Testosterone is often described as a “male hormone”, but women naturally produce it too. It plays a role in sexual desire and sexual response, and it is part of the wider hormone picture across perimenopause and menopause.
However, changes in libido are rarely explained by one hormone alone. Sleep, mood, vaginal comfort, stress, body confidence, relationship strain, caring responsibilities and some medicines can all affect desire and sexual wellbeing.
This guide explains what testosterone can and cannot tell you, when treatment may be considered, why your HRT may need reviewing first, and how LIVVE approaches testosterone safely.
Important
This article is for general information only. It cannot diagnose low testosterone or confirm whether testosterone treatment is suitable for you. Suitability depends on symptoms, history, current treatment, blood results, possible side effects and shared decision-making with a trained prescriber.
Do women naturally produce testosterone?
Yes. Women naturally produce testosterone throughout their lives. Around half is produced directly by the ovaries and adrenal glands, with the remainder formed through the conversion of other hormones in tissues such as fat, skin and muscle. Although levels are much lower than in men, testosterone is an important part of normal female physiology.
Testosterone levels tend to change gradually with age and ovarian function. Some women experience a more sudden decline after surgical menopause, such as following the removal of both ovaries, because ovarian hormone production changes abruptly rather than gradually.
A fall in testosterone does not mean that every symptom after menopause is caused by low testosterone. Oestrogen, progesterone, sleep, mood, physical health, medications, relationship factors and emotional wellbeing can all influence sexual desire and overall wellbeing. For this reason, testosterone is considered alongside the wider clinical picture rather than in isolation.
What symptoms do people often associate with testosterone?
Patients often ask about testosterone when they notice changes such as:
- low sexual desire or a reduced interest in sex
- reduced arousal, response or sexual pleasure
- difficulty feeling connected to sexual thoughts or sensations
- fatigue or low stamina
- low motivation, confidence or drive
- low mood, irritability or feeling emotionally flat
- brain fog or difficulty concentrating
These symptoms are real and can be distressing. But they are not specific enough to diagnose “low testosterone” on their own.
Clinical boundary
Testosterone should not be positioned as a general treatment for tiredness, low mood, brain fog or muscle strength. Some people report wider improvements, but current guideline-backed use focuses on persistent low sexual desire associated with menopause after other causes have been considered.
Why symptoms overlap with other causes
Low libido can feel simple from the outside — “my sex drive has disappeared” — but several parts of sexual wellbeing can change at the same time.
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Desire
Interest in sex, sexual thoughts, anticipation and wanting intimacy.
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Arousal and response
How easily the body responds, including sensation, lubrication and feeling sexually engaged.
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Comfort
Whether sex or intimacy feels physically comfortable, especially if vaginal dryness, soreness or urinary symptoms are present.
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Pleasure and orgasm
How much pleasure is felt and whether orgasm feels different, delayed or harder to reach.
Oestrogen changes can contribute to vaginal dryness, soreness, urinary symptoms, hot flushes, night sweats and poor sleep. These can make sex less comfortable or less appealing even if desire has not fully disappeared.
Stress, anxiety, depression, grief, burnout, body image, relationship pressure and the mental load of caring or parenting can also reduce desire. That is why a good testosterone assessment should include the whole picture, not just a hormone result.
For a gentler symptom-led overview, read Why Has My Libido Changed During Perimenopause and Menopause? If pain, dryness or urinary symptoms are part of the picture, read Low Libido, Painful Sex and Vaginal Dryness: Why It Is Not Always Testosterone.
What does HSDD mean?
HSDD stands for hypoactive sexual desire disorder. In simple terms, it describes persistent or recurrent low sexual desire that causes personal distress and is not better explained by another cause.
This does not mean every person with low libido has a disorder. Desire naturally changes across life, relationships, stress, illness, parenting, grief and menopause. It becomes a clinical concern when the change is persistent, unwanted, personally distressing and not better explained by something else that needs addressing first.
In menopause care, the strongest guideline-backed role for testosterone is persistent low sexual desire associated with menopause after a biopsychosocial assessment — meaning the assessment has considered physical, emotional, relationship and medication-related factors.
Can a blood test diagnose low testosterone as the cause?
A blood test is useful for safe prescribing, but it does not usually explain the whole reason libido has changed.
Before testosterone is prescribed, total testosterone is usually checked to establish a baseline and to make sure levels are not already high. During treatment, total testosterone is monitored to help keep levels within the female physiological range and reduce the risk of androgenic side effects.
But a low or low-normal result does not automatically mean testosterone is the cause of low desire. Some people with low levels do not have distressing low libido, and some people with low desire have other causes that need treating first.
It is also important not to confuse testosterone monitoring with menopause diagnosis. For women and people aged 45 to 55, FSH and oestradiol blood tests are not usually needed to diagnose or manage menopause symptoms. Symptoms, bleeding pattern, medical history and treatment response are usually more useful.
For more detail, read Testosterone Blood Tests for Women and LIVVE Blood Tests.
Could my HRT need reviewing before testosterone?
