Testosterone treatment for women's low libido remains a topic of considerable clinical interest and debate. Whilst testosterone is naturally produced in women's bodies at lower levels than in men, its role in female sexual desire is complex and not fully understood. In the UK, no testosterone product is currently licensed specifically for women, meaning any prescription constitutes off-label use requiring careful consideration. NICE guidance suggests testosterone may benefit some postmenopausal women with low sexual desire when standard hormone replacement therapy has not helped. However, the evidence remains limited, and treatment is appropriate only for carefully selected women following comprehensive assessment. This article examines the current evidence, NHS guidelines, safety considerations, and alternative approaches to managing low libido in women.

Understanding Low Libido in Women

Low libido, medically termed hypoactive sexual desire disorder (HSDD) or Female Sexual Interest/Arousal Disorder (FSIAD) in newer classifications, affects a significant proportion of women at various life stages. It is characterised by a persistent or recurrent lack of sexual thoughts, fantasies, or desire for sexual activity that causes personal distress. Importantly, low libido becomes a clinical concern only when it troubles the woman herself, not simply when sexual frequency differs from a partner's expectations.

Common contributing factors include:

• Hormonal changes – particularly during menopause, postpartum, or whilst breastfeeding

• Psychological factors – stress, anxiety, depression, body image concerns, or relationship difficulties

• Medical conditions – thyroid disorders, diabetes, cardiovascular disease, or chronic pain

• Medications – certain antidepressants (particularly SSRIs), antihypertensives, and hormonal contraceptives

• Lifestyle factors – fatigue, excessive alcohol consumption, or lack of physical activity

The complexity of female sexual desire means it rarely has a single cause. Unlike male sexual function, which is often more physiologically driven, female libido involves an intricate interplay of biological, psychological, and social factors. Research suggests that context, emotional intimacy, and relationship quality play substantial roles in women's sexual interest.

It is essential to recognise that sexual desire exists on a spectrum, and what constitutes 'normal' varies considerably between individuals. A thorough assessment by a healthcare professional should explore all potential contributing factors before considering any treatment. Initial GP assessment may include medication review, screening for depression or anxiety, thyroid function tests where clinically indicated, and evaluation of menopausal symptoms. Referral to specialist menopause or psychosexual services may be appropriate for complex cases or when symptoms are accompanied by sexual pain, unexplained bleeding, or severe mood disturbance.

Can Testosterone Treatment Help with Women's Libido?

Testosterone, whilst primarily considered a male hormone, is naturally produced in women's ovaries and adrenal glands at much lower levels. It plays a role in maintaining bone density, muscle mass, mood regulation, and sexual function. Some research suggests that testosterone may influence sexual desire, arousal, and satisfaction in women, particularly following menopause or surgical removal of the ovaries.

Mechanism of action: Testosterone is thought to act on the central nervous system, potentially enhancing sexual thoughts and motivation. It may also increase genital sensitivity and blood flow. However, the exact mechanisms remain incompletely understood, and the relationship between testosterone levels and libido is not straightforward. Many women with low testosterone levels report normal sexual function, whilst others with normal levels experience low libido.

Clinical evidence for testosterone treatment in women remains limited and somewhat controversial. The British Menopause Society acknowledges that testosterone therapy may benefit postmenopausal women with HSDD, particularly those who have not responded to other interventions. However, this recommendation applies specifically to a subset of women and should only be considered after comprehensive assessment.

Studies examining testosterone supplementation have shown modest improvements in sexual desire and satisfaction in some postmenopausal women, typically resulting in a small increase in satisfying sexual events. A 2019 global consensus statement supported the use of testosterone for postmenopausal women with HSDD, but emphasised the need for careful patient selection and monitoring. Importantly, there is insufficient evidence to support testosterone use in premenopausal women for low libido, and it is not recommended during pregnancy or breastfeeding.

Only transdermal testosterone (applied to the skin) is recommended; oral testosterone should be avoided due to adverse effects on lipid profiles. Compounded testosterone preparations and testosterone pellet implants are not recommended due to quality and dosing concerns.

The response to testosterone therapy varies considerably between individuals, and not all women experience benefit. If no improvement occurs after 6 months, treatment should be discontinued. Treatment should be viewed as one component of a broader management strategy that addresses psychological, relational, and lifestyle factors.

NHS Guidelines and Availability in the UK

In the UK, testosterone treatment for women's low libido occupies a complex regulatory position. No testosterone product is currently licensed by the MHRA specifically for use in women, which means any prescription constitutes 'off-label' use or requires an unlicensed 'special' product. This requires careful consideration, informed consent, and appropriate clinical oversight.

The NICE guideline on menopause (NG23) recommends considering testosterone supplementation for menopausal women with low sexual desire if HRT (hormone replacement therapy) alone has not been effective. Professional bodies such as the British Menopause Society recommend that:

• Treatment should be initiated by healthcare professionals with experience in using testosterone for women

• Treatment should be trialled for an initial period (typically 3–6 months)

• Continuation depends on demonstrable benefit

• Regular monitoring is essential

Monitoring should include measuring total testosterone levels before starting treatment, 3–6 weeks after initiation or dose changes, and then every 6–12 months. The aim is to maintain levels within the upper normal range for premenopausal women.

