Miracle missing hormone – or another menopause story that needs a little more nuance?
Spend five minutes in certain corners of social media and you could be forgiven for thinking testosterone is the missing fairy dust ingredient in every woman’s menopause treatment:
Tired? Take Testosterone.
Foggy-headed? Take Testosterone.
Lost your libido, your muscle tone, your enthusiasm and possibly the will to open another wellness reel? Apparently, take Testosterone.
The truth, unsurprisingly, is rather more complicated.
Testosterone is not hormonal fairy dust.
Women naturally produce testosterone and it plays a part in sexual function, muscles, bones and general wellbeing. But levels vary widely, do not neatly match symptoms and decline largely with age – not simply because natural menopause has arrived.
The best evidence for prescribing testosterone is for women experiencing persistent, distressing low sexual desire after other possible causes have been explored. It can improve desire, arousal and sexual satisfaction for some appropriately selected women.
Your missing desire may have more than one suspect.
What it has not yet been convincingly shown to do is act as a universal treatment for fatigue, brain fog, mood, weight gain or aching joints.
That does not mean women who report wider improvements are imagining them. Better sleep, properly adjusted oestrogen, relief from vaginal pain, changes in lifestyle or simply feeling listened to may all affect how someone feels.
Testosterone: useful hormone, terrible fairy godmother.
And libido itself is rarely governed by one hormone alone. Stress, exhaustion, pain, medication, anxiety, body image, relationships and painful sex can all be firmly camped between a woman and her missing desire.
Testosterone may be helpful for some women—but it is not hormonal fairy dust, and more is certainly not better. In the UK, it may be considered for persistent low sexual desire associated with menopause when HRT alone has not helped. It is generally prescribed off-label in carefully controlled female doses and should be reviewed and monitored.
The useful message? Ask questions, look at the whole picture and be wary of anybody presenting one hormone as the answer to absolutely everything.
Want to read more: NHS references
NICE: Menopause – identification and management
https://www.nice.org.uk/guidance/ng23/chapter/Recommendations
This includes recommendation 1.5.25: consider testosterone for low sexual desire associated with menopause when HRT alone has not been effective.
NHS: Treatment for menopause and perimenopause
https://www.nhs.uk/conditions/menopause-and-perimenopause/treatment/
The testosterone section explains that it may help low libido for some women and notes that desire can also be affected by relationships, self-image and physical discomfort.
Women’s Health Concern: Testosterone for Women
https://www.womens-health-concern.org/help-and-advice/factsheets/
Scroll to Testosterone for women under the menopause factsheets.
A patient-friendly factsheet covering when testosterone may be considered, how it is used and the importance of appropriate monitoring
Global Consensus Position Statement on the Use of Testosterone Therapy for Women
https://pmc.ncbi.nlm.nih.gov/articles/PMC6821450/
This states that the only evidence-based indication is hypoactive sexual desire disorder, and that evidence is insufficient for using testosterone for other symptoms or disease prevention.
Aphrodite’s Note
Testosterone prescribing arrangements vary across the UK. In some areas, treatment is initiated by a menopause specialist or consultant and then continued by a GP under local prescribing arrangements. Some appropriately trained GPs may initiate and monitor it themselves.
Testosterone is not routinely prescribed as a general cure-all for menopausal tiredness, brain fog, low mood or loss of muscle tone—however enthusiastically social media may wave its hormonal wand.
Current NHS guidance says testosterone may be considered for persistent low libido associated with menopause, usually when standard HRT has not helped sufficiently and other possible causes have been explored. It is not currently licensed in the UK specifically for treating menopause symptoms, so it is prescribed off-label, generally with specialist involvement.
A menopause specialist may assess you, recommend or begin treatment and provide a clinical plan. Once treatment is established, ongoing prescriptions may sometimes be issued by your GP—but this depends on local prescribing arrangements and your GP agreeing that it is clinically appropriate. One NHS specialist menopause service, for example, states that established treatment should then be managed in primary care under the relevant local formulary.
At present, the strongest established reason for prescribing testosterone during menopause is distressing loss of sexual desire or libido, particularly when properly adjusted HRT has not resolved it. Evidence for routinely prescribing it for symptoms such as fatigue, concentration problems, mood, weight or general wellbeing remains insufficient.
And one final prescription sting: testosterone products are not covered by England’s HRT Prescription Prepayment Certificate. The certificate only covers listed medicines that are licensed in the UK to treat menopause, while testosterone is currently prescribed off-label for women and does not appear on the NHSBSA’s qualifying list. You will therefore normally pay the usual prescription charge unless you qualify for free prescriptions or have a standard all-prescriptions PPC.
As ever, Aphrodite recommends discussing your individual symptoms, existing HRT and treatment options with your GP or a suitably qualified menopause specialist rather than ordering your hormones according to the latest wellness reel.
Other NHS References
- NHS: Treatment for menopause and perimenopause says testosterone gel or cream may improve low libido for some people and may be available through a menopause specialist.
- NHS: Types of hormone replacement therapy confirms testosterone is not currently licensed for menopause symptoms but can be prescribed by a specialist doctor.
- NHSBSA: Medicines covered by the HRT PPC explains that only certain licensed menopause medicines qualify; the current list, updated 1 July 2026, does not include testosterone.
- Chelsea and Westminster Hospital NHS Foundation Trust says testosterone may be prescribed off-label for significantly reduced libido and that established ongoing prescribing should be managed in primary care under local guidance.
- Leeds Teaching Hospitals NHS Trust explains that testosterone may be offered for libido that has not improved with HRT and that other physical, medical and psychological causes should also be considered.