Often, yes. NICE and BMS guidance support considering testosterone for low sexual desire associated with menopause when HRT alone has not been effective. That means it is usually important to check whether conventional HRT has been tried, tolerated, used consistently and optimised where appropriate before moving to testosterone.
A review does not mean your symptoms are being dismissed. It means your clinician is checking whether the foundations of menopause treatment are right first.
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Has oestrogen been optimised?
If oestrogen symptoms are still active — for example hot flushes, night sweats, poor sleep, joint aches, mood symptoms or vaginal dryness — a clinician may want to review your oestrogen type, dose, route or absorption before adding another hormone.
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Has treatment had enough time?
Some menopause treatments take time to settle. If HRT has only recently been started or changed, your clinician may recommend reviewing symptoms over an appropriate timeframe before deciding whether testosterone is needed.
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Are vaginal or urinary symptoms being treated?
Dryness, soreness, recurrent urinary symptoms, pain with sex or reduced sensation can all reduce desire or make intimacy feel difficult. Vaginal oestrogen, Intrarosa, lubricants, moisturisers or other sexual-health support may be more relevant than testosterone if comfort is the main barrier.
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Is the treatment being used as intended?
Missed doses, patch adhesion problems, gel transfer concerns, applying treatment inconsistently or stopping progesterone can all affect symptom control and safety. A practical review can sometimes solve problems that feel hormonal but are actually related to routine, absorption or adherence.
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Is oral oestrogen affecting available testosterone?
Some oral oestrogen treatments can increase sex hormone binding globulin, which may reduce the proportion of available testosterone. In some cases, a clinician may consider whether transdermal oestrogen is more appropriate before adding testosterone.
The aim is not to delay care. The aim is to choose the safest and most relevant next step — HRT review, local vaginal treatment, wider support or a monitored testosterone trial if appropriate.
Can medicines affect libido?
Yes. A medication review is an important part of assessing low desire. Some antidepressants, especially SSRIs and SNRIs, can affect desire, arousal or orgasm for some people. Other medicines may also contribute, depending on the individual, including some treatments for blood pressure, pain, hormonal contraception, sedating medicines or medicines that affect mood, energy or sleep.
Do not stop prescribed medication suddenly because of libido changes. A clinician can help weigh up benefits, risks and alternatives, and may liaise with your GP or specialist where needed.
When may testosterone not be appropriate?
Testosterone is not suitable for everyone. It may need to be avoided, delayed or handled with specialist input in situations such as:
- pregnancy or breastfeeding
- upper-normal or already-high baseline total testosterone
- unexplained virilising symptoms, such as new facial hair growth, voice deepening or clitoral enlargement
- significant active liver disease
- complex personal history of hormone-sensitive cancer, including breast cancer
- severe androgenic side effects on previous testosterone treatment
- competitive sport, where anti-doping rules may apply
If any of these apply, a specialist review may still be possible, but treatment decisions need careful individualised discussion.
What might treatment involve?
A safe pathway is usually stepwise rather than product-first.
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Understand symptoms
Clarify desire, arousal, pain, dryness, mood, sleep, medication and relationship factors.
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Review foundations
Check HRT, vaginal symptoms, adherence, treatment duration and wider health factors.
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Decide suitability
Use clinical assessment and baseline total testosterone to decide whether a monitored trial is appropriate.
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Monitor and review
Assess benefit, side effects and blood levels, then continue, adjust or stop based on response.
Depending on the assessment, support may include HRT review, vaginal oestrogen, Intrarosa, lubricants, moisturisers, psychosexual or relationship support, medication review, lifestyle support, or a monitored testosterone trial.
If testosterone is appropriate, treatment options may include Androfeme, Tostran or Testogel. These should only be chosen with prescriber guidance. Exact dose, price, licence position and application instructions are covered on the testosterone treatment options comparison and individual product pages.
What benefits are realistic, and how long does it take?
The most realistic expected benefit is improvement in persistent low sexual desire or sexual response where testosterone is clinically appropriate. It should not be promised as a treatment for all menopause symptoms, tiredness, low mood or brain fog.
If testosterone is prescribed, benefit is usually reviewed over months rather than days or weeks. It may take around 3 to 6 months to fully assess whether treatment is helping.
Monitoring usually includes:
- baseline total testosterone before starting
- review of symptoms, sexual wellbeing and distress
- checking for side effects such as acne, unwanted hair growth, scalp hair thinning, voice changes or clitoral changes
- repeat total testosterone monitoring during treatment to keep levels within the female physiological range
- ongoing review of whether treatment is still needed
Why might testosterone be stopped?
Testosterone may be stopped or reviewed if it is not helping after an adequate trial, if side effects develop, if blood levels rise above the female physiological range, if symptoms are better explained by another cause, or if the balance of benefits and risks changes.
Stopping does not mean the symptoms were not real. It may simply mean testosterone was not the right tool for that particular problem.
Start LIVVE’s testosterone assessment pathway
If low desire or reduced sexual response is affecting your quality of life, LIVVE can help you understand whether you need HRT review, vaginal support, wider sexual-health support or a monitored testosterone trial.
