Testosterone for women: low libido, NICE and what to expect

SASian Anderson, Writer and editor, MyGLP. Sources checked 5 November 2026.

Why women's libido gets dismissed

The NHS menopause symptoms page lists reduced sex drive as a menopause symptom. For years, women raising low desire were told to relax, or the subject was skipped. Sexual wellbeing is part of health at any age, and you have every right to raise it. Testosterone research in women is still catching up, which is why most products are made for men. That is about evidence catching up, not women against men.

What NICE and the BMS say

NICE guideline NG23 says doctors can consider testosterone for menopausal women with low sexual desire if HRT alone has not worked. A commentary on the guideline in BMJ Sexual and Reproductive Health notes this means off-licence prescribing, and says oestrogen replacement and any psychosexual issues should be dealt with first.

The British Menopause Society statement on testosterone follows NICE. The BMS says testosterone is not a third standard part of HRT. Testosterone is for women on HRT with low libido where other causes have been looked at and ruled out.

The first step is finding the cause

The BMS tool for clinicians, updated in May 2026, names the main condition as hypoactive sexual desire disorder, meaning low desire which causes you distress. The BMS asks doctors to look at the whole picture first, including:

• vaginal dryness or pain during sex, which our vaginal dryness guide covers
• relationship strain, stress, tiredness and low mood
• medicines which lower desire. The NHS vaginal dryness page names some antidepressants and hormonal contraceptives as causes of dryness
• whether you have had a fair trial of standard HRT

What testosterone does and does not help

A UK trial is now testing the wider claims. The ESTEEM trial, sponsored by Cardiff University and funded by the NIHR, is giving over 400 women on HRT either testosterone cream or a dummy cream for 12 months. The trial measures flushes, sleep, mood and energy as well as libido. Until results arrive, be wary of any clinic selling testosterone for energy or focus.

Licensing and the products used

The BMS 2026 tool sets out where things stand in the UK.

• Most testosterone gels used by women are licensed for men. Doctors prescribe them off licence, at a much lower dose than men use, and record this in your notes.
• AndroFeme, a 1% testosterone cream made for women, has full UK marketing authorisation from the MHRA, with a pump pack expected during 2026. Before this, the cream came in through a special import licence for private use.
• Testosterone implants are unlicensed in the UK and unavailable at present because of a quality recall.
• Compounded "bioidentical" testosterone from specialist pharmacies is not recommended by regulators or menopause societies.

Getting testosterone on the NHS

The NHS treatment page says testosterone comes as a gel or cream, can help low libido in some women, and you may be able to get it on prescription from a menopause specialist. The BMS says GP practices can prescribe and monitor testosterone depending on the clinician's experience and local arrangements, sometimes after a first decision by a specialist menopause service. Access varies by area, so ask your GP what your local pathway is.

Blood tests and reviews

1. A total testosterone blood test before you start, to check your level is not already high.
2. A repeat test a few weeks to a few months in, to make sure your level stays in the normal female range.
3. A review at 3 to 6 months. The 2023 BMS statement says to stop if there is no improvement by 6 months.
4. At least a yearly review with a blood test if you carry on, weighing benefits and risks as with HRT.

The BMS says free testosterone tests and the free androgen index are not recommended, and routine blood count or cholesterol checks are not needed.

Side effects

The BMS says side effects are uncommon when levels stay in the female range. The most common are extra hair growth, acne and weight gain, and these usually reverse with a lower dose or stopping. Hair loss on the scalp, a deeper voice and enlargement of the clitoris are rare. The 2023 statement warns these can be permanent at higher doses, which is why monitoring matters. Long-term heart and breast data are still being gathered.

Questions to ask before you start

• Have we treated vaginal dryness, pain, sleep and mood first?
• Is my HRT dose right before we add testosterone?
• Which product will I use, and is it licensed for women or prescribed off licence?
• When is my first blood test, and who will check the result?
• What change should I expect, and when will we decide whether to carry on?
• Who prescribes it after the first review: my GP or a menopause clinic?

Write down how often you feel desire and how much low desire bothers you before you start. A simple note each month makes the 3 to 6 month review much easier, because changes in desire are gradual and easy to forget.

Sources

1. Menopause: identification and management (NG23) (NICE)
2. Testosterone replacement in menopause (tool for clinicians) (British Menopause Society, 2026)
3. BMS statement on testosterone (British Menopause Society, 2023)
4. Commentary on the NICE menopause guideline (BMJ Sexual and Reproductive Health, 2016)
5. Menopause and perimenopause: treatment (NHS)
6. Menopause and perimenopause: symptoms (NHS)
7. ESTEEM: testosterone for menopause quality of life (research summary) (Health Research Authority)
8. Vaginal dryness (NHS)