Testosterone is usually filed under men's health, which is why most women are surprised to learn they produce it at all — and more surprised that it is sometimes prescribed around the menopause.
This guide covers what testosterone does in women, what the symptoms of low levels look like, why testing is less straightforward than for men, and what UK guidance actually recommends. It is deliberately specific about the last part, because this is an area where what is marketed and what is recommended are not the same thing.
Key takeaways
- Yes, women produce testosterone, in the ovaries and adrenal glands, at much lower concentrations than men.
- Levels fall gradually with age, and sharply after both ovaries are removed.
- There is no agreed reference range for women in the way there is for men, which is why testing is interpreted differently.
- NICE recommends considering testosterone for low sexual desire associated with menopause, where HRT alone has not worked (NICE NG23).
- It is an off-label use. No testosterone product is licensed for women in the UK, and NICE says so explicitly in the recommendation itself.
What testosterone does in women
Women make testosterone in the ovaries and adrenal glands. It contributes to sexual desire, energy, mood, muscle mass and bone strength — much the same roles as in men, at roughly a tenth to a twentieth of the concentration.
Levels peak in the twenties and decline gradually from there. By the time a woman reaches her forties, testosterone is typically around half what it was two decades earlier. This decline is slow and continuous rather than tied to the menopause itself, which is part of why its effects are hard to separate from everything else happening at that age.
The sharpest fall happens when both ovaries are surgically removed, which removes a substantial source of production abruptly rather than over decades.
Symptoms of low testosterone in women
The commonly cited symptoms are:
- Persistently low sexual desire, and reduced response
- Fatigue that rest does not fix
- Low mood and reduced motivation
- Reduced muscle strength
- Brain fog and poor concentration
The honest problem is that every one of these overlaps almost completely with perimenopause, thyroid disease, iron deficiency, poor sleep, depression and chronic stress. There is no symptom that points specifically at testosterone in women the way, say, spoon-shaped nails point at iron.
This is why a good assessment looks wider before it looks at testosterone. Our perimenopause checklist and thyroid symptom checker are free ways to rule the common explanations in or out first.
Why testing is different for women
For men there are agreed thresholds. For women there are not.
Three practical reasons:
- No agreed reference range. Normal values in women are low and vary considerably between individuals and across the cycle, so "within range" and "outside range" carry much less meaning.
- Assay precision. Many standard laboratory assays were designed for male concentrations and are less reliable at the much lower levels found in women.
- Symptoms correlate poorly with levels. Women with low readings often have no symptoms, and women with symptoms often have unremarkable readings.
The consequence is that a blood test is not usually how the decision gets made. Where testosterone is considered, levels are typically checked before starting and monitored afterwards to make sure they stay within the female range — which is a safety check rather than a diagnostic one.
If you are having hormone bloods done for other reasons, our guide to private blood tests in the UK covers what the panels include.
What UK guidance actually says
This is the part worth reading carefully, because it is narrower than the marketing around it.
NICE's recommendation is specific: "Consider testosterone supplementation for people with low sexual desire associated with menopause if HRT alone is not effective" (NICE NG23, 1.5.25). The same recommendation notes that this is an off-label use of testosterone.
The NHS puts it similarly: testosterone gel or cream can help improve low libido for some, and it may be available on prescription from a menopause specialist. The NHS also makes a point worth repeating — there are many reasons for low libido around the menopause, including relationship difficulties, how you feel about yourself, and physical discomfort (NHS).
Three things follow from that, and they are frequently lost:
- The indication is specific — low sexual desire associated with menopause, not fatigue, brain fog, low mood or muscle loss. Those are not what the recommendation covers.
- It comes after HRT, not instead of it. The recommendation applies where HRT alone has not worked.
- Off-label means no product is licensed for women in the UK. Prescribing off-label is legal, common and sometimes entirely appropriate — but it places more responsibility on the prescriber, and it is a reason this is usually a specialist conversation rather than a routine one.
What about high testosterone in women?
Raised testosterone in women is a different question with a different answer. The most common cause is polycystic ovary syndrome, and the typical features are acne, excess hair growth on the face or body, scalp hair thinning, and irregular or absent periods.
Unlike low testosterone, high testosterone is worth testing for, because the result changes what happens next and there are recognised thresholds. If those features describe you, that is a reason to see a GP rather than to seek treatment for low levels.
Where this leaves you
If low libido around the menopause is the main problem and HRT has already been tried without success, testosterone is a legitimate conversation to have with a menopause specialist.
If the main problem is fatigue, low mood or brain fog, the evidence does not support testosterone as the answer, and the more productive route is finding what is actually causing them. Thyroid function, iron, B12 and the menopause transition itself account for a large share of those presentations, and each has a better-supported treatment.
Our guides to perimenopause symptoms and HRT side effects cover the ground that usually comes first.
Frequently asked questions
Do women have testosterone?
Yes. Women produce testosterone in the ovaries and adrenal glands, at roughly a tenth to a twentieth of male concentrations. It contributes to sexual desire, energy, mood, muscle and bone strength.
What are normal testosterone levels in women?
There is no single agreed reference range for women in the UK in the way there is for men. Levels are low, vary between individuals and across the menstrual cycle, and many standard assays are less precise at those concentrations. Where testosterone is prescribed, levels are monitored to keep them within the female range rather than used to make the diagnosis.
What are the symptoms of low testosterone in women?
Low sexual desire, fatigue, low mood, reduced motivation, muscle weakness and brain fog. All of them overlap heavily with perimenopause, thyroid problems, iron deficiency and poor sleep, so none is specific to testosterone on its own.
Can women get testosterone on the NHS?
Sometimes. The NHS says testosterone may be available on prescription from a menopause specialist, for low libido. NICE recommends considering it for low sexual desire associated with menopause where HRT alone has not been effective, and notes this is an off-label use. Availability varies by area.
Is testosterone licensed for women in the UK?
No. No testosterone product is currently licensed for use in women in the UK, which is why NICE describes it as an off-label use. Off-label prescribing is lawful and sometimes appropriate, but it means the prescriber takes on additional responsibility, and it is one reason this tends to be handled by specialists.
Does testosterone help with fatigue or brain fog in women?
The recommendation does not cover those symptoms. NICE's guidance relates specifically to low sexual desire associated with menopause. Fatigue and brain fog have many causes around this age — thyroid, iron, sleep, mood and the menopause transition itself — and those are more likely to be the productive thing to investigate.
What causes high testosterone in women?
Most commonly polycystic ovary syndrome. Typical features are acne, excess facial or body hair, thinning scalp hair and irregular periods. Unlike low testosterone, this is worth testing for, because the result changes management.
Sources
- NICE NG23 — Menopause: identification and management
- NHS — Treatment for menopause and perimenopause
- NHS — Menopause and perimenopause
This article is for information and is not a substitute for individual medical advice. Decisions about off-label treatment should be made with a clinician who knows your history.
