Testosterone is naturally produced by women as well as men. In perimenopause and menopause, it may be prescribed to help treat distressing low sexual desire (low libido) after conventional HRT has been tried and optimised where appropriate.
There is no single testosterone treatment that is right for everyone. Some women may be prescribed Androfeme, a testosterone cream licensed for use in women. Others may be prescribed Tostran or Testogel, which are licensed for men but are commonly prescribed off-label for women at carefully adjusted female doses.
This guide explains how the main options differ in formulation, measuring method, licensing position, routine, practical use and monitoring.
This article is not designed to help you self-select a product. At LIVVE, testosterone treatment is considered through clinical assessment, review of other possible causes of low sexual desire, current HRT, baseline total testosterone testing, side effects, routine, availability and shared decision-making.
When may testosterone be considered?
Testosterone may be considered for people with low sexual desire associated with menopause when conventional HRT has been tried, reviewed or optimised where appropriate.
Before prescribing, a clinician should consider whether other factors may be contributing to low libido, such as vaginal dryness, painful sex, mood, stress, medication, relationship factors, genitourinary symptoms of menopause, or whether HRT needs reviewing.
This article focuses on treatment options. For a wider explanation of symptoms, suitability and evidence, read Testosterone in Women: Symptoms, Evidence, Treatment and Who It May Help and Low Libido, Painful Sex and Vaginal Dryness: Why It Is Not Always Testosterone.
Why are some testosterone products used off-label?
Historically, there have been limited testosterone products designed specifically for women in the UK. Because of this, clinicians have often used testosterone products originally developed and licensed for men, but at much lower, carefully directed doses.
This is known as off-label prescribing. It does not automatically mean the medicine is inappropriate, but it does mean it should be prescribed with clear clinical reasoning, careful instructions and monitoring.
The main testosterone options
Androfeme
Androfeme is a 1% testosterone cream licensed for use in women. It is supplied with a measuring applicator to help deliver small, consistent doses. Your clinician will advise whether Androfeme is the most appropriate option for you based on your individual assessment and product availability.
At a glance
- Licensed for use in women.
- Measuring applicator helps deliver consistent doses.
- Often an intuitive option for women starting testosterone treatment.
- Suitability depends on your individual clinical assessment.
- Regular blood tests and clinical monitoring are still required.
Tostran 2%
Tostran is a 2% testosterone gel licensed for use in men but commonly prescribed off-label for women. Your clinician will advise the dose and application schedule that is appropriate for you, as women require much lower doses than men.
At a glance
- Metered pump helps deliver a consistent amount of gel.
- Prescribed off-label for women at carefully adjusted female doses.
- Your prescribed schedule may differ from the manufacturer’s instructions for men.
- Always follow the instructions on your individual prescription label.
- Regular blood tests and clinical monitoring are still required.
Testogel
Testogel is a testosterone gel supplied in 40.5 mg sachets. It is licensed for use in men but commonly prescribed off-label for women using a carefully measured female dose. Your clinician will advise exactly how much to use and how to apply it safely.
At a glance
- Supplied in single-use sachets.
- Prescribed off-label for women at carefully adjusted female doses.
- Only a small proportion of each sachet is used.
- Always follow the instructions on your individual prescription label.
- Regular blood tests and clinical monitoring are still required.
Androfeme vs Tostran vs Testogel: comparison table
| Feature | Androfeme | Tostran | Testogel |
|---|---|---|---|
| Formulation | 1% testosterone cream | 2% testosterone gel | Testosterone gel sachets |
| Format | Cream | Metered pump gel | Sachet gel |
| Measuring method | Applicator | Pump used to a clinician-directed schedule | Carefully measured fraction of a sachet |
| Female use position | Licensed for use in women | Prescribed off-label for women | Prescribed off-label for women |
| Transfer precautions | Required | Required | Required |
| Pack duration | Approximately 100 days at 0.5 mL daily | Approximately 240 days at 1 pump on alternate days | Approximately 8 days per sachet at ⅛ sachet daily |
| Consultation, blood tests and reviews | May be separate unless included in a LIVVE care plan | May be separate unless included in a LIVVE care plan | May be separate unless included in a LIVVE care plan |
| Monitoring required? | Yes | Yes | Yes |
Is one option better than the others?
Not necessarily. There is no single testosterone treatment that is best for everyone. The most appropriate option depends on your individual needs, clinical assessment, product availability and practical preference.
- Androfeme is a testosterone cream licensed for use in women and is supplied with a measuring applicator for small, consistent doses.
- Tostran is a metered pump gel commonly prescribed off-label for women at carefully adjusted female doses.
- Testogel is supplied in sachets and is commonly prescribed off-label for women using a carefully measured female dose.
Whichever treatment you are prescribed, the goal is the same: to achieve safe testosterone levels within the normal female physiological range while improving symptoms. Regular monitoring is required with all options.
Why practical fit matters
Choosing a testosterone option is not just about the medicine itself. It also depends on whether the routine is clear, safe, realistic and suitable for you to use consistently.
Some products may be easier for certain patients to measure, while others need a more adapted routine. Your prescriber will consider practical use alongside symptoms, current HRT, baseline blood results, side-effect risk, availability and monitoring needs.
Monitoring is needed whichever option is used
All testosterone options require monitoring. BMS recommends checking total testosterone before treatment to establish a baseline and to ensure levels are not already high. Monitoring during treatment helps assess clinical response, side effects and whether levels remain within the female physiological range.
Monitoring usually focuses on symptoms, side effects and total testosterone levels. SHBG may sometimes provide useful supporting context, but free testosterone and Free Androgen Index are not usually the primary measures used to guide day-to-day treatment decisions.
Hormone blood tests such as FSH and estradiol are not usually needed to diagnose or manage menopause in people aged 45 to 55. This article does not go into blood-test interpretation in detail because that is covered separately. Read LIVVE Blood Tests and Testosterone Blood Tests for Women.
How long does testosterone take to work?
Testosterone works gradually. While some women notice changes within 6–12 weeks, it can take 3–6 months to fully assess its benefits.
Application, transfer precautions and side effects
Androfeme, Tostran and Testogel are applied to the skin, so transfer precautions are important whichever product is prescribed. Patients should follow their prescription label and product-specific instructions carefully.
Possible side effects can include acne, oilier skin, unwanted hair growth, weight gain or scalp hair thinning. Rare side effects can include voice deepening or clitoral enlargement, particularly if levels rise above the female physiological range. Any new or concerning symptoms should be reviewed promptly.
For more detail, read How to Use Testosterone Gel or Cream Safely and Testosterone Side Effects in Women.
When might a formulation change be discussed?
Sometimes a clinician may discuss changing from one testosterone option to another because of supply, difficulty measuring, side effects, blood-test results, routine preferences, prescriber recommendation.
Patients should not swap between Androfeme, Tostran and Testogel without clinical advice. The products are not used in the same way, and the instructions are different.
Ask LIVVE which testosterone option may be appropriate for you
Testosterone treatment should be considered as part of a safe menopause pathway, including suitability, current HRT, baseline total testosterone testing, product choice, application guidance and ongoing monitoring.
