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Do you struggle with low libido and wonder how to improve your sexual desire? This guide explores the role of testosterone** in menopause and whether using testosterone gel or cream could be beneficial for you.
For too long, sexual pleasure—especially for older women—has been overlooked as a vital part of health. Our holistic approach recognizes that sexual satisfaction and relational intimacy are essential components of a woman’s well-being. We support treatments that address these needs, empowering women to thrive at every stage of life.
What is Testosterone?
Testosterone is a hormone that has multiple effects in the body that is made by the ovaries and to a lesser extent the adrenal glands. As ovarian function declines during perimenopause, estrogen, progesterone and testosterone production declines.
Prior to menopause, the ovaries produce more testosterone than estrogen. However there is a natural decline in testosterone production between age 20 and 40. It is estimated that by 40 years of age, testosterone levels are half of what they were at age 20 years.
Symptoms of Low Testosterone in Women During Menopause
As ovarian function declines through perimenopause, testosterone levels also reduce. Low testosterone in women can contribute to menopausal changes to body and brain including:
reduced muscle and bone mass and strength,
changes in hair growth,
reduced sexual desire/libido,
altered metabolism,
low mood
fatigue or low energy and metabolism.
What is Testosterone Hormone Therapy in Menopause?
Testosterone replacement therapy for women is commonly given via a transdermal route ie via a cream or gel that is applied to the skin. The testosteone is absorbed via the skin into the circulation and distributed around the body.
Testosterone treatment aims to increase and restore testosterone levels and improve libido while maintaining testosterone in the the female physiological range.
Testosterone therapy has been used in sexual health for over 35 years. Testosterone use appears to improve:
energy,
mood,
well-being and
self-perception,
all of which contribute beneficially to improve sexual desire. It also appears to directly improve measures of sexuality including:
increased libido or sexual desire
increased sexual activity,
increased sexual arousal,
improved sexual excitability and
improved sexual pleasure and satisfaction (Testosterone in Menopause 2023).
Testosterone Hormone Therapy in Menopause
Testosterone can be used to raise testosterone levels which fall through perimenopause and post-menopause. It is a significant hormone for women's health and brain function in the premenopausal years and during this time it is the highest sex steroid in the female body.
It peaks in the 20s and declines from there. Lower levels of testosterone especially around menopause can contribute to reduced sexual desire, changes in pelvic tissue and organ function, loss of muscle and bone mass and impacts negatively on mood, cognition, and energy levels.
Testosterone Gel
Testosterone gel is absorbed via the skin and is used daily. Testogel is the only transdermal testosterone funded by PHARMAC and available in New Zealand. It can be prescribed off-label for menopausal women.
It's use requires careful use and monitoring to ensure testosteorne levels remain in the female physiologic range and no side effects occur.
If you do experience side effects or you absorb effieciently, your dose may need to be reduced.
For more information please read the Medsafe datasheet for Testogel.
What Are The Benefits of Using Testosterone for Low Sexual Desire in Menopause?
Testosterone is primarily used to treat female sexual dysfunction in postmenopausal women such as hypoactive sexual desire disorder - the medical term for low sexual desire or low libido.
Low sexual desire encompasses a lot besides hormone levels. It includes how you feel about;
yourself,
your body,
your sexuality,
your relationships, intimacy and connectivity with partner/s,
your zest for life and
your experience of pleasure in general.
The Global Consensus Position Statement on the Use of Testosterone Therapy for Women recommends testosterone use in doses equivalent to your premenopausal testosterone level for sexual dysfunction in menopausal women.
The UK NICE Guidelines for Menopause Diagnosis and Management recommends testosterone for low sexual desire where HRT alone is not effective.
It is important to know that low testosterone is only one contributing factor to low sexual desire or low libido in women. Female sexual dysfunction at all phases of life are usually multifactorial and can also be impacted by:
hormonal issues
neuroendocrine imbalance - particularly stress,
medications,
psychological factors,
relationship dynamics and
cultural factors. such as religious, or moral views of sexuality and
history of sexual trauma.
For this reason it is beneficial to see a clinician who treats difficulties with sexual desire from a biopsychosocial perspective.
Read more about Female Libido or Sexual Desire.
Are There Other Benefits Of Testosterone For Women?
Vulva, Vaginal & Urinary Health
Testosterone is important for vulva and vaginal skin health and integrity. It helps maintain skin thickness and elasticity, and helps prevent vaginal dryness. It supports bladder and pelvic floor function. For this reason either testosterone or DHEA which converts to testosterone can be used for vulva-vaginal or urinary symptoms in menopause. Studies have shown vaginal testosterone:
improved sexual desire,
increased vaginal lubrication,
increased orgasm and
reduced pain (Effects of Vaginal Testosterone versus Placebo on Female Sexual Function).
Vaginal testosterone has also been shown to be a beneficial treatment for women on estrogen-blocking medications (such as aromatase inhibitors) who experience vaginal dryness and irritation (Testosterone Improves Sexual Satisfaction & Vaginal Symptoms Associated With Aromatase Inhibitors).