Access to testosterone therapy through the NHS varies considerably across the UK. Some specialist menopause clinics and sexual health services offer this treatment, but availability is inconsistent. Women may be referred to endocrinologists or gynaecologists with specific expertise in this area. Due to the lack of licensed female formulations, clinicians typically prescribe male testosterone preparations (such as Testogel or Tostran) at much lower doses, or occasionally imported female-specific products (such as AndroFeme 1) as unlicensed 'specials'.

Private prescription is an alternative route, though this involves out-of-pocket costs and the same requirement for appropriate clinical supervision. Women considering testosterone therapy should discuss the off-label nature of treatment, potential benefits and risks, and monitoring requirements with their healthcare provider. It is crucial to obtain testosterone through legitimate medical channels rather than unregulated online sources, which may supply counterfeit or inappropriately dosed products that pose significant health risks.

Potential Side Effects and Safety Considerations

Testosterone therapy in women requires careful monitoring due to potential adverse effects, particularly when doses exceed physiological levels. The goal is to restore testosterone to the upper end of the normal premenopausal range, not to achieve male-typical levels.

Common side effects include:

• Androgenic effects – acne, oily skin, increased facial or body hair (hirsutism)

• Voice changes – deepening of voice (potentially irreversible)

• Hair loss – male-pattern scalp hair thinning

• Clitoromegaly – enlargement of the clitoris

• Mild fluid retention in some individuals

• Mood alterations – irritability or mood changes in some individuals

Safety considerations: When used as recommended (transdermal application at physiological doses), testosterone has not shown clinically significant adverse effects on lipid profiles or cardiovascular health in clinical trials. However, oral testosterone should be avoided due to potential adverse lipid effects. Long-term safety data in women remain limited.

Contraindications to testosterone therapy include:

• Pregnancy or breastfeeding (testosterone is teratogenic)

• Hormone-sensitive cancers (breast or endometrial)

• Severe liver or kidney disease

• Cardiovascular disease (requires careful risk-benefit assessment)

Women of childbearing potential should use effective contraception during treatment, as testosterone can harm a developing foetus.

Regular monitoring should include clinical assessment of symptoms, physical examination for androgenic side effects, and blood tests measuring testosterone levels (baseline, 3–6 weeks after initiation or dose changes, then every 6–12 months). The aim is to maintain levels within the normal female range.

When to seek medical advice:

• Development of significant acne or unwanted hair growth

• Voice changes or hair loss

• Mood changes

• Any concerning or persistent symptoms

Women should be counselled that benefits may take several months to become apparent, and treatment should be discontinued if no improvement occurs after 6 months. If you experience any suspected side effects, report them through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Alternative Treatments for Low Libido in Women

Given the complexity of female sexual desire and the limitations of testosterone therapy, a comprehensive approach addressing multiple contributing factors is often most effective. Evidence-based alternatives should be considered before or alongside hormonal interventions.

Psychological and relationship-based interventions:

Cognitive behavioural therapy (CBT) and psychosexual counselling have demonstrated effectiveness for low libido, particularly when psychological factors or relationship difficulties contribute. These approaches address negative thought patterns, anxiety, body image concerns, and communication issues. Couples therapy may be beneficial when relationship dynamics affect sexual desire. The College of Sexual and Relationship Therapists (COSRT) maintains a register of accredited therapists across the UK. NHS psychosexual services may be accessed via GP referral, though availability varies regionally.

Mindfulness-based interventions have shown promise in improving sexual desire and reducing distress. These techniques enhance present-moment awareness and reduce performance anxiety that may inhibit sexual response.

Hormone replacement therapy (HRT):

For menopausal women, standard HRT (oestrogen with or without progestogen) often improves libido indirectly by addressing symptoms such as vaginal dryness, hot flushes, and sleep disturbance. Vaginal oestrogen specifically treats genitourinary symptoms that may make sexual activity uncomfortable, thereby improving sexual function. Vaginal oestrogen can be used safely long-term with minimal systemic absorption.

Lifestyle modifications:

• Regular physical exercise improves body image, mood, and cardiovascular health, all of which may enhance sexual function

• Stress management techniques including yoga, meditation, or relaxation exercises

• Sleep optimisation – addressing sleep disorders or improving sleep hygiene

• Alcohol moderation – excessive consumption impairs sexual function

• Medication review – discussing alternatives if current medications affect libido

Addressing underlying medical conditions:

Treating depression, thyroid disorders, or chronic pain may significantly improve sexual desire. If antidepressants are causing sexual side effects, clinicians may consider alternatives with potentially fewer sexual side effects, such as mirtazapine or vortioxetine, following NICE guidance. Bupropion, used in some countries for this purpose, is not licensed for depression in the UK and would require specialist consideration.

Flibanserin, a medication approved in some countries for premenopausal HSDD, is not currently licensed in the UK. Other pharmacological options remain limited, emphasising the importance of holistic, individualised management strategies that address the multifaceted nature of female sexual desire.

Frequently Asked Questions