Testogel is a testosterone gel licensed in the UK for men with hypogonadism, but it may be prescribed off-label by specialists for postmenopausal women with hypoactive sexual desire disorder (HSDD) when other treatments have not provided sufficient benefit. Using Testogel for women requires careful dosing, application technique, and ongoing monitoring to ensure safety and effectiveness. This article explains how to use Testogel safely, including application methods, dosage guidelines, potential side effects, and essential precautions. Treatment should only be initiated and supervised by specialists experienced in female endocrinology or menopause care, with regular monitoring to maintain testosterone levels within the normal premenopausal female range.

What Is Testogel and Why Is It Prescribed for Women?

Testogel is a transdermal testosterone gel formulation licensed in the UK for testosterone replacement therapy in men with hypogonadism. It is not licensed for use in women, but may be prescribed off-label by specialists for postmenopausal women with hypoactive sexual desire disorder (HSDD) when other causes have been excluded and oestrogen therapy (if appropriate) has been optimised without sufficient benefit.

HSDD is characterised by persistent or recurrent absence of sexual desire that causes personal distress and is not better explained by other factors. Before considering testosterone therapy, it is essential to exclude or address other potential causes of low sexual desire, including:

• Relationship difficulties or psychosocial stressors

• Medications (particularly antidepressants such as SSRIs)

• Genitourinary syndrome of menopause (vaginal dryness, dyspareunia)

• Mental health conditions (depression, anxiety)

• Inadequately treated menopausal symptoms

Testosterone plays a role in female physiology, but robust evidence of benefit is limited to sexual function in the context described above. Claims regarding benefits for energy, mood, bone density, or muscle mass in women are not supported by sufficient evidence for routine clinical use. The diagnosis of testosterone deficiency in women is not based on serum testosterone levels alone; treatment is symptom-led, with biochemical monitoring used to ensure levels remain within the normal premenopausal female reference range and to avoid excessive dosing.

Testosterone therapy for women should only be initiated by specialists experienced in female endocrinology or menopause care (such as menopause specialists or endocrinologists), often with shared-care arrangements with GPs for ongoing prescribing and monitoring. Women must be fully informed of the unlicensed status, realistic treatment goals, potential risks, and the need for ongoing monitoring. Self-medication or use without medical supervision is strongly discouraged.

References: NICE NG23 Menopause: diagnosis and management; British Menopause Society guidance on testosterone therapy for women (2022); 2019 Global Consensus Position Statement on Testosterone Therapy for Women.

How to Apply Testogel Safely and Effectively

Correct application technique is essential to ensure optimal absorption and minimise the risk of accidental transfer to others, particularly children and male partners. Testogel should be applied once daily, ideally at the same time each day, to maintain stable testosterone levels.

Important: Application instructions differ depending on the specific Testogel formulation you have been prescribed. Always follow the instructions in the patient information leaflet supplied with your product. The following general guidance applies, but check your product's Summary of Product Characteristics (SmPC) for exact instructions:

• Testogel 50 mg/5 g gel (1% sachet): Typically applied to shoulders, upper arms, or abdomen.

• Testogel 16.2 mg/g gel (pump): Typically applied to shoulders and upper arms only; abdomen is not a permitted site for this formulation.

The gel should be applied to clean, dry, intact skin. Do not apply to the breasts, genital area, or any broken, irritated, or inflamed skin.

Step-by-step application guidance:

• Wash and dry your hands thoroughly before opening the sachet or using the pump.

• Apply the prescribed dose directly onto the application site (applying directly to the skin rather than your palm reduces the risk of transfer).

• Spread the gel thinly and evenly over the designated area.

• Allow the gel to dry completely (approximately 3–5 minutes) before dressing. Cover the application site with clothing once dry.

• Wash your hands thoroughly with soap and water immediately after application.

To prevent accidental transfer, avoid direct skin-to-skin contact with others at the application site. The time you must wait before close contact, or the need to wash the site before contact, varies by product—follow the specific instructions in your product leaflet. If accidental skin contact occurs, the other person should wash the affected area with soap and water promptly.

It is advisable to rotate application sites within the permitted areas to reduce the risk of skin irritation. If you forget a dose, apply it as soon as you remember on the same day; do not apply a double dose the following day. Consistency in application timing and technique helps maintain stable testosterone levels.

References: Electronic Medicines Compendium (EMC) SmPC for Testogel 50 mg/5 g and Testogel 16.2 mg/g; British Menopause Society guidance.

Dosage Guidelines and Treatment Monitoring for Women

Testosterone dosing in women requires careful titration, as female physiological testosterone levels are significantly lower than male levels. The typical starting dose for women is much smaller than the standard male dose—often around 5–10 mg daily (approximately one-tenth of the male dose). Because Testogel sachets and pumps are formulated for male dosing, achieving accurate low-dose administration can be challenging and may require careful measurement (for example, using a measured syringe to draw a fraction of a sachet, or using a fraction of a pump actuation as directed by your specialist).

Your specialist will provide specific instructions on how to measure your prescribed dose. The dose should be individualised based on your symptom response and testosterone levels, with adjustments made gradually over several months. The therapeutic aim is to keep your total testosterone level within the normal premenopausal female reference range for your local laboratory, avoiding levels that exceed the upper limit of this range.

Note: The British Menopause Society and MHRA advise against the use of unregulated compounded bioidentical hormone preparations. Your specialist will prescribe a regulated product and provide dosing instructions appropriate for female use.