Bone Health
Testosterone also helps increase bone density in postmenopausal women. Testosterone stimulates osteoblasts which are the cells that produce new bone.
Postmenopausal women are at greater risk of developing osteoporosis due to estrogen deficiency combined with age-related bone loss. Testosterone supports the maintenance of both muscle mass and strength.
A large study of 2198 women aged 40-60 in the USA demonstrated that women with the highest testosterone levels had higher bone density in their lumbar spine. This benefit persisted even when researchers adjusted for factors such as age, race, BMI, calcium and phosphorus levels, hormone use, and lifestyle habits.
This association persisted across various subgroups, including Non-Hispanic Black and other racial groups, different income and education levels, high BMI, smoking status, previous use of and those who had never smoked, birth control pills, or current hormone replacement therapy (HRT) users. The findings of the study suggest that testosterone is a significant predictor of bone health in midlife women (Testosterone levels and bone mineral density in females aged 40–60 years).
A small clinical trial of 34 postmenopausal women demonstrated that testosterone with estrogen was more effective at increasing bone mineral density in the lumbar spine, hip and total body over 2 years compared with estrogen therapy alone (Testosterone enhances estradiol's effects on postmenopausal bone density).
Monash University is undertaking a study looking at use of testosterone for the prevention of loss of bone density in postmenopausal women.
Muscle Mass and Strength in Females
Testosterone is important for muscle mass maintenance in females. During aging and perimenopause there is progressive muscle degeneration which over time can lead to sarcopenia. Sarcopenia is the progressive loss of skeletal muscle. It is associated with an increased likelihood of falls, fractures, chronic pain, disability and premature death.
Menopause hormone therapy with estrogen is associated with a reduced risk of sarcopenia, as is physical activity and adequate protein intake.
Monash university is studying testosterone supplementation for muscle mass in postmenopausal women.
Testosterone and Female Brain Health
Testosterone has been demonstrated to play an important role in healthy brain function in postmenopausal women. A few studies indicates that testosterone use improves memory, executive function, verbal learning and visuospatial planning (Testosterone improves verbal learning and memory in postmenopausal women). It is also important for energy levels.
Heart Health and Testosterone in Females
Research shows that testosterone is a vasodilator and reduces blood pressure in postmenopausal women (Testosterone Therapy May Improve Endothelium Vasodilation in Postmenopausal Women, Inhaled Testosterone in Postmenopausal Women). Women with lower natural testosterone levels after menopause are at higher risk of heart attacks and strokes than those with higher levels (Testosterone and the heart: friend or foe?).
A 6-month double-blind RCT of postmenopausal women with heart failure demonstrated that testosterone therapy improved VO2max a measure of aerobic capacity, 6-min walk test time and insulin sensitivity (Testosterone Therapy in Women With Chronic Heart Failure).
Although the emerging research indicates many benefits of testosterone therapy in menopausal women, we do need larger and longer lasting clinical trials.
Side Effects Of Using Testosterone For Women?
Potential common side effects of testosterone include:
acne and oily skin (less dry skin is often seen as a benefit);
increased body hair at the site of application (to reduce this, vary site, spread thinly or reduce the dose);
minor weight gain (average 0.5kg - from clinical trials)
thinning of head hair/ female pattern balding (more likely with excess dosing or genetic pre-disposition)
headache;
abdominal symptoms such as bloating or constipation.
increased cholesterol - this only has been noted when females use oral testosterone and not transdermal testosterone (ie. delivered through the skin) .
Rare side effects: deepening of voice and enlargement of clitoris. These are unusual when using physiological doses of testosterone. However many women do report a restoration of fullness of clitorus and vulva where post-menopausal loss of hormones has resulted in thinning and shrinking of these tissues.
Always check with your doctor if you have any side effects from testosterone use.
Who should not use Testosterone?
People with the following conditions should get medical advice before using testosterone therapy:
cancers that are stimulated by androgens/testosterone,
kidney disease known as nephrotic syndrome,
high calcium levels in the blood,
pregnant or breastfeeding women.
How to use Testosterone?
Most women use a low dose of testosterone daily.
It is applied to clean dry skin on the lower abdomen or upper thighs.
You need to wash your hands after application to avoid transfer of the hormone to other people
Avoid washing the area of application for 2-3 hours after application.
Testosterone use is monitored by testing the testosterone levels via a blood test every 3 months.
It can take up to 6-12 months to have optimal effect, however studies have shown there can be an improvement in satisfying sexual experiences after only 4 weeks use.
If there is no effect after 6 months it can be discontinued.
When should testosterone levels get checked?
Testosterone blood tests should be completed just prior to your next application of testosterone. This will check if your testosterone levels are in the female range during its lowest point (a trough level).
Testosterone levels are usually also checked with your sex hormone binding globulin to calculate the amount of free testosterone.
Testosterone is usually checked 6-12 weeks after initiation and once stable 3 monthly.
FAQs About Testosterone In Menopause
Where can I buy Testosterone in NZ?
