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.

When is Testosterone Hormone Therapy Used For Menopausal Women?

Testosterone replacement therapy for women is usually given via a topical as cream or gel that is applied to the skin. Testosteone is absorbed via the skin into the circulation and distributed around the body. It is used to treat female sexual dysfunction (medically known as hypoactive sexual desire disorder or commonly known as low libido).

Testosterone treatment aims to increase and restore testosterone levels to improve libido or sexual function, while maintaining testosterone in the the female physiological range. 

Testosterone therapy has been used in female 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 associated with low libido. Testosterone levels fall through perimenopause and 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.

It is particularly beneficial for women who have had both ovaries removed and who have very little endogenous androgen production as a result. 

Topical Testosterone

Testosterone is a prescription medicine and is applied to the skin daily. It's use has beenfits and risks. It's use requires careful use and monitoring to ensure testosteorne levels remain in the female physiologic range and no side effects occur. It is considered an off-label use in women. You should discuss this with your medical professional. 

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 Testosterone.

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 despite ethinicity, income and education level, BMI, smoking status, birth control use or HRT use. 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 currently undertaking a larger study looking at use of testosterone for the prevention of loss of bone density in postmenopausal women. 

The investigations into the impacts of testosterone on female bone health are ongoing and it will be exciting to see further trials confirm that testosterone use is able to reduce bone loss in post-menopausal 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, frailty, 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 doing further research into testosterone supplementation for muscle mass in postmenopausal women. 

Testosterone and Female Brain Health

Testosterone appears to play important roles 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). 

Heart Health and Testosterone in Females

Research shows that testosterone is a vasodilator and reduces blood pressure in postmenopausal women (Testosterone Therapy & 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 V_O2max 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 do work out the nuances of testosterone therapy. Is there an optimal dose, and which women benefit from it? 

Side Effects Of Using Testosterone For Women?

Potential common side effects of testosterone include:

1. Acne and oily skin (less dry skin is often seen as a benefit);

2. Increased body hair at the site of application or increased facial hair (to reduce this, vary site, spread thinly or reduce the dose);

3. Minor weight gain (average 0.5kg - from clinical trials which did not lead to discontinued use)

4. Thinning of head hair or female pattern balding (more likely with excess dosing or genetic pre-disposition)

5. Headache;

6. Abdominal symptoms such as bloating or constipation.

7. 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 discuss 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 transdermal 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.

Oral testosterone is not recommended in women as it has a negative impact on cholesterol. 

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 and use the lowest effective 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 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. Minor weight gain is seen in some women in clinical trials (average 0.5kg). The studies do not differentiate between body composition - ie weight gain that is fat vs weight gain that is muscle. 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.

Dr Deborah Brunt is a menopause doctor at Rebelle Health and would love to support you through the perimenopause and menopausal stages, supporting all aspects of your health and wellbeing.

Join our Menothrive Programs to feel great and love your life during peri and menopause.

Dr Deborah Brunt | Rebelle Health | Book Appointment

**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