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In this blog, I am going to tell you a story that is only one version of what many of us experience as we navigate the changes that come with hormonal ageing and getting older, often starting around our late thirties; sometimes earlier, sometimes later. It is different for us all, and impacts us to a greater or lesser degree individually.
It is my story, but versions of it are unfolding right now in consulting rooms, GP surgeries, and private clinics all over the UK and beyond.
It is a story about a hormone that plays a role in multiple systems in the body, yet remains largely invisible in women's healthcare conversations: testosterone. In women, the clinical evidence for treatment is strongest in the area of sexual desire, with other effects still being actively researched, but the breadth of its influence is far greater than most of us realise.
A short while ago, we covered the impact of Oestrogen on our skin and our bodies in a 3-part series, do check that out if you're interested.
Since then I've learnt much more about where my body is at this stage (aged 50, at the time of writing), and while the largest part of me wants to keep this private, if sharing this helps only one person, it would be 100% worth it. Writing about my hormone journey and the fallout of it all is not something I thought I'd ever do, but this is the kind of information I so wish I knew before.
Today we're talking about Testosterone in your mid to late thirties - and during peri and menopause.
If you have ever felt as though your body changed overnight, as though the energy, clarity, and resilience you once took for granted quietly packed their bags and left, testosterone, or rather the absence of it, may be one part of the overall picture.
And the frustrating truth is that the standard blood tests your doctor orders may not reveal it, or it may reveal an overall 'normal' reading when in fact it is everything but when you look at the complete picture. This is where so many of us fall through the cracks.
This is not a blog about bodybuilding or masculinity.
This is about a hormone that your body has produced since puberty, one that plays a role in your muscles, your bones, your metabolism, your brain, your mood, your connective tissue, and yes, your skin. When levels drop significantly, many systems in the body can begin to shift.
Let me start at the beginning.
I started my periods at ten or eleven years old, and from the very beginning they were heavy. Not inconveniently heavy: debilitatingly heavy. The kind of heavy that meant missing school, planning life around cycles, and becoming intimately familiar with iron infusions before I was out of my twenties.
By the time I was in my thirties, the reason had a name: uterine fibroids. Multiple, large, and persistent. I had my first fibroid surgery in 2013, still hoping to get pregnant. But the fibroids returned, and with them came a prolapsed uterus, chronic pain from fibroids pressing against my spine, and worsening anaemia that left me perpetually exhausted.
By 2019, at 43, one fibroid had grown too large to manage conservatively. Several others had joined it. My gynaecologist was honest with me: pregnancy would not survive and would only accelerate the growth. The hysterectomy was medically necessary.
What nobody told me, and what I want you to understand, is that a hysterectomy is not just a surgical event.
Hysterectomy, even when the ovaries are retained, has been associated with an increased risk of earlier ovarian decline. The exact mechanism isn't fully understood, although changes in blood flow to the ovaries may play a role. What it means in practice is that ovaries that were "saved" may not function as they did before. The hormonal consequences can be immediate, or they can unfold over months and years.
There was also grief: years of trying, years of not conceiving, and the final acceptance that I would never be a mother.
That grief does not belong in a footnote. It is woven into the hormonal story because it is woven into the experience, but that's not for today.
If you have walked that path in some way, or perhaps walking that path now, I also want you to know you're not alone, even though I know it can feel desperately lonely.
This is my personal experience, not a diagnosis or recommendation. Hormonal health is complex, and what I've shared here is intended to open the conversation, not close it.
After the hysterectomy there was no aftercare, and definitely no hormonal follow-up.
It was never suggested, and I had no idea that it would be as necessary and life-changing as it has been. I just carried on until my body completely gave in and collapsed. Literally.
There was no suggestion of monitoring of ovarian function, no assessment of whether those retained ovaries were still doing their job.
After about 2 years of struggling, I was sent from one doctor to the next, each offering different advice, much of it contradictory. Multiple practitioners told me flatly: no hormones. My numbers were 'normal'. Others suggested some support.
Over the last 5 years or so I have been on transdermal oestrogen, transdermal testosterone, and levothyroxine for my thyroid, and then taken off, then prescribed again. At some point, navigating conflicting guidance, I stopped everything.