Testosterone is a prescription medicine. It must be prescribed by a doctor in New Zealand. Testogel is a funded version of testosterone available in New Zealand.
Is it safe to use Testosterone long-term?
There is no safety data for use of testosterone in postmenopausal women beyond 24 months, because there are no studies longer than 24 months.
The available data is reassuring that transdermal testosterone is not associated with higher blood pressure. cholesterol levels, kidney function, liver function, insulin levels or blood cell counts in women.
There is no increased risk of breast cancer in the short term and it does not appear to stimulate the endometrium.
How Long Does It Take For Testosterone To Work?
It can take up to 3-4 weeks for you to notice any improvements in general wellbeing and libido/sexual desire/pleasure.
When it comes to mood, improvements are often seen at 3-6 weeks, but may take 3-6 months for optimal improvements to occur (Testosterone treatment 2011).
What is the recommended dosage for Testosterone?
The recommended dosage of testosterone for females is a dose that keeps the free androgen index in the female physiological range. Most females typically start with a dose of around 5mg, although some start with less to avoid the occurance of a skin breakout.
Testosterone levels need to be monitored and reduced if the level goes above the female range.
It is usually used as an additional menopausal hormone therapy, once you are on optimised estradiol and progesterone and continue to have low libido.
How is Testosterone different from other hormone therapies?
Testosterone is usually used in conjunction with other menopause hormone replacement therapies such as estrogen and progesterone. Estrogen and progesterone are usually optimised first as it is our clinical experience that around 80 percent of women will have an improvement in libido with optimised estrogen, and fewer disruptive peri/menopausal symptoms.
How To Prevent Hair Loss When Taking Testosterone?
Testosterone can be converted to dihydrotestosterone (DHT), which is a more potent androgen. High DHT appears to be involved in androgen-related hair loss. To prevent hair loss while using testosterone, it is best to start with a low dose.
If hair loss is an issue, discuss with your doctor regarding treatment options.
What is the cost of Testosterone in NZ?
Testosterone gel in New Zealand is subsidised by Pharmac and the cost is between $5-$15 depending on who prescribes GP/Specialist.
Find out more about HRT funding in New Zealand here.
Can you use testosterone if you have had a blood clot or a family history of blood clots?
Transdermal testosterone is absorbed through the skin. It is used in low dose in women and levels are measured periodically to ensure the level stays within the female physiological range. In this range there is no increased risk of blood clot.
Does testosterone cause weight gain in women?
High levels of testosterone can cause weight gain in women. This occurs in conditions like polycystic ovarian syndrome where high levels of androgens (testosterones) are high and associated with increased insulin resistance and weight gain.
In menopause, the aim is to increase testosterone levels to normal female physiological levels. There has been some minor weight gain seen in some women in clinical trials (average 0.5kg). Your individual response to hormone treatment may be different.
If you experience weight gain or unexpected changes in your body composition, talk to your health provider.
As a menopause doctor, Dr Deb Brunt @ Ōtepoti Integrative Health would love to support you through the perimenopause and menopausal stages of life, supporting all aspects of your health and wellbeing.
Dr Deb Brunt is a menopause doctor in Dunedin, New Zealand and also provides menopause health coaching internationally to support optimal health habits for aging well so you can live your best life.
****Testosterone is a prescription medicine. It should be prescribed by trained medical professionals. Ask your doctor about the benefits and risks of using testosterone and whether it is right for you. If you have any side effects or concerns speak to your health professional. It has benefits and risks. Always follow your doctor’s instructions. For more information refer to the Consumer Medicine Information for Testosterone at www.medsafe.govt.nz
References
Behre H, et al. Long-Term Effect of Testosterone Therapy on Bone Mineral Density in Hypogonadal Men, The Journal of Clinical Endocrinology & Metabolism, Volume 82, Issue 8, 1 August 1997, Pages 2386–2390
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M Martinez, A Sandozi, L Vafina, et al. The Effects of Vaginal Testosterone versus Placebo on Female Sexual Function: Interim Analysis of the PIVoT Trial (Prevention of Recurrent Urinary Tract Infection using Vaginal Testosterone), The Journal of Sexual Medicine, Volume 20, Issue Supplement_1, May 2023, qdad060.002.
Davis, S.R., McCloud, P., Strauss, B.J. & Burger, H. (1995) Testosterone enhances estradiol's effects on postmenopausal bone density and sexuality. Maturitas, 21, 227–236.
Worboys S, Kotsopoulos D, Teede H, et al. Evidence That Parenteral Testosterone Therapy May Improve Endothelium-Dependent and -Independent Vasodilation in Postmenopausal Women Already Receiving Estrogen, The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 1, 1 January 2001, Pages 158–161,
Davis, S. R. (2023). Testosterone and the heart: friend or foe? Climacteric, 27(1), 53–59.
Iellamo, F, Volterrani, M, Caminiti, G. et al. Testosterone Therapy in Women With Chronic Heart Failure: A Pilot Double-Blind, Randomized, Placebo-Controlled Study. JACC. 2010 Oct, 56 (16) 1310–1316.
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