Testosterone is a useful and increasingly popular treatment for low libido as part of hormone therapy (HT). It is most commonly prescribed as a testosterone gel, though you may come across other options such as creams or implants. Here’s everything you need to know.
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When to use testosterone during menopause
Testosterone can be a really useful addition to your HT treatment. It has been proven to help people with hypoactive sexual desire disorder (HSDD), which is when low libido becomes distressing. A 2017 paper found that women with HSDD who took testosterone had greater satisfaction with sex, more orgasms, and a higher sex drive. Sounds good, right?
Unfortunately, it is not so simple. Your sex drive is complex and can be affected by many different things. For this reason, your healthcare provider will explore all of the different possible causes of your symptoms before recommending testosterone. These can include depression and relationship difficulties as well as physical problems like incontinence, vaginal prolapse, or other vaginal discomfort due to menopause, which can be treated safely and easily with vaginal hormones. Erectile dysfunction in a partner also needs to be discussed.
They may then recommend a trial of testosterone. This usually happens after you have been on conventional HT – containing estrogen and sometimes progesterone too – for at least three months.
Which kinds of testosterone are available for women?
Testosterone is not currently FDA-approved to treat low libido in women, but providers can still prescribe it if they think it will help you.
Testosterone for women is prescribed as a gel, cream, or implant. The testosterone is absorbed from the skin into your bloodstream. Be aware that different products come with different concentrations of testosterone, so you need to follow your healthcare provider’s instructions carefully to ensure the right dose.
Due to the increasing popularity of testosterone, there are many unreliable and unsafe sources of testosterone creams and gels. Accept only boxed, branded, FDA-approved testosterone products. “Compounded” products and testosterone “substitutes” can cause serious overdoses and health risks.
Testosterone gel
Testosterone gel is the most common type of HT to treat low libido. Brands available include Tostran and Testogel. When these products are used to treat women it is off-label.
What does off-label mean?
Off-label means that the medication was FDA-approved to treat certain patients or conditions, but a healthcare provider is using them to treat problems that the medication was not approved for by the FDA. This is common practice in medicine – it simply means that your healthcare provider needs sufficient knowledge and training and will ensure you are monitored for safety if necessary.
In this case, testosterone gels were originally studied for use by men with low testosterone levels. Research on their safety and efficacy in women was not conducted as part of the original approval process.
It’s important to follow your healthcare provider’s instructions when something is prescribed off-label as instructions can be very different from what is listed on the product information sheet. For instance, women using testosterone gel will generally need to take a much lower dose than men who have been prescribed the same medication.
Testosterone implants
Testosterone implants are also available off-label, but they are more dangerous and harder to dose correctly compared to creams and gels. These little pellets sit under your skin for six months and slowly release testosterone over this time. They cannot be removed easily and the dosages are often too high. It is best to stay away from testosterone pellets.
Testosterone cream
Androfeme is a testosterone cream designed specifically for women during menopause, but it is not currently available in the US – it has so far only been approved in Australia. It contains a lower concentration of testosterone compared with the testosterone gels currently available, so it is easier to take the doses that most women require.
How to use testosterone gel and cream
Follow your healthcare provider’s instructions on how much product to apply. In general:
- Gently rub the product onto clean, dry skin
- Wait until the product is dry before getting dressed – this usually takes about 30 seconds
- Wash your hands afterwards
- Wait at least 30 minutes before getting your skin wet
- Don’t use any moisturizers, perfumes, or body care products on the area where you apply your testosterone
For more details, check your pack leaflet.
Where should you apply testosterone gel or cream?
To apply your testosterone gel or cream:
- Choose a hairless area of skin – usually your buttocks or upper outer thighs
- Regularly change the place where you apply the gel or cream
- Avoid damaged areas of skin – for example, if you have skin conditions like eczema or psoriasis
- Don’t apply testosterone to your genital area
How long does it take for testosterone gel or cream to work?
It can take several months for the benefits of testosterone to really kick in, just like with other forms of HT.
If things aren’t improving by three months, it’s worth checking in with your healthcare provider. They may advise:
- Increasing your dose
- Re-evaluating your symptoms or looking for an alternative cause
Find out more about what to do if your HT is not working for you.
Final word
Testosterone gel is a useful treatment option for women in menopause who are struggling with low libido. Testosterone creams and implants may be prescribed by some healthcare providers, but they are less regulated and can be more dangerous.
Find out more about menopause on our blog or in our symptoms library.
