Testosterone & Libido in Women — What the Evidence Says

Testosterone & Libido in Women: Evidence, NHS Rules & Safety

Why women are usually asked to say they’re using testosterone for libido

In the UK, professional guidance and NHS pathways make clear that the primary evidence-based indication for prescribing testosterone to women is Hypoactive Sexual Desire Disorder (HSDD) , i.e., clinically low sexual desire causing distress, especially when standard HRT hasn’t helped. Because of this, clinicians will commonly record and treat testosterone as a targeted therapy for libido. This is not a bureaucratic quirk; it reflects the scope of the evidence and the fact that testosterone is unlicensed for general use in women in the UK, so prescribers must follow guideline-based indications and document clinical rationale. (NHS)

What the research says (evidence-based benefits)

• A meta-analysis and multiple randomised controlled trials show that testosterone treatment can increase sexual desire and the number of sexually satisfying events in post-menopausal women with HSDD compared with placebo. Many trials report measurable benefit after 8–12 weeks of therapy. (OUP Academic)

• International consensus and systematic reviews conclude the best-supported use of testosterone in women is for HSDD; evidence for broad benefits on mood, cognition or energy is weak or inconsistent. (ScienceDirect)

(In plain language: testosterone helps the sexual desire problem it’s been tested for — it’s not a proven fix for tiredness, “brain fog” or low mood in general.)

Typical clinical pathway (how it’s used safely)

1. Assessment first: rule out relationship, psychological, medication or medical causes of low desire (biopsychosocial approach). (British Menopause Society)

2. Trial HRT first: where appropriate, standard systemic HRT is usually tried before considering testosterone. (British Menopause Society)

3. Off-label, low-dose trial: if HRT fails and HSDD persists, a carefully monitored trial of low-dose testosterone (topical gels or low-dose preparations) may be offered, with documented informed consent. (HWE Clinical Guidance)

4. Review & monitor: outcomes (libido, sexual satisfaction) and side effects are reviewed after ~3 months, and treatment is continued only if benefit outweighs risk. (HWE Clinical Guidance)

Safety & cautions (what you must know)

• Short-term evidence is favourable for libido outcomes, but long-term safety data are limited. This is why cautious, time-limited trials and regular reviews are recommended. (OUP Academic)

• Possible androgenic side effects include acne, unwanted facial/body hair growth, and (rarely) voice changes at higher doses.

• Potential cardiovascular, metabolic and liver effects have been discussed in literature; data are mixed and require careful monitoring, especially in women with existing cardiac, liver or thrombotic risk factors. (PMC)

• Because there are no licensed testosterone products for women in many countries, prescriptions are off-label — prescribers must document rationale and obtain informed consent. (Knowledge NoW)

Practical points patients and prescribers should discuss:

• Is low sexual desire the primary problem, and is it causing distress? (HSDD)

• Have other issues been discussed, such as relationship or medication?

• Has standard HRT been tried if suitable?

• What is the realistic timeline (expect 8–12 weeks to assess response)? (HWE Clinical Guidance)

• What are the stopping rules (no benefit, adverse effects)?

• How will monitoring be done (lipids, liver function, clinical review)?

Why transparency about the indication matters (NHS context)

Because NHS guidance and specialist society statements specify HSDD as the evidence-based indication, clinicians prescribing testosterone typically document that the treatment is for low sexual desire. This ensures:

• treatment follows best evidence and guidance;

• safer prescribing practice (selection, monitoring); and

• clarity for medicolegal and commissioning reasons when using an unlicensed product. (HWE Clinical Guidance)

Final take

Testosterone can be a valuable, evidence-based option for carefully selected women with distressing low sexual desire after other causes are ruled out and HRT has been tried. It requires informed consent, clear goals for a trial, and active monitoring because long-term safety is still incompletely defined. If you’re discussing testosterone with your doctor, ask for realistic expectations (it may take weeks), and a plan to stop if no benefit or side effects occur. (OUP Academic)

Helpful resources & further reading

• NHS Menopause information (patient-facing): Testosterone gel for reduced sex drive. nhs.uk

• British Menopause Society guidance on testosterone replacement. British Menopause Society

• Lancet Diabetes & Endocrinology systematic review/meta-analysis (2019) on safety & efficacy. OUP Academic