP and a menopause specialist with the British Menopause Society who runs an NHS menopause service in Somerset. She says: “Testosterone is an important hormone for women. It is mainly produced in our ovaries and adrenal glands.” The British Menopause Society describes testosterone as “essential for development and maintenance of female sexual anatomy and physiology, and modulation of sexual behaviour”. Prior to menopause, women produce three to four times as much testosterone as oestrogen. You might assume that testosterone plummets at menopause in the same way that oestrogen does, but instead there is a gradual fall in levels from a peak in our 20s to a plateau in midlife. Indeed, healthy ovaries can continue to produce testosterone for many years after menopause. However, if the ovaries are removed surgically or you are plunged into menopause by treatment such as chemotherapy, women can “experience a sudden drop in testosterone levels of up to 50 per cent”, says Balfour, “and may benefit the most from adding testosterone to their HRT”. 

Can testosterone therapy help your sex drive?

The National Institute for Health and Care Excellence (Nice) guidelines state that testosterone supplementation can be considered for menopausal women with low sexual desire if HRT alone is not effective. 

The truth is nobody really knows exactly how testosterone supplementation boosts libido, but for some women, it definitely does. In 2020, a review of 36 trials into testosterone for women found that, compared to a placebo or oestrogen and progesterone HRT, testosterone therapy “increased sexual function including satisfactory sexual event frequency, sexual desire, pleasure, arousal, orgasm, responsiveness and self-image”. However, it’s not effective for all women. Balfour says: “I see some women whose libido improves dramatically after testosterone treatment, but others are disappointed by a lack of benefit and/or [they] develop unwanted side effects.” 

Dr Paula Briggs is a consultant in sexual and reproductive health based at Liverpool Women’s NHS Foundation Trust and is the chair of the British Menopause Society. She says: “Libido is a complex area and is influenced by many factors, not just low levels of testosterone. I’ve seen women crying because they don’t feel the way they thought they would. It’s not a quick fix for everyone.”

What are the symptoms of low testosterone?

While blood tests can show if testosterone is too high, there’s no specific level of testosterone in women that is considered a deficiency. Balfour says: “Many women function well with low blood levels of testosterone and may not notice any symptoms. Others find they lose their sexual desire, arousal and responsiveness.” Briggs agrees: “You can have women with low testosterone who feel fine and have great sex lives, and women with higher testosterone who don’t. Low testosterone itself is not necessarily a problem.” 

What else could testosterone treatment do for women? 

Some doctors and celebrity influencers claim that testosterone will also boost women’s energy, dispel brain fog, strengthen their bones, help shed their midlife middle and build lean muscle. But, says Balfour: “The randomised clinical trials done so far have not shown any evidence that testosterone supplementation can help with mood, energy levels, cogitation or musculoskeletal health. However, I and other menopausal specialists have certainly treated some women who feel these effects. We need more research to find out whether testosterone really does have these other benefits, and if it does, to make it more accessible to women.” 

Potential side effects of testosterone treatment

Balfour says: “Common early side effects are greasier hair and skin, spots, excess hair on the face and body, irritability and weight gain. These usually settle with a reduction in dosage. Serious and potentially irreversible side effects can be hair thinning or male pattern baldness, a deepening voice and, very rarely, clitoral enlargement. This is why testosterone levels are checked every six to 12 months while women are on the treatment.” Regular testing will ensure that levels remain within the normal female range. 

According to Briggs, women who stick to prescribed doses should only experience manageable side effects, but unfortunately some women increase the amount of testosterone cream or gel that they apply in the hope of intensifying any benefits and develop unwanted side effects. Some studies show that high doses of testosterone can contribute to feelings of anger and hostility. 

How to know if testosterone will help you

If you are experiencing a low libido, doctors usually like to rule out other causes before prescribing testosterone, such as certain medications, relationship issues, stress, sleep deprivation and depression. Balfour says: “I see many people in my NHS menopause clinic who stopped having sex years ago as it was so painful, due to vaginal or vulval dryness or soreness.” 