We don't need to go into all the details, but most recently I had testosterone readings that showed my total testosterone at 0.0 nmol/L. Free testosterone: 0.0 pmol/L.
Literally undetectable. Not low. Not borderline. Absent.
The doctor said he'd never seen anything like it. Using testosterone therapy my bioavailable testosterone was 0.211 nmol/L against a reference range of 2.87 to 8.91.
That is less than 2.5% of the lower limit. Meanwhile, my total testosterone appeared to sit "within range" at 0.25 ng/mL (range 0.08 to 0.35).
This is one of the ways low testosterone levels and symptoms potentially related to androgens can be missed, and I want to explain why, and why it's so important to see and understand that whole picture.
When your doctor tests your testosterone, they almost always test total testosterone.
This is the sum of all testosterone circulating in your blood. The problem is that the vast majority of that testosterone is not actually available to your tissues.
Here is what I've learnt about how it works.
Testosterone circulates in three forms.
A small fraction (typically 1 to 3%) floats freely in the blood: this is free testosterone, and it can enter cells and do its work immediately.
A larger portion is loosely bound to albumin; because this binding is weak, albumin-bound testosterone can also become available to tissues relatively easily. Together, free testosterone and albumin-bound testosterone make up what is called bioavailable testosterone: the portion your body can actually use.
The third fraction, and by far the largest, is tightly bound to a protein called sex hormone binding globulin (SHBG). SHBG binds testosterone, which can reduce the amount that is biologically available to tissues. It counts towards your total, but your tissues may not be able to access it. This is why SHBG can sometimes help explain symptoms that don't match total testosterone levels alone.
Total testosterone is currently the most widely used and practical test in clinical settings. SHBG can provide useful additional context, particularly where symptoms don't align with total levels. Measurements of free or bioavailable testosterone are sometimes discussed, but are not routinely recommended due to variability and limitations in testing methods.
If SHBG is elevated (which it commonly is after menopause, with HRT containing oral oestrogen, with thyroid conditions, with low insulin, or simply with age), it binds more of the available testosterone, leaving less for the body to use. My SHBG was 76.77, sitting in the upper half of the reference range.
It was binding nearly everything.
The total looked acceptable on paper, and that is why I was sent away previously, several times, and told that everything was 'fine', when I felt anything but fine. I also kept thinking it was oestrogen that was the problem, never considering that it was testosterone.
The bioavailable level added important context: my body was likely functioning on very little available testosterone.
This is not uncommon in clinical practice, and it is one of the ways women can fall through the cracks.
This is one of the key testing gaps that can leave many women being told "your levels are normal" when they are anything but.
Testosterone is not a male hormone that women happen to have in small quantities.
Women produce significant amounts of testosterone throughout their reproductive lives, primarily from the ovaries and adrenal glands, and it plays a role across multiple systems in the body. It is not a trace hormone or an afterthought: it is a core part of female physiology.
Muscle and Metabolism:
Testosterone acts directly on androgen receptors in skeletal muscle, stimulating protein synthesis and maintaining lean muscle mass. Muscle is not just about strength: it is the body's primary metabolic tissue, responsible for glucose uptake and insulin sensitivity. When testosterone declines, muscle mass may decrease, metabolic rate can drop, and the body may become less efficient at managing blood sugar. This is one of several pathways that may contribute to insulin resistance and weight gain, particularly around the abdomen.
Insulin Sensitivity:
There are complex interactions between hormones, body composition, and metabolic health. Low testosterone may be associated with certain metabolic patterns, but this relationship is not fully understood and is likely influenced by multiple factors. The relationship appears to be bidirectional: low testosterone may be associated with reduced insulin sensitivity, and insulin resistance in turn may further suppress testosterone levels. My own HOMA-IR (a measure of insulin resistance) rose from 1.7 to 2.39 in the space of four months: a trajectory that concerned my endocrinologist and one that is consistent with the research in this area.
Bone:
Testosterone contributes to bone mineral density both directly (through androgen receptors on osteoblasts, the cells that build bone) and indirectly (through its conversion to oestrogen via the enzyme aromatase). Low testosterone may accelerate bone loss and increase fracture risk, compounding the effects of oestrogen decline.
