Low Libido and Testosterone in Women: What a Blood Test Can Actually Tell You
- Dr James Coleman
- 3 days ago
- 8 min read
Low sex drive is very common and many women suffer in silence. They might think it's stress, or just getting older, or something they should learn to accept. Sometimes those explanations are worth exploring. But sometimes there's a hormonal picture worth looking at, and testosterone can be part of the picture, particularly around and after menopause.
This isn't a fringe idea. It's supported by NICE guidance, the British Menopause Society, and a growing body of clinical trial evidence. And yet most women have no idea they even produce testosterone, let alone that it might be relevant to how they're feeling.
The strongest evidence for testosterone in women is in postmenopausal women with persistently low sexual desire that causes distress, especially when HRT alone has not been enough. Evidence in premenopausal women is limited.
Testosterone isn't just a male hormone
Women produce testosterone throughout their lives. It's made primarily in the ovaries and adrenal glands. Its clearest evidence-based role is in sexual desire. The evidence for effects on mood, energy, cognition, and general wellbeing is less well established, and the biology is more complicated than is often suggested.
Women's testosterone levels are much lower than men's (roughly a tenth of the concentration), but that doesn't mean they're unimportant. And as those levels fall with age, the effects can be felt in ways that don't obviously connect back to hormones.
How testosterone falls over time
Testosterone levels in women generally decline with age from early adulthood. By midlife they are often meaningfully lower than in the 20s [Davison SL et al., JCEM, 2005].
Natural menopause does not appear to cause the same sharp independent fall in testosterone that is seen with oestrogen. The postmenopausal ovary continues to produce some testosterone. However, broader hormonal changes around midlife, including oestrogen fluctuation and the ageing of the adrenal glands, can still affect symptoms and treatment response.
Oral oestrogen adds a further layer to this. Oral oestrogen (taken as tablets) raises sex hormone binding globulin (SHBG), which binds to testosterone and reduces the proportion that is freely available to tissues. Women who take oral HRT may have less testosterone available to tissues than their total level suggests. Switching from oral to transdermal oestrogen (gel, patch, or spray) may improve this [Cagnacci A, et al, 2002].
When and how to get tested
Testosterone samples are often taken in the morning, particularly when checking a baseline or monitoring treatment, and any specific instructions from the requesting clinician or laboratory should be followed [Gibbons, S, M. et al., BJGP, 2025].
If you're already using transdermal testosterone gel, the timing of your blood draw matters. Taking your sample after applying the gel can give a falsely elevated result. Always follow any specific instructions from the clinician or laboratory requesting the test, as protocols can vary between services.
Where monitoring is needed, blood levels should be kept within the normal physiological female range using the local laboratory's own reference range. The BMS recommends that baseline levels and follow-up results are interpreted in that context rather than against a single universal threshold, because reference ranges vary between labs [BMS, 2026; Gibbons, S, M. et al., BJGP, 2025].
What low testosterone can feel like
The symptom most clearly linked to falling testosterone is hypoactive sexual desire disorder (HSDD), a persistent, distressing reduction in sexual desire. The evidence for testosterone in other symptoms such as fatigue, mood, and concentration is less well established. The British Menopause Society's guidance specifically supports testosterone for HSDD rather than as a general energy or mood treatment [BMS, 2026].
HSDD refers to a persistent loss of sexual desire that causes personal distress. It's the distress component that separates a clinical disorder from a normal variation in libido. The condition peaks in occurrence in women aged 45 to 64 [Shifren JL et al., Obstet Gynecol, 2008].
Specific symptoms can include:
Reduced or absent sexual desire that feels different from your usual baseline
Decreased sexual arousal and difficulty reaching orgasm
A sense that intimacy requires effort rather than being something you want
Low mood and fatigue, though these overlap with many other conditions and should prompt a broader investigation
What the blood test tells you, and what it doesn't
A total testosterone level should not be used to diagnose HSDD. This is a firm position in the major clinical guidelines. There's no threshold that reliably predicts who will or won't have low libido. The relationship between circulating testosterone and sexual desire is more complex than a single number can capture [ISSWSH, Parish SJ et al., J Sex Med, 2021].
Many women with low circulating testosterone report no relevant symptoms. And some women with HSDD have levels within the normal range. How individual cells process and use testosterone locally, including within brain tissue, may matter more than the amount floating freely in the bloodstream [International Menopause Society, 2022].
Testing still serves two important purposes.
First, a baseline result before any treatment is started gives you something to compare against. The British Menopause Society recommends checking total testosterone before starting therapy, then again at 3 to 6 weeks, and subsequently every 6 to 12 months, to ensure levels stay within the physiological female range [BMS, 2026].
