Women make testosterone too, and levels gradually fall with age. Guidelines say the one evidence-based reason to consider testosterone for women is persistent, distressing low sexual desire, usually after menopause, once other causes have been looked at and if HRT alone has not helped. It is not an established treatment for muscle loss, weight gain, fatigue, mood or brain fog, and a blood test cannot show whether you “need” it. Whether it is right for you is a decision to make with your doctor.
This article answers one question: what does testosterone actually do, and not do, for women around menopause, especially when it comes to muscle, weight and libido? The British Menopause Society’s patient charity, Women’s Health Concern, explains that women produce testosterone alongside estrogen and progesterone, that levels gradually reduce with age, and that many women notice no symptoms from this change at all. If you want the wider picture of how all these hormones shift, our guide to hormones during perimenopause and menopause is a good place to start.
Testosterone has become a popular topic online. Some posts present it as the missing piece behind softer muscles, a thicker waist, low energy and a vanished sex drive, all at once. The guidelines tell a quieter, more specific story, and it is worth knowing before you go into an appointment.
Can declining testosterone cause muscle loss after 40?
Testosterone plays a role in muscle, but there is no good evidence that giving testosterone to women at physiological doses improves muscle mass or strength. Midlife changes in strength can have several causes, and regular strengthening activity is something the NHS recommends for all adults.
Many women first notice the change in ordinary moments. The shopping bags feel heavier. Getting up from the floor takes more effort. An exercise routine that once kept you strong no longer seems to give the same results.
It is tempting to look for a single hormone behind this. But a 2019 international consensus statement on testosterone therapy for women, endorsed by menopause and endocrine societies worldwide, found that testosterone at physiological doses had no statistically significant effect on lean body mass, total body fat or muscle strength. The same statement says there is not enough evidence to recommend it for bone or general musculoskeletal health.
So feeling weaker does not automatically point to low testosterone. Activity levels, sleep, food intake, illness and simply getting older can all play a part, and a doctor can help you look at the bigger picture.
What does have practical support is giving your muscles a regular reason to stay. The NHS recommends strengthening activities that work all the major muscle groups on at least 2 days a week, alongside regular aerobic activity. Our article on strength training during menopause explains why this matters so much after 40.
No hormone can replace the message that tells muscle, “We still need you.”
Can low testosterone cause weight gain or more belly fat?
There is no good evidence that testosterone therapy changes body fat in women, and it is not a weight-loss treatment. Guidelines do not recommend it for weight, metabolism or body shape.
Midlife body changes are real, and they are frustratingly resistant to simple explanations. You may weigh roughly the same but notice that your waist has changed.
Testosterone is sometimes pulled into this conversation because of its link with muscle in men. But the 2019 consensus statement found no significant effect of physiological-dose testosterone on total body fat in women. Women’s Health Concern even lists weight gain among the possible side effects of testosterone treatment, alongside greasy skin, acne and slightly increased facial hair.
If your body has been changing in ways that worry you, it is worth talking to your doctor about everything that may be involved, from sleep, activity and medicines to other health conditions, rather than starting from a single hormone.
Can a blood test tell whether you have low testosterone?
A blood test can measure testosterone, but it cannot tell you whether you need treatment. No blood level reliably separates women with low sexual desire from women without it.
When symptoms feel hormonal, it is natural to want a number. Numbers feel objective. Unfortunately, testosterone in women does not work that way.
The 2019 consensus statement says that no cut-off blood level of any androgen can distinguish women with and without sexual difficulties, and that a total testosterone level should not be used to diagnose low sexual desire. Women’s Health Concern puts it plainly: blood tests cannot diagnose whether or not you need testosterone, but they are used as a safety check to make sure you are not getting too much on top of your own natural levels, so that your level stays within the normal female range.
So if a commercial hormone panel labels your testosterone as “suboptimal,” that does not mean you need treatment. A result has to be interpreted by a doctor, together with your symptoms and your health history.
What do guidelines say testosterone can be used for?
Guidelines describe one evidence-based use: persistent, distressing low sexual desire, mainly after menopause, once other causes have been assessed and if HRT alone has not been effective. Whether that applies to you is something only your doctor can help you decide.
In the UK, the NICE menopause guideline says testosterone can be considered for people with low sexual desire associated with menopause if HRT alone is not effective. NICE notes that this was an off-label use of testosterone when the recommendation was made.
The 2019 consensus statement goes further in defining the limits: it says the only evidence-based indication for testosterone in women is low sexual desire that causes distress (hypoactive sexual desire disorder, or HSDD) in postmenopausal women, diagnosed after a full assessment of physical, psychological and relationship factors. In studies, the average benefit was moderate: on average, about one more satisfying sexual experience per month than with placebo, along with improvements in desire, arousal and pleasure.