Monitoring is essential and should include:

• Baseline blood tests before starting treatment: total testosterone, and sex hormone-binding globulin (SHBG) if indicated. Additional tests such as full blood count, lipid profile, and liver function tests may be performed based on your individual clinical circumstances and comorbidities, but are not routinely required in all women.

• Follow-up testosterone levels measured approximately 2–3 months after starting treatment or after any dose adjustment. Blood samples should be taken at a consistent time relative to your last gel application, as advised by your specialist or local laboratory protocol.

• Ongoing monitoring every 6–12 months if your treatment is stable, including assessment of symptoms, side effects, and repeat testosterone levels. Blood pressure and other tests may be performed as clinically indicated.

Treatment response should be assessed holistically, considering symptom improvement (particularly sexual desire and distress), quality of life, and tolerability, rather than testosterone levels alone. If no meaningful benefit is observed after 3–6 months of adequate dosing, discontinuation should be considered in discussion with your specialist.

References: British Menopause Society Clinical Guidance on Testosterone in Menopause (2022); NICE NG23.

Potential Side Effects and When to Seek Medical Advice

While testosterone therapy can be beneficial for appropriately selected women, it carries potential risks that require careful monitoring. Common side effects at therapeutic doses may include:

• Acne or oily skin, particularly on the face, chest, or back

• Increased body or facial hair growth (hirsutism), or localised increased hair growth at the application site

• Scalp hair thinning or male-pattern hair loss

• Application-site reactions (redness, irritation, rash)

• Weight gain or changes in body composition

Mild acne and slight increases in hair growth are relatively common and may be acceptable to some women if balanced against symptom improvement. Mood changes such as irritability or aggression are uncommon at physiological doses used in women.

Signs of excessive testosterone exposure (virilisation) include:

• Voice deepening or hoarseness (which may be irreversible)

• Clitoral enlargement

• Significant facial hair growth or male-pattern baldness

These symptoms indicate that your testosterone dose is too high and require immediate dose reduction or cessation. Contact your prescribing specialist promptly.

You should contact your GP or prescribing specialist promptly if you experience:

• Any signs of virilisation (voice changes, clitoral enlargement, severe hirsutism)

• Severe acne unresponsive to usual treatments

• Persistent mood disturbances or depression

• Unexplained weight gain or swelling

Seek urgent medical attention if you experience:

• Chest pain, leg swelling, or shortness of breath

• Signs of liver problems (jaundice, dark urine, persistent nausea or vomiting)

These symptoms are not typical of physiological testosterone therapy but warrant urgent assessment if they occur.

Long-term safety: There is limited long-term safety data for testosterone therapy in women. At physiological doses used in women, effects on haematocrit (red blood cell concentration) and cardiovascular risk appear to be minimal, but data remain limited. The relationship between testosterone therapy and breast cancer risk is uncertain; women with a personal history of hormone-sensitive cancers should discuss potential risks thoroughly with their specialist. Regular monitoring allows early detection of adverse effects and appropriate dose adjustment or treatment discontinuation when necessary.

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.mhra.gov.uk/yellowcard or search for 'Yellow Card' in the Google Play or Apple App Store.

References: EMC SmPC for Testogel products; British Menopause Society guidance; MHRA Yellow Card scheme.

Precautions and Contraindications in Female Patients

Testosterone therapy is not suitable for all women, and careful patient selection is essential. Absolute contraindications include:

• Pregnancy: Testosterone can cause virilisation of a female foetus. If you become pregnant while using testosterone, stop treatment immediately and contact your doctor.

• Breastfeeding: Testosterone is excreted in breast milk.

Women of childbearing potential must use reliable contraception throughout treatment, as testosterone does not provide contraceptive protection.

Relative contraindications and situations requiring specialist assessment include:

• Hormone-sensitive cancers, particularly breast or endometrial cancer (current or recent history). The evidence regarding testosterone and breast cancer risk is uncertain; women with a personal history should be counselled about theoretical concerns and monitored closely.

• Cardiovascular disease (previous heart attack, stroke, or uncontrolled hypertension): Use with caution and specialist input. Evidence at physiological female doses is limited.

• Liver disease or significantly abnormal liver function tests.

• Polycystic ovary syndrome (PCOS) with existing hyperandrogenism: Women with PCOS often have elevated endogenous testosterone levels. Baseline androgen levels and symptoms should be carefully evaluated before considering therapy, as additional testosterone may worsen androgenic symptoms.

• Severe acne or hirsutism at baseline.

• Obstructive sleep apnoea.

Important safety considerations:

• At physiological doses used in women, effects on haematocrit (red blood cell concentration) and thrombotic risk appear to be uncommon, but monitoring may be considered based on individual clinical risk factors.

• Lipid profiles may be monitored as clinically indicated; effects at physiological female doses appear modest.

• Perioperative management: There is no evidence-based requirement to stop testosterone therapy routinely before surgery at physiological female doses. Follow the advice of your surgical or anaesthetic team and local hospital policies regarding hormone therapy.

Women should inform all healthcare providers, including dentists and pharmacists, that they are using testosterone therapy. Treatment should be reviewed regularly, with ongoing assessment of the benefit-risk balance. If symptoms have not improved after an adequate trial period (3–6 months), or if side effects become problematic, discontinuation should be considered in consultation with your prescribing specialist.

References: EMC SmPC for Testogel; British Menopause Society guidance; NICE NG23.

Frequently Asked Questions