If testosterone is being considered for low sexual desire associated with menopause, blood tests are used as part of a wider clinical assessment. They help your prescriber check whether treatment is safe to start and whether levels remain within the expected female physiological range during treatment.
Blood testing is not the same as diagnosing “low testosterone” from a number. Many symptoms that people associate with testosterone — including low desire, reduced arousal, fatigue, low motivation, mood change and brain fog — can overlap with sleep disruption, stress, vaginal symptoms, relationship strain, medicines, mood changes, other health conditions and HRT that may need reviewing.
Key message: testosterone blood tests support safe prescribing and monitoring. They do not, on their own, prove that testosterone is the cause of low libido or that treatment will help.
Why are blood tests used before testosterone treatment?
Before testosterone is prescribed, a baseline blood test helps establish where your level is before treatment starts. This matters because testosterone should usually be avoided or used with specialist caution if levels are already high, or if there are unexplained signs of androgen excess such as new facial hair growth, voice change or scalp hair thinning.
Baseline testing also gives your prescriber something to compare with future results. If testosterone is started, changed or continued, monitoring helps check that your levels are not rising above the female physiological range and that any benefits are balanced against possible side effects.
At LIVVE, blood tests sit alongside a menopause and sexual-health assessment. That means your clinician will also ask about desire, arousal, pain, vaginal or urinary symptoms, mood, sleep, relationship context, medicines, current HRT and any side effects.
Why a blood result alone does not diagnose the cause of low libido
Low sexual desire is rarely explained by one number. A person can have a testosterone level in the lower part of the laboratory range and not have distressing low desire. Another person may have symptoms that feel hormonal, but their main driver may be painful sex, vaginal dryness, poor sleep, anxiety, low mood, medication side effects or pressure within the relationship.
This is why testosterone is usually considered only for persistent low sexual desire associated with menopause after a wider assessment has looked for other contributing causes and after HRT has been tried, reviewed or optimised where appropriate.
Blood tests are also different from menopause diagnostic tests. For women and people aged 45 to 55, FSH and oestradiol are not usually needed to diagnose or manage menopause. Testosterone monitoring has a different purpose: it is mainly about baseline safety and ongoing prescribing safety.
Total testosterone explained
Total testosterone is the amount of testosterone measured in your blood sample. It includes testosterone that is attached to proteins in the blood and testosterone that is not attached.
For menopause-related testosterone treatment, total testosterone is usually the most useful result for monitoring safety. The aim is not to push the result as high as possible. The aim is to keep levels within the normal female physiological range used by the laboratory where your sample is tested.
Total testosterone is interpreted with your clinical picture. Your prescriber will consider whether desire has improved, whether side effects are present, how long treatment has been used, whether HRT or vaginal symptoms need reviewing, and whether the result fits safely with continued prescribing.
SHBG explained
SHBG stands for sex hormone-binding globulin. It is a protein in the blood that binds to sex hormones, including testosterone. When more testosterone is tightly bound to SHBG, less may be freely available to tissues.
SHBG can sometimes add useful context. For example, some forms of oral oestrogen can increase SHBG, which may reduce the proportion of available testosterone. A high SHBG may help explain why someone has limited response despite a total testosterone result that appears within range. A very low SHBG may sometimes help explain androgenic side effects even when total testosterone is not obviously high.
SHBG is not a treatment target by itself. It is one part of the wider assessment and should be interpreted by a clinician who understands your HRT, symptoms, medicines and health background.
Free Androgen Index explained carefully
Free Androgen Index, often shortened to FAI, is a calculation based on total testosterone and SHBG. It is sometimes used to estimate how much testosterone may be more available in the body.
FAI can be useful context in some situations, but it has limitations. It is a calculation, not a direct measure of how your tissues are responding to testosterone. It can also be affected by SHBG levels, laboratory methods and individual variation.
Because of these limitations, FAI should not be used on its own to decide whether someone “needs” testosterone, whether treatment is working, or whether a dose should be increased. Clinical response and side effects remain central, with total testosterone usually carrying more weight for monitoring safety.
Patient-friendly way to think about it: total testosterone is the main safety number. SHBG helps explain how much testosterone may be bound up. FAI is a calculation that may add context, but it does not replace a proper review.
The aim: safe range, not high range
Testosterone prescribing in menopause care is not about creating a “high” testosterone level. The aim is to use the lowest appropriate amount that may help persistent low sexual desire while keeping levels within the female physiological range and avoiding androgenic side effects.
If a result is above range, or if side effects develop, your prescriber may advise reducing treatment, pausing treatment, changing how it is used, checking for sample contamination or stopping treatment altogether.
When are testosterone blood tests needed?
