Testogel is a testosterone gel licensed for men but prescribed off-label for women experiencing low sexual desire, particularly after menopause or ovarian surgery. Women require significantly lower doses than men—typically 5–10 mg daily—to avoid virilisation (development of male characteristics). Correct dosing, application technique, and regular monitoring are essential for safe and effective treatment. This article explains recommended Testogel dosages for women in the UK, how to apply the gel safely, what monitoring is required, and when to seek medical advice. Always follow your prescriber's specific instructions and never adjust your dose without medical supervision.

What Is Testogel and Why Is It Prescribed for Women?

Testogel is a transdermal testosterone gel licensed primarily for testosterone replacement in men with hypogonadism. However, it is prescribed off-label for women experiencing symptoms of low sexual desire, particularly in the context of menopause or following bilateral oophorectomy (surgical removal of both ovaries). Testosterone is not solely a male hormone; women naturally produce it in smaller quantities via the ovaries and adrenal glands, and it plays a role in sexual function, energy, mood, bone density, and muscle mass.

When women experience a significant drop in testosterone—often during or after menopause, or following certain surgical or medical treatments—they may develop symptoms such as persistent low sexual desire (hypoactive sexual desire disorder, HSDD), fatigue, reduced sense of wellbeing, and diminished motivation. NICE guidance (NG23 Menopause: diagnosis and management) and the British Menopause Society (BMS) acknowledge that testosterone therapy can be considered for postmenopausal women with HSDD when other causes have been excluded and oestrogen-based hormone replacement therapy (HRT) alone has been insufficient. The strongest evidence of benefit in women is for improvement in sexual function and desire; evidence for mood, energy, and general wellbeing is more limited and inconsistent.

It is important to note that Testogel is not licensed specifically for use in women in the UK, meaning its prescription in this context is off-label. This requires careful clinical judgement, informed consent, and close monitoring by a healthcare professional experienced in hormone replacement therapy. Before starting testosterone, other causes of low sexual desire should be explored and addressed, including relationship factors, psychological issues, medications (e.g., antidepressants), thyroid dysfunction, and anaemia. Women should not self-medicate or adjust doses without medical supervision, as inappropriate use can lead to virilisation (development of male characteristics) and other adverse effects. A thorough assessment, including discussion of symptoms, medical history, and potential risks and benefits, is essential before initiating testosterone therapy.

Recommended Testogel Dosage for Women in the UK

The appropriate dose of Testogel for women is significantly lower than that used in men. While men typically use 50–100 mg of testosterone daily, women require only a fraction of this amount—usually in the range of 5–10 mg per day. The British Menopause Society recommends starting at the lower end of this range and titrating upwards based on clinical response and serum testosterone levels.

Because Testogel sachets and pumps are formulated for male dosing, achieving the correct female dose requires careful measurement and product-specific guidance. Dosing varies by product:

• Testogel 1% (50 mg per 5 g sachet): Women may be advised to use approximately 0.5 g daily (about one-tenth of a sachet), delivering approximately 5 mg of testosterone. This requires careful measurement using a dosing syringe or spatula.

• Tostran 2% gel (pump): Each pump actuation delivers approximately 10 mg of testosterone. Women may be instructed to use one pump actuation on alternate days (averaging approximately 5 mg per day), or as directed by their prescriber.

• Testogel 16.2 mg/g pump and Testavan pump: These products deliver higher doses per actuation (approximately 20 mg or more) and are generally not suitable for direct use in women without very careful measurement of a small fraction of the dose.

It is crucial that women do not use a full pump actuation of higher-strength products or a full male sachet, as this can rapidly lead to excessive testosterone levels and virilisation. Always follow the specific instructions provided by your prescriber, who will tailor the dose to the exact product dispensed.

Individualisation is key: the optimal dose varies between women depending on baseline testosterone levels, symptom severity, body weight, and individual response. Blood tests measuring serum testosterone are essential to guide dosing. The goal is to achieve testosterone levels within the normal premenopausal female reference range for your local laboratory, avoiding levels that exceed the upper limit. Fixed target ranges (e.g., 0.3–1.5 nmol/L) vary by laboratory and assay, so results must be interpreted in clinical context.

Dose adjustments should be made gradually and only under medical supervision, typically after 3–6 weeks of treatment and appropriate biochemical monitoring, then every 6–12 months once stable. Any change in dose or product should only be made under the guidance of a specialist or experienced GP.

How to Apply Testogel Safely and Effectively

Correct application technique is essential to ensure safe and effective testosterone absorption while minimising the risk of transfer to others. Testogel should be applied once daily, ideally at the same time each day, to clean, dry, intact skin. Application sites vary by product and must follow the instructions in the Summary of Product Characteristics (SmPC) for the specific gel you are using:

• Testogel 1% sachets and Testogel 16.2 mg/g pump: Apply to shoulders, upper arms, and/or abdomen.

• Tostran 2% gel: Apply to the abdomen.

• Testavan: Apply to the thighs.

Before application, wash and dry your hands thoroughly. Measure or dispense the prescribed small amount of gel as directed by your prescriber, then spread it thinly over the designated area. Avoid applying to the breasts, genitals, or broken or irritated skin. Allow the gel to dry completely (usually 3–5 minutes) before dressing. Gels are flammable until dry—avoid smoking, naked flames, or open heat sources during and immediately after application. Once dry, wash your hands thoroughly with soap and water to prevent accidental transfer.

