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Testosterone can be an effective treatment for low libido, but the jury is out when it comes to fatigue, brain fog and mood disorders.


Testosterone is a hormone that is naturally produced in the ovaries of women but also in various other tissues from pre-hormones produced in the adrenal gland. Most testosterone is bound to blood proteins such as sex hormone binding globulin (SHBG) and albumin, with only around 3-5% being free and available for your body to use. Conditions that elevate SHBG, such as using the oral contraceptive pill or oral oestrogen in MHT, can increase SHBG thereby reducing available testosterone. In PCOS and insulin resistance, SHBG is reduced (increasing the bioavailability of testosterone, one of the causes of increased body hair and acne in PCOS).

Testosterone is an important hormone both before and after menopause and plays a role in maintaining healthy blood vessels, skin, muscle and bone, breast tissue and the brain. In both women and men, testosterone can act on its own or be converted into oestrogen.

Testosterone naturally and gradually declines by about 25% between the age of 18 years to 40 years, stabilises, then rises a little in the 60’s-70’s. This differs from the sudden change in oestrogen and progesterone that occurs around the menopause.

Interpreting blood testosterone levels is difficult for a number of reasons. Most assays are designed to measure the much higher testosterone levels of men and are not as reliable in women; low levels don’t indicate a lack of testosterone function because much of the hormone is made in the tissues where it is needed (by conversion from pre-hormones); and finally, there is no proven association between low levels and various symptoms in women. As such, there is no such clinical entity as female “testosterone deficiency”.

There is sound evidence that testosterone therapy may improve sexual desire in post-menopausal women who have developed low sexual desire that distresses them, so called hypoactive sexual desire disorder (HSDD). Of course, many other factors contribute to low sexual desire such as relationship issues, medication use, depression etc with hormones being only one small part. Hormone treatment for low sexual desire should therefore be part of a multi-pronged approach.

There is currently no current convincing evidence that testosterone therapy is beneficial for mood disorders or brain fog and research is underway regarding any benefit for bone and muscle health in women.

Testosterone therapy involves supplementing the body’s natural testosterone using a body-identical cream applied to the skin daily. Blood tests are required after starting to make sure blood levels do not exceed the female range which may cause unwanted side effects of facial hair, acne and hair loss along the part and hairline.

Blood tests to measure your own levels do not need to be low in order to consider using supplementation but testosterone therapy is not for everyone and the only current indication for use in women is in hypoactive sexual desire disorder (HSDD). This said, many women trial testosterone for other symptoms persisting despite being on routine MHT. A 3 month trial is usually sufficient to determine its effectiveness.


Key Take Aways

Testosterone can improve distress in HSDD

Its role in improving energy, mood and brain fog is as yet unproven

Body-identical testosterone cream is applied to your skin daily

Check blood levels to prevent side effects if using testosterone



Global Consensus Position Statement on the Use of Testosterone Therapy for Women

Climacteric, 2019