Testogel is a testosterone gel licensed in the UK for men with hypogonadism, but may be prescribed off-label by specialists for postmenopausal women with hypoactive sexual desire disorder (HSDD). Knowing where to put Testogel safely is essential for women using this treatment. The recommended application sites are the lower abdomen or upper outer thighs and buttocks—areas that optimise absorption whilst minimising the risk of accidental transfer to others. Women must apply the gel to clean, dry skin, allow it to dry completely, and cover the site with clothing. Proper application technique, combined with regular specialist monitoring, ensures both safety and effectiveness of this off-label therapy.

Understanding Testogel Use in Women

Testogel is a testosterone replacement therapy licensed in the UK for use 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 approaches have not been effective. Testosterone contributes to female physiology, including sexual function, bone density, and muscle mass. When levels fall—particularly after surgical menopause (bilateral oophorectomy) or as part of natural ageing—some women experience persistent low sexual desire that causes distress.

In the UK, NICE guidance (NG23) and the British Menopause Society (BMS) recognise that testosterone may be considered as an add-on treatment for postmenopausal women with HSDD, after optimising oestrogen-based hormone replacement therapy (HRT) and addressing other potential causes of low libido (such as relationship issues, depression, or other medical conditions). The evidence supporting testosterone therapy in women is strongest for HSDD; claims regarding benefits for energy, mood, or general quality of life are not robustly supported and should not be the primary reason for treatment.

Because testosterone therapy for women is unlicensed, any prescription must be given under specialist guidance—typically by a menopause specialist or endocrinologist—and women must receive clear counselling about the off-label nature of treatment, potential benefits, possible adverse effects, and the need for ongoing monitoring. Testogel contains testosterone in a gel formulation designed for transdermal (through the skin) absorption, allowing steady hormone delivery. Dosing for women is much lower than for men—typically starting at around 5 mg of testosterone daily—and requires careful titration under medical supervision. Women should never use testosterone therapy without proper medical assessment, including baseline blood tests, and regular follow-up to ensure safety and efficacy. Understanding the rationale, risks, correct application technique, and monitoring requirements is essential for optimising outcomes and minimising potential side effects.

Key contraindications and cautions include pregnancy and breastfeeding, androgen-dependent cancers (such as breast cancer), active liver disease, and severe acne or hirsutism. Women with these conditions should not use testosterone therapy.

Where to Apply Testogel: Recommended Sites for Women

The application site for Testogel in women is critically important for both efficacy and safety. Because the product is licensed for men, application advice for women is based on specialist guidance and off-label use protocols. Women are generally advised to apply testosterone gel to sites that optimise absorption whilst minimising the risk of accidental transfer to others, particularly children and male partners.

Recommended application sites for women (based on British Menopause Society guidance) include:

• Lower abdomen – A common site that allows for good absorption and is easily covered by clothing, reducing transfer risk.

• Upper outer thighs or buttocks – These areas provide adequate skin surface and are typically covered by clothing.

It is essential to avoid applying Testogel to the breasts, genital area, or any broken, irritated, or inflamed skin. The gel should be applied to clean, dry skin and allowed to dry completely (typically 3–5 minutes) before dressing. Women should rotate application sites within the recommended areas to prevent skin irritation and ensure consistent absorption.

Key safety considerations include washing hands thoroughly with soap and water immediately after application. Once the gel has dried, the application site must be covered with clothing to prevent accidental skin-to-skin transfer. The time required to avoid direct skin contact or to wash the site before contact varies by formulation:

• Testogel 16.2 mg/g (pump): avoid direct skin-to-skin contact for at least 2 hours after application, or wash the site with soap and water before contact.

• Testogel 1% (50 mg sachet): avoid direct skin-to-skin contact for at least 6 hours after application, or wash the site with soap and water before contact.

If someone else does come into contact with the application site, they should wash the affected area with soap and water promptly. Women should apply the gel at a consistent time each day that suits their routine; there is no need to mimic circadian rhythms in postmenopausal women. Your specialist will advise on the most appropriate timing and formulation for your individual circumstances.

How to Apply Testogel Safely and Effectively

Proper application technique is fundamental to achieving therapeutic benefit whilst minimising risks. Women prescribed Testogel should receive clear, written instructions from their prescribing specialist and follow these steps carefully:

Step-by-step application process:

1. Wash and dry hands thoroughly before opening the gel sachet or pump.

2. Ensure the application site is clean and completely dry – avoid applying immediately after bathing; wait at least 10–15 minutes.