Cardiovascular Health:
Testosterone influences vascular tone, endothelial function, and lipid metabolism. Research suggests that testosterone deficiency in women has been associated in some studies with changes in cardiovascular risk markers, including changes in arterial stiffness and cholesterol profiles. The cardiovascular system has androgen receptors throughout, and maintaining physiological testosterone levels may support aspects of vascular health.
Brain: Cognition, Mood, Motivation, and Memory:
This is where many women first notice that something has changed. Research suggests that testosterone may play a role in brain function: it is associated with dopamine signalling (the neurotransmitter linked to motivation, reward, and drive), and emerging evidence connects it to cognitive processing, memory consolidation, and mental clarity.
The evidence here is less established than for oestrogen's effects on the brain, but it is growing. When testosterone drops, women often describe a particular kind of cognitive fog: not forgetfulness in the way you lose your keys, but a pervasive loss of sharpness, as though your brain is wading through treacle.
The motivation to do things you once found engaging simply evaporates. Some of my own testing suggested changes in neurotransmitter patterns, which I found interesting in the context of how I was feeling. However, the relationship between testosterone, dopamine, and mood is complex and not something that can be used diagnostically in a straightforward way.
Connective Tissue: Tendons, Ligaments, and Joints:
Testosterone is thought to play a role in collagen turnover in tendons and ligaments, and it may play a role in the inflammatory response within joints. When testosterone is deficient, connective tissue may become more vulnerable to injury, and recovery from injury can be slower.
As someone who formulates skincare for women navigating changing skin from their late thirties onward, this is where the science becomes deeply personal to what we do.
Testosterone likely plays a role in skin biology, including effects on sebaceous activity and dermal structure.
However, its role in improving skin quality through supplementation is not well established, and evidence in this area remains limited. What we do know is worth understanding.
Collagen Production via Fibroblasts:
Your skin's dermis is populated by fibroblasts, the cells responsible for producing collagen, elastin, and the extracellular matrix that gives skin its structure and resilience. Fibroblasts have androgen receptors, meaning they respond directly to testosterone. When testosterone is present at physiological levels, it may stimulate fibroblast activity and support the production of type I and type III collagen, the primary structural proteins of skin. When testosterone declines, fibroblast activity may slow. This is one reason skin can seem to change rapidly during perimenopause and menopause: it is not just oestrogen decline driving the change. Testosterone loss may contribute to it.
Dermal Thickness:
Androgen levels have been associated with dermal thickness, with much of the research drawn from comparisons between men and women and from androgen deprivation models. Women with higher physiological testosterone tend to have thicker, more robust skin. As testosterone declines, the dermis is likely to thin, contributing to the crepey texture and loss of firmness that many women notice from their forties onward.
Sebum and Barrier Function:
Testosterone regulates sebaceous gland activity, influencing the production of sebum, the oily substance that forms part of your skin's barrier. A certain amount of sebum is essential: it protects the skin from transepidermal water loss, supports the acid mantle, and contributes to the skin's defence against environmental aggressors. When testosterone is very low, sebum production can drop significantly, leaving skin drier, more sensitive, and more vulnerable to barrier disruption. Many women in perimenopause notice a sudden shift from combination skin to persistently dry, reactive skin: this can be part of the picture.
Hyaluronic Acid Production:
Testosterone is thought to support the production of glycosaminoglycans, including hyaluronic acid, in the dermis, though the evidence here is less robust than for oestrogen's role. Hyaluronic acid is the molecule responsible for binding water within the skin, maintaining hydration, and contributing to that plump, resilient quality. Declining testosterone may contribute to reduced hyaluronic acid synthesis, which would compound the dehydration effect of reduced sebum.
Wound Healing:
The role of testosterone in wound healing is more nuanced than for the other areas discussed here. Oestrogen is the dominant hormone in skin wound healing research, and androgens can have variable effects depending on context. That said, physiological testosterone levels may play a supporting role in tissue repair, and very low testosterone has been associated with slower recovery. This is an area where the science is still developing.
Hair:
The relationship between testosterone and hair is nuanced. In the scalp, testosterone (specifically its metabolite dihydrotestosterone, or DHT) can contribute to hair thinning at high levels, which is why women with PCOS sometimes experience androgenic alopecia. But testosterone at physiological levels supports healthy hair growth and hair follicle cycling. When testosterone is absent, hair can become thinner, more brittle, and slower to grow, particularly on the scalp, eyebrows, and body.