Briggs says: “Depression can reduce libido, as can sleep deprivation. But also sometimes the relationship just isn’t what it used to be. It’s unrealistic to expect to feel the same levels of desire after 30 years.” The bottom line, she says, is that “you can’t know if testosterone will help until you try it”. 

Balfour says: “Before considering using testosterone, a woman usually needs to be on a suitable dose of transdermal oestrogen [oral oestrogen in pill form can reduce libido and reduce the effectiveness of testosterone supplementation], via a patch, spray or gel, plus a progestogen in the form of a tablet, combined patch or Mirena coil if they still have a womb. If most symptoms have settled with HRT but libido is still low, testosterone can then be considered.”  

If testosterone treatment hasn’t worked after six months, says Briggs, despite the testosterone levels in the blood being at the upper end of the normal range, “then it probably isn’t going to work”.  

Testosterone treatments available

At present there are no testosterone medications specifically licensed for use in women in the UK since the last female-specific testosterone treatment was withdrawn by the manufacturers in 2012 for financial reasons. This means that all currently available NHS preparations are designed for men and prescribed “off label” (when a medication is prescribed for something it has not been granted a licence for) for women. 

Balfour says: “NHS doctors may prescribe one of the testosterone gels licensed for men that can be used for women at a much smaller dose. However, the way these gels are packaged can make it difficult for them to work out the correct amount to use.” The most commonly prescribed medications are Testim gel, which comes in a tube, and Testogel, which comes in a sachet. Women apply one 10th of the tube or an eighth of a sachet every day, which can be tricky to estimate. Testosterone also comes in pump versions but only one of these, Tostran, is suitable to be adapted for female use. 

Other countries are way ahead of us on this. Briggs says: “There is a testosterone cream licensed for women in Australia called Androfeme, which can only be prescribed privately here and is expensive.” Tempting as it may be, Briggs warns against buying testosterone online, as you may not be monitored for side effects or receive proper advice on dosage. 

How much does testosterone for women cost? 

If testosterone is prescribed by an NHS GP or NHS menopause clinic, you only pay the usual prescription charge. However, testosterone is not included in the annual HRT prepayment certificate of £19.30, so you will have to pay separately for it. At a private menopause clinic, expect to pay from around £180 to £350 for a consultation, plus the cost of the prescription. Androfeme costs around £100 for a tube that lasts about three months. Many clinics will add on a fee of £25 to £35 for each prescription, plus you will have to pay for follow-up consultations and regular blood tests. 

Balfour says: “Some online pharmacies offer testosterone to women after they’ve filled in an online questionnaire and sent in their blood test results. These charge around £18 for three sachets of Testogel, which will only last women 24 days – it’s expensive over time.” More worryingly, she adds: “They offer no counselling about use or possible side effects.”

It’s important to realise that testosterone therapy isn’t suitable for everyone. If HRT is contraindicated by your medical history, such as if you have had breast cancer or have active liver disease, then testosterone usually is too.

All in all, while testosterone therapy can work wonders to put the spark back into some women’s love lives, doctors agree that the current situation isn’t satisfactory. “We really need more good-quality research on the use of testosterone supplementation in women,” says Balfour. “We currently have no long-term safety data and no medical evidence of potential benefits of testosterone apart from helping libido in some women. A licensed product for women that provides an accurate daily dose would also help.”

Briggs also calls for better access. “In some areas, a referral to an NHS menopause clinic is needed to initiate testosterone treatment, but we do not have enough of these clinics and the waiting times are very long.”

The British Menopause Society reports that in the past the pharmaceutical industry has been reluctant to finance clinical studies to achieve licensing of testosterone for women. But the licensing of Androfeme in Australia could point to a brighter future. The BMS says: “Regulators in other countries may be encouraged by this enlightened approach by the Australian regulators, who recognised the unmet need and the large body of evidence already available for testosterone in women.”