Blood tests are an important part of using testosterone safely. At LIVVE, they usually follow this pathway, although your clinician may adjust the timing to suit your individual circumstances.
Before treatment starts
A baseline total testosterone blood test is completed to help ensure treatment is safe and appropriate, and to provide a starting point for future monitoring.
Around 3 months after starting treatment
A follow-up blood test and clinical review check that testosterone levels remain within the normal female range, assess for any side effects, and review how your symptoms are responding.
After a dose or treatment change
A further blood test may be recommended around 3 months after a significant dose or product change to ensure treatment remains safe and appropriate.
Once stable
Blood tests are usually repeated every 6–12 months, alongside a clinical review, to support ongoing prescribing and confirm treatment continues to be safe and effective.
You may also need an earlier review if:
- your symptoms do not improve
- you develop side effects
- your HRT changes significantly
- you switch to a different testosterone treatment
- there has been a break in your treatment.
How testosterone gel or cream can affect a blood sample
Testosterone gel or cream can contaminate the skin or blood-sampling area and produce a falsely high result. This can happen if the product is applied near the arm used for the blood test, if residue transfers from hands, or if the sample is taken from skin that has come into contact with testosterone.
LIVVE Clinical Tip
LIVVE recommends venous blood testing for monitoring women using testosterone gel or cream. Finger-prick blood tests are not recommended because testosterone can persist in the skin of the fingers after application, even with routine handwashing, increasing the risk of contaminating the sample and producing a falsely high result.
To reduce this risk, follow the preparation instructions given by LIVVE or your testing provider. These may include washing hands carefully after application, avoiding application near the blood-test site, wearing clothing over the application area once dry, and telling the person taking your blood that you use testosterone gel or cream.
Do not stop, skip or change prescribed treatment before a blood test unless your clinician has specifically advised you to do so. If a result is unexpectedly high and does not fit your symptoms or routine, your clinician may repeat the test with stricter preparation guidance before making a decision.
What happens after my result?
Your result is reviewed together with your symptoms, side effects, treatment routine and current HRT. The next step depends on the whole picture, not the blood result alone.
| Result or situation | What LIVVE may review | Possible next step |
|---|---|---|
| Baseline level already high | Symptoms of androgen excess, medicines, supplements, PCOS history or other causes. | Testosterone may not be started until the reason is understood or specialist input is sought. |
| Level within female physiological range | Whether low desire remains distressing after HRT, vaginal symptoms and wider causes have been reviewed. | A monitored testosterone trial may be considered if clinically appropriate. |
| Level high during treatment | Application routine, sample contamination, dose, product change and side effects. | Repeat test, dose review, pause, reduction or stopping may be discussed. |
| Symptoms have not improved | Time on treatment, HRT optimisation, vaginal comfort, pain, mood, medicines, relationship context and adherence. | Treatment may be continued for a defined review period, adjusted, or stopped if there is no meaningful benefit. |
| Androgenic side effects occur | Acne, oilier skin, unwanted hair growth, scalp hair thinning, voice change or genital changes. | Prompt clinical review. Dose reduction, pausing or stopping may be recommended. |
How blood tests connect to repeat prescriptions
Repeat testosterone prescribing depends on safety as well as symptom benefit. If monitoring is overdue, if levels are above range, if side effects have developed, or if symptoms have not improved after an appropriate trial, your prescriber may need a review before issuing further treatment.
We cannot safely or responsibly continue prescribing without the appropriate monitoring and clinical review. Regular blood tests are an essential part of your treatment and help ensure it remains safe, effective and appropriate for your ongoing care.
What if my result is normal but I still feel low desire?
A normal testosterone result does not mean your symptoms are not real. It means the answer may not be as simple as “raise testosterone”. Your clinician may review whether your HRT is working well enough, whether vaginal dryness or pain is reducing desire, whether sleep or mood needs support, or whether medication side effects could be contributing.
Sometimes testosterone may still be considered if the clinical picture fits persistent low sexual desire associated with menopause. Sometimes a different first step is more appropriate, such as optimising HRT, treating vaginal symptoms, reviewing medicines or offering psychosexual support.
How this links to Androfeme, Tostran and Testogel
Androfeme, Tostran and Testogel all require monitoring when prescribed for women. Each product has different practical instructions, but the monitoring principle is the same: treatment should be reviewed clinically and levels should remain within the female physiological range.
This article covers blood-test principles only. Product-specific information, including how each option is used, should remain on the individual product pages and the treatment comparison guide.
Book a testosterone blood test or treatment review
Whether you are considering testosterone, already using it, changing product or due a repeat prescription, LIVVE can help you understand what monitoring is needed and what your results mean.