The Menopause Society notes that there is evidence testosterone may help low sexual desire in both perimenopausal and postmenopausal women (the 2019 consensus statement, however, based its recommendations on studies in postmenopausal women and found too little data to recommend testosterone before menopause), that side effects such as acne and facial hair growth may occur, and that long-term risks are still being investigated.
Women’s Health Concern adds two important caveats: testosterone should only be prescribed after all other possible factors, including inadequate estrogen replacement, have been addressed, and even then it does not help everyone. The NHS says testosterone gel or cream can help improve low libido for some women and may be available on prescription from a menopause specialist.
Lower desire is not automatically a problem that needs fixing. The Menopause Society points out that there is no standard to meet when it comes to sexual activity and desire: some women notice a decline at midlife, some an increase, and some no change at all. Treatment is only part of the conversation when the change genuinely bothers you. If it does, talk to your doctor about your own situation and the options that fit it.
What else can lower sexual desire around menopause?
Many things can lower desire, and hormones are only one of them. Vaginal dryness, poor sleep, stress, low mood, some medicines, health conditions and relationship strain can all play a part.
The NHS lists the main causes of a low sex drive as relationship problems; stress, anxiety or depression; sexual problems such as vaginal dryness; lower hormone levels as you get older, particularly during the menopause; certain medicines, such as blood pressure medicines or antidepressants; drinking too much alcohol; and some long-term conditions, such as heart disease, diabetes or an underactive thyroid.
The Menopause Society adds that hot flashes and night sweats can disturb sleep, and that not having restful sleep might reduce interest in sex. If you are waking exhausted, our article on why you may wake up tired even after sleeping looks at what can sit behind it.
Pain matters too. When sex hurts, desire understandably fades. The NHS lists vaginal moisturisers and water-based lubricants among the things you can try yourself for vaginal dryness, and says that if dryness is caused by hormone changes, a doctor may discuss hormonal treatment, which is not recommended for everybody. Talk to your doctor if dryness has lasted a few weeks and the things you have tried are not helping, or if it is affecting your daily life.
Can testosterone help with fatigue, mood or brain fog?
Current evidence does not support testosterone for fatigue, low mood or brain fog. These symptoms deserve attention, but they have many possible causes.
Women’s Health Concern states that there is currently not enough evidence to recommend testosterone for low energy, low mood, fatigue or brain fog. The 2019 consensus statement likewise found no effect on general wellbeing or depressed mood, and not enough evidence to support it for thinking and memory after menopause.
That does not make these symptoms less real. It means they deserve a proper look at what else may be going on. Our article on whether perimenopause can cause fatigue covers the many factors that can overlap.
What side effects and safety questions are there?
At doses that keep levels within the normal female range, the side effects reported most often are mild: acne and increased facial or body hair in some women. Long-term safety data are limited, and treatments that push levels above the female range are not recommended.
The 2019 consensus statement found that physiological doses were associated with mild increases in acne and body or facial hair growth in some women, but not with hair loss, clitoral enlargement or voice change. Women’s Health Concern says side effects at the recommended dose are very few and usually reversible on stopping.
The bigger uncertainty is the long term. The consensus statement says safety data at physiological doses were not available beyond 24 months, that research is insufficient to assess long-term breast cancer risk, and that the studies excluded women at high risk of heart and metabolic disease. Women’s Health Concern, in its fact sheet reviewed in 2026, still describes a lack of long-term data, while noting that data up to five years show no adverse effect in healthy women after menopause.
The consensus statement does not recommend any testosterone preparation that raises levels above the normal female range, including pellets and injections, and the panel recommended against compounded “bioidentical” testosterone because there is not enough evidence on its effectiveness and safety. Where no testosterone product is approved for women, the statement says a doctor may prescribe a product approved for men off-label, in a female dose, keeping levels within the normal female range. Whether any of this is relevant to you is a question for your doctor. “Bioidentical” describes the hormone molecule, not how carefully a product is made or dosed.
If testosterone is prescribed as a gel, Women’s Health Concern advises avoiding skin contact with partners or children until the gel has dried, and washing your hands straight after applying it.
If you notice any change you are unsure about while using testosterone, contact the doctor who prescribed it rather than changing anything yourself. Any decision about starting, continuing or stopping treatment belongs in a conversation with your doctor about your own health.
What can you track and ask before talking to your doctor?
Note how your desire has changed, how long it has been going on, how much it bothers you and what else changed around the same time. That picture is far more useful than a single hormone result.
Sexual desire is hard to remember accurately over months, especially when sleep, mood and other symptoms are changing at the same time. You do not need to turn intimacy into a spreadsheet. A brief weekly note is enough:
- Did sexual thoughts or interest come up at all?