3. Dispense the prescribed dose – women typically use a much smaller amount than men. The usual starting dose is approximately 5 mg of testosterone daily, which may be increased to up to 10 mg daily if needed, based on symptom response and blood test results. Your specialist will explain how to measure the correct small volume from the sachet or pump (for example, using a calibrated applicator or a measured pea-sized amount). Note that the dose refers to milligrams of testosterone, not the volume of gel.

4. Apply the gel in a thin, even layer over the chosen area (lower abdomen or upper outer thigh/buttock), gently rubbing it in until the skin appears dry. Do not massage vigorously.

5. Allow the gel to dry completely (3–5 minutes minimum) before dressing. The application site should feel dry to touch.

6. Wash hands immediately and thoroughly with soap and water after application.

7. Cover the application site with clothing once dry to prevent transfer to others.

Important safety precautions include avoiding swimming, bathing, or showering for a period after application to ensure adequate absorption. The required interval depends on the formulation:

• Testogel 16.2 mg/g: avoid washing the site for at least 2 hours.

• Testogel 1% (50 mg): avoid washing the site for at least 6 hours.

Women should not apply moisturisers, sunscreen, or other topical products to the application site immediately before or after using Testogel, as these may interfere with absorption. If a dose is missed, it should be applied as soon as remembered, unless it is nearly time for the next dose—never double the dose.

Women should be aware of potential local side effects including skin irritation, redness, or itching at the application site. If these occur persistently, rotate the application site within the recommended areas and inform your prescribing specialist. More significant concerns, such as signs of virilisation (deepening voice, increased facial or body hair, acne, clitoral enlargement), should prompt immediate medical review. If testosterone therapy does not lead to a meaningful improvement in sexual desire by 6 months, it should be stopped.

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 MHRA Yellow Card in the Google Play or Apple App Store.

Monitoring and Adjusting Your Treatment

Regular monitoring is essential for women using testosterone therapy to ensure treatment efficacy, detect adverse effects early, and adjust dosing appropriately. Because testosterone use in women is off-label, monitoring must be individualised under specialist supervision, following British Menopause Society and NICE guidance.

Baseline assessments before starting treatment should include:

• Serum total testosterone level – to establish your baseline and ensure levels are not already elevated.

• Liver function tests – to ensure safe metabolism.

• Lipid profile – if clinically indicated, as testosterone may affect cholesterol levels.

• Assessment of symptoms – using validated questionnaires for sexual function and quality of life.

Ongoing monitoring typically involves a blood test to measure total testosterone at approximately 6–12 weeks after starting treatment or after any dose adjustment, then every 6–12 months once stable. For consistency, blood samples should be taken at a similar time relative to your dose on each occasion (for example, always in the morning). The aim is to keep your total testosterone level within the healthy premenopausal female reference range for your local laboratory, and to avoid exceeding the upper limit of that range. Your specialist will interpret results in the context of your symptoms and overall health.

Clinicians will assess for signs of virilisation, including voice changes, clitoral enlargement, male-pattern hair growth, or acne. Women should report any such changes immediately. Full blood count and haematocrit monitoring may be considered if testosterone levels are high or if there are clinical concerns, as testosterone can stimulate red blood cell production. Lipid profiles and liver function tests should be reviewed if clinically indicated.

Dose adjustments are made based on symptom response and blood results. Many women find benefit at low doses (around 5 mg daily), though some may require an increase to up to 10 mg daily. Doses above 10 mg daily are rarely needed and increase the risk of adverse effects. Treatment should be reviewed at least every 6–12 months to assess ongoing need, benefits, and risks. If there is no meaningful improvement in sexual desire by 6 months, testosterone therapy should be stopped. Women should maintain open communication with their specialist, reporting any concerns promptly, and should never adjust their dose without medical guidance.

Key references for UK practice include the British Menopause Society 2022 position statement on testosterone replacement in menopause, NICE guideline NG23 (Menopause: diagnosis and management), the MHRA/emc Summaries of Product Characteristics (SmPCs) for Testogel formulations, and the British National Formulary (BNF) monograph for testosterone (topical).

Frequently Asked Questions