This is why I care so much about this topic.
The best topical skincare in the world, and I work very hard to make that skincare, is working with the biology it is given.
If the hormonal foundation is compromised, if fibroblasts are under-stimulated, if collagen production has slowed, if hyaluronic acid synthesis is diminished, then the topical actives we apply are working uphill.
They still work, they still matter, and they are still worth using.
But understanding the hormonal picture gives you the full context, and the full power to advocate for yourself.
One of the most important things to understand about low testosterone is that it is not a single problem with a single consequence. It can become a cascade, where each consequence feeds the next.
Hormones, body fat distribution, and metabolism interact in complex ways. When testosterone drops, muscle mass may decline. With less muscle, metabolic rate can fall and insulin sensitivity may decrease. The body may begin to store more fat, particularly viscerally. Adipose tissue can influence hormone balance: it produces aromatase, an enzyme that converts testosterone to oestrogen, which may further reduce the already diminished testosterone supply. Shifts in these systems may reinforce one another, although this is not a simple or uniform pathway.
The result may be a self-reinforcing pattern: less testosterone contributing to more fat, more fat contributing to less testosterone, and the metabolic, cognitive, musculoskeletal, and dermatological consequences compounding over time.
My own trajectory illustrates this clearly.
Testosterone begins declining in women from around the age of 30, gradually and steadily. By the time a woman reaches menopause, her testosterone may have already fallen by 50% or more from its peak. But natural ageing is only one factor.
Menopause and Perimenopause: The ovaries are a primary source of testosterone production, and as they wind down, testosterone output falls alongside oestrogen and progesterone.
Hysterectomy: Hysterectomy, even when the ovaries are retained, has been associated with an increased risk of earlier ovarian decline. The exact mechanism isn't fully understood, although changes in blood flow may play a role. This can reduce ovarian hormone production immediately or progressively over time. It has been described in the literature, yet many women undergoing hysterectomy are not counselled about it.
PCOS: Polycystic ovary syndrome is typically associated with androgen excess, but hormonal patterns can shift significantly over time. Some women notice changes that feel very different from earlier life stages. This is still an area where more research is needed, and experiences can vary widely. It is not universally established, but it is worth being aware of.
Adrenal Decline: The adrenal glands produce DHEA-S, a precursor to testosterone. Adrenal output naturally declines with age (a process sometimes called adrenopause), and chronic stress can accelerate this decline.
Thyroid Dysfunction: Thyroid hormones influence SHBG production and overall hormonal metabolism. Hypothyroidism, hyperthyroidism, and even subclinical thyroid conditions can alter the availability of testosterone through effects on binding proteins and conversion pathways.
In my case, several of these factors converged: a hysterectomy with likely effects on my retained ovaries, suspected PCOS with possible changes in androgen patterns, benign thyroid nodules, and the natural age-related decline.
The result was not just low testosterone, but extremely low functional testosterone levels.
There is a detail in my story that adds another layer of complexity, and one that I think many women will recognise.
My retained ovaries were still producing oestrogen, but what was happening was that my ovaries were producing oestrogen without ovulating, creating a state of unopposed oestrogen: oestrogen without the balancing influence of progesterone that would normally follow ovulation.
This pattern is common in PCOS and in the perimenopausal transition, and it creates its own set of risks, including effects on breast tissue, endometrial tissue (in women who still have a uterus), and metabolic health.
Meanwhile, those same ovaries were not producing adequate testosterone. The hormonal picture was not simply "low everything": it was a complex imbalance where some hormones were present (and in the case of oestrogen, present without adequate opposition) while others were almost entirely absent.
This is the kind of nuance that gets lost when healthcare focuses narrowly on whether a woman is "menopausal" or not, based on a single FSH test.
Again, this is not something I ever thought I would share openly online, and sharing even a relatively small amount of detail feels hugely personal, but this is the kind of information I didn't know that I needed, and that I wish with all my heart I had much earlier on.
If you live in the UK and suspect you have low testosterone, I want to prepare you for what you may face. You may have similar experiences where you're from (even within the UK, and whether you have access to private health care or not), but I can only share my own.
