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)
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.)
Assessment first: rule out relationship, psychological, medication or medical causes of low desire (biopsychosocial approach). (British Menopause Society)
Trial HRT first: where appropriate, standard systemic HRT is usually tried before considering testosterone. (British Menopause Society)
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)
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)
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)
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)?
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)
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)
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