Key safety precautions include:

• Covering the application site with clothing once the gel has dried to prevent skin-to-skin contact with partners or children.

• Avoiding swimming, bathing, or showering for a minimum period after application to ensure adequate absorption. This interval is product-specific: some gels require at least 2 hours, others at least 6 hours. Check the patient information leaflet for your specific product.

• Washing the application site with soap and water before any anticipated close physical contact.

• Storing the gel safely out of reach of children and pets.

Transfer of testosterone to others, particularly children and pregnant women, can have serious consequences. If accidental contact occurs, the affected area should be washed immediately with soap and water. Women should inform household members about their treatment and take appropriate precautions. If you experience persistent skin irritation at the application site, consult your prescriber, as rotating application sites (within the approved areas for your product) or switching formulations may be necessary.

Monitoring and Adjusting Your Testosterone Treatment

Regular monitoring is a critical component of safe testosterone therapy in women. Before starting treatment, your clinician should assess your symptoms, medical history, and measure baseline serum testosterone levels. Sex hormone-binding globulin (SHBG) may also be measured if needed to interpret testosterone levels. Additional baseline tests—such as full blood count, lipid profile, liver function tests, or bone density scanning—may be considered based on your individual risk factors and medical history, but are not routinely required for all women starting physiological testosterone therapy.

Your clinician should also assess for cautions and contraindications. Absolute contraindications include pregnancy, breastfeeding, active liver disease, and current or past hormone-sensitive cancers (specialist advice is required in these cases). Cardiovascular disease is not an absolute contraindication but requires individualised risk assessment and discussion with your prescriber.

Once treatment begins, follow-up blood tests are typically performed after 3–6 weeks to assess response and guide any necessary dose adjustment, then every 6–12 months thereafter if stable. Testosterone levels should be measured at a consistent time; for transdermal gels, sampling just before the next dose (trough level) is recommended, though strict morning timing is less critical than with other formulations. The goal is to maintain levels within the normal premenopausal female reference range for your local laboratory while achieving symptom improvement. If levels exceed the upper limit, dose reduction is necessary; if symptoms persist despite adequate levels, other causes should be explored.

In addition to testosterone levels, monitoring should include:

• Clinical assessment of symptom response, particularly sexual function and desire.

• Screening for virilisation signs: acne, hirsutism (excess hair growth), voice deepening, clitoral enlargement, or male-pattern hair loss.

• Cardiovascular risk factors: blood pressure, lipid profile (if clinically indicated), and weight.

• Haematological parameters (full blood count, haematocrit, haemoglobin) if clinically indicated or if symptoms suggest polycythaemia, though this is rare at female physiological doses.

• Liver function if there is pre-existing liver disease or clinical concern.

Dose adjustments should be made gradually and only under medical supervision. If symptoms improve, treatment is typically continued long-term with ongoing monitoring. However, if there is no benefit after 6 months of adequate dosing, discontinuation should be considered. Women should maintain regular contact with their prescriber and report any concerns or new symptoms promptly.

Potential Side Effects and When to Seek Medical Advice

While testosterone therapy can be beneficial for appropriately selected women, it carries potential risks and side effects that require awareness and vigilance. Common side effects at appropriate doses may include mild acne, oily skin, increased body hair growth, and occasional mood changes. These effects are usually mild and may diminish with time or dose adjustment.

Signs of excessive testosterone (virilisation) require immediate medical attention and include:

• Voice deepening or hoarseness (often irreversible)

• Significant increase in facial or body hair

• Male-pattern baldness or scalp hair thinning

• Clitoral enlargement

• Menstrual changes (in premenopausal women)

• Aggressive behaviour or significant mood disturbance

If you develop signs of virilisation (especially voice deepening or clitoral enlargement), stop the gel and contact your prescriber urgently, as some changes may be irreversible.

Other potential adverse effects include fluid retention, weight gain, and changes in cholesterol levels. Sleep disturbances, including sleep apnoea, have been reported mainly in men; the risk at female physiological doses is considered low but should be monitored if you are symptomatic or at high risk. There is ongoing research into long-term cardiovascular and metabolic effects, though current evidence suggests that physiological testosterone replacement in women does not significantly increase cardiovascular risk when properly monitored.

You should contact your GP or prescribing clinician if you experience:

• Any signs of virilisation

• Persistent or severe skin reactions at application sites

• Chest pain, leg swelling, or shortness of breath

• Significant mood changes, depression, or anxiety

• Jaundice (yellowing of skin or eyes)

• Unexplained vaginal bleeding

Women using testosterone should inform all healthcare providers about their treatment, particularly before surgery or when starting new medications. Testosterone therapy is contraindicated in pregnancy and breastfeeding, and women of childbearing potential should use reliable contraception.

Reporting side effects: If you experience any side effects, talk to your doctor or pharmacist. You can also report suspected side effects directly via the MHRA Yellow Card scheme at www.yellowcard.mhra.gov.uk or by downloading the Yellow Card app. Reporting helps provide ongoing safety information about medicines.

Regular monitoring and open communication with your healthcare team are essential to maximise benefits while minimising risks. If you have concerns about your treatment, never simply stop without medical advice—discuss your worries with your prescriber to determine the most appropriate course of action.

Frequently Asked Questions