First, getting the right test is a challenge in itself. Most GPs will test total testosterone if they test it at all. Many will not, and it may be quite the struggle to get it done.
Bioavailable testosterone and SHBG are not part of standard panels, and requesting them often requires persistence, knowledge, or a referral to an endocrinologist or menopause specialist.
Second, even when the results clearly show low levels, treatment is not straightforward.
Access to testosterone for women in the UK has historically been off-label and inconsistent. However, regulatory developments are evolving, with female-specific formulations now moving toward broader availability.
Currently, it is typically prescribed as a fraction of a male dose of transdermal testosterone (gel or cream). Not all GPs are willing to prescribe off-label, not all menopause clinics offer it, and access varies enormously depending on where you live: the postcode lottery is real.
Third, and this is perhaps the most damaging, women are routinely dismissed. If the total testosterone comes back "within range," that is often the end of the conversation. The fact that SHBG may be binding the majority of that testosterone, the fact that bioavailable levels may be critically low, the fact that the woman sitting in front of the doctor is describing symptoms consistent with low testosterone: none of this necessarily changes the outcome. "Your levels are normal" is a door that closes.
If anything in this article resonates with your experience, here is what I would encourage you to discuss with your doctor.
1. Request a comprehensive hormone panel that includes: total testosterone, SHBG, oestradiol, progesterone, FSH, LH, DHEA-S, and a full thyroid panel including TSH, free T4, free T3, and thyroid antibodies. Free or bioavailable testosterone can provide additional context, though testing methods vary in reliability.
2. Ask specifically about SHBG. If your SHBG is in the upper portion of the range, a "normal" total testosterone may not tell the whole story because much of it may be bound and unavailable.
3. Know what the numbers mean. Reference ranges for testosterone in women vary between laboratories, and many were established using populations that included women on hormonal contraception (which suppresses testosterone). A result at the bottom of the "normal" range is not necessarily normal for you, particularly if you are symptomatic.
4. Look for red flags that suggest low testosterone even when total levels appear normal: persistent fatigue that is not explained by sleep or iron levels, loss of motivation and cognitive sharpness, decreased muscle mass or strength, joint and tendon problems, slow wound healing, dry or thinning skin, reduced libido, and unexplained weight gain particularly around the midsection.
5. If your GP is unable or unwilling to investigate, consider a referral to an NHS menopause clinic, a British Menopause Society-registered specialist, or an endocrinologist. Private clinics that specialise in hormonal health may also offer comprehensive testing, though costs vary.
Where testosterone is prescribed for women, it is almost always administered transdermally, meaning through the skin via a gel or cream.
This is the safest and most physiological route of delivery, as it avoids the first-pass metabolism through the liver that oral testosterone would involve.
In the UK, when it is prescribed, the most common approach is to use a male-licensed testosterone gel (such as Testogel or AndroFeme in other markets) at a fraction of the male dose, typically one-tenth.
The aim is to restore testosterone to the normal premenopausal physiological range, not to push levels into the male range. Careful dosing is important, as excess testosterone can lead to side effects such as acne, hair changes, or voice deepening.
Some women report that when testosterone is restored to physiological levels, they experience a gradual return of energy, improved cognitive clarity, better mood stability, increased motivation, improved body composition over time, and, yes, improved skin quality.
It is worth noting that the strongest clinical evidence for testosterone therapy in women is currently for sexual function and libido, with evidence for benefits in other areas (energy, cognition, mood, body composition, skin) still emerging and less robust.
That said, clinical observations in practice are often consistent and the direction of the evidence is encouraging. The effects are not immediate: it can take several weeks to months to notice meaningful changes, and monitoring through regular blood tests is essential to ensure levels remain in the appropriate range.
Monitoring approaches vary between clinicians and guidelines. In women using physiological doses, the focus is typically on symptoms and testosterone levels, with some clinicians also assessing haematocrit, liver function, or lipids based on individual risk factors.
A good prescribing clinician will track these regularly and adjust the dose based on both blood results and symptom response.
It is also important to be aware that long-term safety data for testosterone therapy in women beyond a few years is still limited, and cardiovascular and breast safety are areas of ongoing research.
The British Menopause Society, the International Menopause Society, and the Endocrine Society all recognise the potential benefits but recommend ongoing monitoring and individualised risk assessment.