- Did intimacy feel appealing, neutral or unwelcome?
- Was there dryness or pain?
- Did the change bother you?
- How were sleep, stress and mood that week?
- Did any medicine or hormone treatment change?
Menoup lets you log these alongside sleep, mood, energy, cycle changes and other menopause symptoms. Mona, the app's AI companion, can help you look at those patterns and share general, evidence-informed information—it isn't a substitute for advice from your doctor.
Questions you might bring to your appointment:
- What else could be contributing to my low desire, and how can we look at it?
- Could vaginal dryness, sleep, mood or one of my medicines be part of the picture?
- Is testosterone something that applies to my situation, and why or why not?
- If we try it, how will we check that it is safe and decide whether it is working?
- What should make me get in touch with you?
It is worth being cautious about any service that promises muscle gain, weight loss, energy and confidence from one hormone, offers pellets or levels above the female range, or skips assessment and blood tests. None of that matches what the guidelines describe.
When should you talk to a doctor?
Talk to a doctor if a change in your sex drive worries you, if you think a medicine may be affecting it, or if sex has become painful. Always get bleeding after menopause checked.
You do not need to prove that your libido is “low enough” to deserve a conversation. The NHS suggests seeing a GP if you are worried about your low sex drive, or if you are taking a medicine or using hormonal contraception and think it may be affecting your sex drive. Never stop a prescribed medicine on your own; ask your doctor first.
The NHS also says to see a GP if you notice bleeding from your vagina after your menopause, even if it is only a small amount or has only happened once. It is usually not serious, but it should always be checked.
Key Takeaways
- Women produce testosterone, and levels gradually fall with age; many women notice no symptoms from this.
- Guidelines describe one evidence-based use: persistent, distressing low sexual desire, mainly after menopause, after other causes have been assessed and if HRT alone has not helped.
- Testosterone at physiological doses has not been shown to improve muscle mass, strength or body fat in women; strength training has practical support.
- A blood test cannot show whether you need testosterone; it is used as a safety check, so that your level stays within the normal female range.
- There is not enough evidence to recommend testosterone for fatigue, low mood or brain fog.
- Mild acne and extra hair growth are the most commonly reported side effects; long-term safety data are limited.
- The international consensus statement does not recommend pellets, injections, compounded “bioidentical” testosterone or other products that raise levels above the female range, because of a lack of evidence on effectiveness and safety.
- Low desire has many possible causes, so the conversation with your doctor should start with the whole picture, not with a single hormone.
Frequently Asked Questions
Is low testosterone common after menopause?
Testosterone levels gradually reduce as women get older, but Women’s Health Concern notes that many women do not experience any symptoms from this. Women who have had their ovaries removed or who have premature ovarian insufficiency may notice the change more. A lower level on its own does not mean treatment is needed.
Is testosterone licensed for women?
It depends on the country. According to the 2019 consensus statement, in most countries testosterone for women is prescribed off-label, often using a product approved for men at a female dose. In the UK, Women’s Health Concern says the NHS products are not currently licensed for women, so your prescriber will explain what “off-licence” means for you.
Can testosterone be used alongside HRT?
It is possible: NICE suggests considering testosterone if HRT alone has not helped low sexual desire, and Women’s Health Concern notes that it is usually given alongside HRT. The consensus statement looked at women with or without estrogen therapy. Whether it fits your situation is a question for your doctor.
Will testosterone make my voice deeper?
At doses that keep levels within the normal female range, the 2019 consensus statement found no link with voice change. The concern is with treatments that push levels higher, which guidelines do not recommend. If you notice any change in your voice while using testosterone, tell your doctor promptly.
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Last updated: October 11, 2026
Medical Note: This article is for general information only and does not replace medical advice, diagnosis or treatment. Testosterone is a prescription treatment, so please talk to your doctor about your own situation before starting, changing or stopping any treatment. If you notice bleeding after your menopause, or any change that worries you, see your doctor.
References
- National Institute for Health and Care Excellence (NICE). Menopause: identification and management (NG23). Recommendations. 2015, updated 2026. nice.org.uk
- Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. The Journal of Clinical Endocrinology and Metabolism. 2019. pmc.ncbi.nlm.nih.gov
- Women’s Health Concern (British Menopause Society). Testosterone for women. Fact sheet. 2026. womens-health-concern.org
- The Menopause Society. Sexual Health. menopause.org
- NHS. Treatment for menopause and perimenopause. nhs.uk
- NHS. Low sex drive (loss of libido). 2026. nhs.uk
- NHS. Vaginal dryness. 2025. nhs.uk
- NHS. Postmenopausal bleeding. nhs.uk
- NHS. Physical activity guidelines for adults aged 19 to 64. nhs.uk