The conversation about women's hormonal health has come a long way.
We talk about oestrogen. We talk about progesterone.
We talk about hot flushes and HRT and the menopause transition in ways that would have been unthinkable a generation ago. And that progress matters enormously.
But testosterone remains the forgotten hormone in women's health. It is not routinely tested. It is not routinely discussed. Access for women in the UK has historically been off-label and inconsistent.
And the consequences of its absence, from metabolic disruption to cognitive changes to skin changes to musculoskeletal effects, are often attributed to "ageing" or "stress" or "just how it is" rather than being recognised as potentially related to a specific hormonal picture.
Ageing is physiology, not pathology. But physiology deserves to be understood, and where it can be supported, it should be.
If your skin has changed, if your energy has disappeared, if your body feels unfamiliar, if your brain is not working the way it used to: you are not imagining it, and you are not "just getting older." There may be a measurable hormonal component worth investigating, although this is not always the case and symptoms can have multiple causes. You deserve to have it investigated properly.
Ask the questions. Request the tests. Do not accept "normal" without seeing the numbers for yourself. Your body is not failing you. But the system might be.
At the time of writing, the strongest clinical evidence for testosterone therapy in women relates to low sexual desire in postmenopausal women. Other potential benefits are being explored, but are not yet established in the same way. That doesn't make the conversation less important: it simply means we need to approach it with both curiosity and care.
Is testosterone really important for women, or is it mainly a male hormone?
Testosterone is produced by women throughout their reproductive lives, primarily by the ovaries and adrenal glands. Premenopausal women produce meaningful levels of testosterone alongside oestrogen, and both are essential to healthy physiology. It plays a role in muscle maintenance, bone density, metabolic health, brain function, connective tissue integrity, and skin biology. Calling it a "male hormone" is one of the reasons it has been so overlooked in women's healthcare.
How do I know if my testosterone is low?
Common signs include persistent fatigue that is not explained by sleep or iron levels, cognitive fog or loss of mental sharpness, reduced motivation and drive, loss of muscle mass or strength, unexplained weight gain (particularly around the midsection), joint and tendon problems or slow injury recovery, dry or thinning skin, thinning hair, and reduced libido. Many of these symptoms overlap with perimenopause and menopause generally, which is part of why low testosterone is so often missed.
My doctor tested my testosterone and said it was normal. Should I accept that?
Not necessarily. Most doctors test total testosterone, which is currently the most practical clinical test. However, if your SHBG is elevated (common after menopause, with oral oestrogen HRT, with thyroid conditions, or simply with age), your total may look acceptable while the amount available to your tissues is much lower. Ask for SHBG to be tested alongside total testosterone, as this can provide useful additional context. If your result sits in the lower half of the range and you are symptomatic, it is worth investigating further.
What is SHBG and why does it matter?
Sex hormone binding globulin (SHBG) is a protein produced by the liver that binds testosterone, which can reduce the amount that is biologically available to tissues. When SHBG is high, more of your testosterone is bound and less is available. This is why SHBG can sometimes help explain symptoms that don't match total testosterone levels alone. SHBG levels are influenced by age, oestrogen (particularly oral oestrogen), thyroid function, insulin levels, and body composition.
I have had a hysterectomy but my ovaries were kept. Am I at risk?
Potentially, yes. Hysterectomy, even when the ovaries are retained, has been associated with an increased risk of earlier ovarian decline. The exact mechanism isn't fully understood, although changes in blood flow may play a role. If you have had a hysterectomy with ovaries retained and you are experiencing symptoms consistent with low testosterone, it is worth requesting comprehensive testing. This is not something all surgeons discuss beforehand, and many women are unaware of the risk.
I have PCOS. Does that mean my testosterone is high, not low?
Not always. PCOS is typically associated with androgen excess, particularly in younger women. However, hormonal patterns can shift significantly over time, and some women notice changes that feel very different from earlier life stages. This is still an area where more research is needed, and experiences can vary widely. If you have PCOS and are noticing a change in your symptom profile as you move into your late thirties or forties, your testosterone levels are worth rechecking.
Can testosterone help my skin?
Testosterone likely plays a role in skin biology, including effects on sebaceous activity and dermal structure. It may stimulate fibroblast activity (the cells that produce collagen), and is associated with dermal thickness and sebum production. However, its role in improving skin quality through supplementation is not well established, and evidence in this area remains limited. When testosterone is at physiological levels, these functions may be better supported. Restoring testosterone to physiological levels may support skin biology from the inside, working alongside the topical actives in your skincare routine.
Is testosterone replacement safe for women?
Transdermal testosterone replacement at physiological doses is generally considered safe for women when prescribed and monitored appropriately. The goal is to restore levels to the normal premenopausal range, not to push them into the male range. Careful dosing matters, as excess testosterone can lead to side effects such as acne, hair changes, or voice deepening. Monitoring approaches vary between clinicians, with the focus typically on symptoms and testosterone levels. The British Menopause Society, the International Menopause Society, and the Endocrine Society all recognise the potential benefits of testosterone therapy in women, though they note that long-term data beyond a few years is still being gathered.
Why is testosterone not licensed for women in the UK?
This is largely a commercial and regulatory gap rather than a safety one. Pharmaceutical companies have not historically pursued the licensing process for a female-specific testosterone product in the UK, partly because the market was seen as too small and partly because of the complexity of the approval process. However, regulatory developments are evolving, with female-specific formulations now moving toward broader availability. The British Menopause Society supports the use of testosterone for women with low levels and relevant symptoms, but individual GPs and clinics vary in their willingness to prescribe.
Can I get testosterone tested and prescribed outside the UK?
Access varies significantly by country. In the United States, compounding pharmacies can prepare custom testosterone formulations, and many practitioners are willing to prescribe for women, though insurance coverage varies. In Australia, AndroFeme (a female-specific testosterone cream) is available by prescription. In South Africa, access is more limited and varies by practitioner. In the UAE and parts of Southeast Asia, prescribing practices can be more flexible, though quality and regulation vary. Wherever you are, the key is finding a practitioner who understands female testosterone physiology and is willing to test comprehensively and prescribe appropriately.
How long does it take to notice a difference after starting testosterone?
Most women report that the first changes, typically improved energy, mood, and mental clarity, begin within four to eight weeks. Body composition changes (improved muscle tone, shift in fat distribution) tend to take longer, often three to six months. Skin improvements are gradual and may take several months to become noticeable, as collagen remodelling and dermal changes happen over longer timescales. Everyone responds differently, and dosage adjustments based on blood work and symptoms are a normal part of the process.
If you have read this article and something resonated, here is a practical guide to what to do next. I have separated the steps depending on whether you have had a hysterectomy or not, because the clinical conversation is slightly different, and I have included notes for readers outside the UK.
Step 1: Write down your symptoms. Before you see anyone, spend ten minutes making a list of everything that has changed. Include when it started, how it affects your daily life, and whether it has worsened over time. Be specific: "persistent fatigue for 18 months, worse in the mornings, not improved by sleep" is more useful than "I feel tired." Include physical symptoms (fatigue, weight changes, joint pain, muscle weakness, hair changes, skin changes, slow healing), cognitive symptoms (fog, poor concentration, memory lapses, loss of motivation), and emotional symptoms (low mood, irritability, loss of interest in things you used to enjoy). Bring this list to every appointment.
Step 2: Know what tests to request. Ask for a comprehensive hormone panel that includes total testosterone, SHBG, oestradiol, progesterone (if you still have a uterus), FSH, LH, DHEA-S, and a full thyroid panel (TSH, free T4, free T3, thyroid antibodies). Also request fasting insulin and fasting glucose (to calculate HOMA-IR for insulin resistance), a full blood count (to check for anaemia), and vitamin D. Free or bioavailable testosterone can provide additional context, though testing methods vary in reliability. If your doctor will only agree to some of these, prioritise total testosterone and SHBG as the minimum.
Step 3: Ask for a copy of your results with reference ranges. Do not accept "everything is normal" without seeing the numbers. You are entitled to your own results. Write down or photograph the actual values and the laboratory's reference ranges. This matters because "within range" and "optimal" are not the same thing, and because you need these numbers to track changes over time.
Step 4: Look at the results critically. Check whether your total testosterone is in the lower third of the range. Check whether SHBG is in the upper half. If both are true, the amount of testosterone available to your tissues may be very low even if the total looks "acceptable." If bioavailable or free testosterone was tested, check where it sits within the range, not just whether it is technically inside the reference values.
Step 5: If the results suggest low levels, or if your symptoms are significant and the testing was incomplete, seek a specialist. A GP may not have the experience or the willingness to prescribe testosterone for women. That is not a failing on their part; it is a gap in training and licensing. The next step is a referral.
Additional context for your appointment: When you see your doctor or specialist, make sure they know the date of your hysterectomy, whether your ovaries were retained or removed, and whether you have had any hormonal monitoring since the surgery. If your ovaries were retained, explain that you are aware that hysterectomy has been associated with an increased risk of earlier ovarian decline and that you would like this assessed. Many practitioners may not be aware of this association, so you may need to advocate for yourself. If your ovaries were removed, you should already be on HRT (including testosterone, ideally), but many women are not offered testosterone even after oophorectomy.
What to emphasise: Post-hysterectomy women have a specific and well-documented risk of accelerated ovarian decline and low testosterone. Your clinical situation is not the same as a woman moving through natural menopause, and the urgency of testing and treatment is arguably greater. If your practitioner is dismissive, this is a legitimate reason to seek a second opinion.
Additional context for your appointment: If you are in your late thirties or forties and noticing changes, the perimenopausal transition is the most likely context. Testosterone begins declining from around age 30, well before periods stop. If you have PCOS, thyroid issues, or have been on hormonal contraception for a long period, mention these specifically, as all of them can affect testosterone levels and SHBG. If you are over 45 and still having periods but experiencing symptoms, do not let anyone tell you that you "cannot be perimenopausal" because you are still menstruating. Perimenopause can last years while periods continue.
What to emphasise: You do not need to be postmenopausal to have low testosterone. If your symptoms are consistent and your testing supports it, treatment should be considered regardless of where you are in the menopausal transition.
In the UK: Start with your GP. If they are unable to help, request a referral to an NHS menopause clinic (availability varies by area) or an endocrinologist. The British Menopause Society maintains a register of specialists with a special interest in menopause (available on their website). Private menopause clinics are another option, though costs for initial consultations typically range from £200 to £400, with follow-up appointments and blood tests on top. Newson Health, The Marion Gluck Clinic, and The London Hormone Clinic are among the better-known private options, but there are many others across the country.
In the United States: Endocrinologists, gynaecologists, and integrative medicine practitioners are generally more willing to test and treat low testosterone in women. Compounding pharmacies can prepare custom formulations. The North American Menopause Society (NAMS) has a practitioner directory that can help you find a menopause-certified clinician in your area. Insurance coverage for testing is generally good; coverage for compounded testosterone varies by plan.
In South Africa: Access is more limited. Endocrinologists in private practice are your best route. The South African Menopause Society can provide guidance, though practitioner availability outside major cities is limited. Testing is generally accessible through private pathology laboratories like Lancet and Ampath.
In the UAE and other countries: If you are in the UAE, endocrinologists and gynaecologists in private healthcare settings can generally test comprehensively and are often willing to prescribe. In Southeast Asia, prescribing practices vary by country but can be more flexible. Wherever you are, look for a practitioner who specifically mentions testosterone, androgen health, or comprehensive hormonal health in their profile, not just menopause or HRT in general terms.
This is important, because it happens often.
If you see a doctor and are told that your levels are "normal" despite significant symptoms, or that testosterone is not something they prescribe for women, or that your symptoms are "just ageing," you have every right to seek a second opinion.
You can request a referral, you can see a different GP within your practice, you can ask to be referred to a specialist.
Write a letter or email to your GP summarising your symptoms, the tests you would like, and the clinical rationale (you can reference the British Menopause Society's position statement on testosterone for women, which supports the use of testosterone in women with low levels and relevant symptoms).
Be persistent, but do not be discouraged. The medical system's gaps are not your fault, and advocating for yourself is not being difficult. It is being informed.
This article reflects my personal experience and is intended for general information and awareness. It is not medical advice.
Always consult a qualified healthcare professional for guidance on testing, diagnosis, and treatment. If you believe you may be experiencing low testosterone, please seek support from a menopause specialist or endocrinologist.
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