Second, testing helps rule out other causes of the same symptom cluster. Thyroid dysfunction, iron deficiency, low vitamin B12, and anaemia can all produce fatigue, low mood, and reduced libido. A good hormone and nutrient screen will flag these before anyone assumes testosterone is the answer.
What the guidelines say
The 2024 NICE menopause guidelines (NG23, updated) state that testosterone should be considered for menopausal women with low sexual desire when HRT alone has not been effective [NICE, NG23, 2024].
That wording matters. NICE uses 'offer' when evidence supports near-universal benefit; 'consider' reflects a likely but variable response. In the UK, testosterone prescribing for women has historically relied on off-label use of male-formulated products or imported preparations. The regulatory position is now evolving: the BMS notes that AndroFeme has been granted UK marketing authorisation by the MHRA, with pump-pack availability anticipated in 2026 [BMS, 2026].
Short- to medium-term trial data have not shown a clear increase in the risk of breast cancer, cardiovascular disease, or venous thromboembolism when testosterone is used transdermally at physiological female doses [BMS, 2026; Parish SJ et al., J Sex Med, 2021]. Robust long-term safety data beyond two years of use are not yet available, and trials generally excluded women at high cardiometabolic risk or with a history of hormone-sensitive breast cancer.
The largest trial of testosterone for HSDD in postmenopausal women not taking oestrogen, the APHRODITE study (814 participants, 52-week trial), found that at 24 weeks women receiving transdermal testosterone experienced a net increase of approximately 1.4 satisfying sexual events per 4-week period compared with placebo (2.1 events from baseline in the treatment group versus 0.7 in the placebo group). The effect was real but modest, and it took 8 to 12 weeks to become clinically apparent in most women [Davis SR et al., N Engl J Med, 2008].
When to see your GP
A blood test is a starting point, not an endpoint. If your results suggest a hormonal or nutritional picture worth treating, you'll need a prescribing clinician to assess your full clinical picture, including symptoms, duration, and any psychological or relationship factors that may be contributing.
A normal testosterone level does not rule out HSDD, and a low level does not diagnose it. The blood test is one input among several that a clinician will consider.
NICE guidance recommends a bio-psycho-social approach to low sexual desire, meaning hormones are one part of the assessment, not the whole of it. If there are relationship difficulties, significant stress, or symptoms of depression, these should be addressed alongside any hormonal investigation.
Access to testosterone for women on the NHS varies across England. Some areas prescribe via GP with specialist input; others require a menopause clinic referral. Your GP is the right first port of call.
How Brooksby Medical can help
At Brooksby Medical, every result is reviewed by Dr James Coleman, a practising GP. That means you receive more than a lab value. You receive a clear clinical interpretation of what the result may mean, how relevant it is to your symptoms, and whether anything further should be considered.
If low sexual desire is the concern, blood testing can be a useful starting point, but it is only one part of the assessment. Testosterone testing is most useful for establishing a baseline and supporting wider clinical decision-making, particularly in women around or after menopause.
In many cases, it is also important to look beyond testosterone alone. Thyroid dysfunction, iron deficiency, low vitamin B12, and anaemia can all overlap with symptoms such as fatigue, low mood, and reduced sexual desire. A broader view is often more clinically useful than a single hormone result in isolation.
Relevant options include:
A focused baseline testosterone check for women being assessed for distressing low sexual desire, particularly around or after menopause. Best used as part of a broader clinical picture, not as a diagnostic test in isolation.
Includes FSH, LH, oestradiol, and testosterone. While many women aged 45 and over with typical menopausal symptoms do not need blood tests to identify menopause, this panel can be helpful in selected situations such as diagnostic uncertainty, younger women with symptoms, suspected early menopause, or where hormone testing has been advised by a clinician.
A broader hormonal screen combining a full thyroid panel with key sex hormones. Useful where symptoms such as low libido, fatigue, or low mood may have more than one explanation, and where ruling out common medical contributors matters before focusing too narrowly on testosterone.
If your results show a pattern worth discussing, Brooksby Medical provides GP-led interpretation to help you understand what the numbers may mean and what the next step should be.
References
NICE. Menopause: identification and management. NG23 (updated 2024). https://www.nice.org.uk/guidance/ng23
Parish SJ, Simon JA, Davis SR, et al. ISSWSH Clinical Practice Guideline for the Use of Systemic Testosterone for HSDD in Women. J Sex Med. 2021;18:849-867
Gibbons, S, M., et al. Optimising testosterone therapy in patients with HSDD. BJGP. 2025;75(753):189-190
Cagnacci A, et al. Long-term effects of continuous oral and transdermal estrogen replacement therapy on sex hormone binding globulin and free testosterone levels. Eur J Obstet Gynecol Reprod Biol. 2002;101(2):154-158. PubMed: https://pubmed.ncbi.nlm.nih.gov/11788176/
Davis SR, et al. Testosterone for low libido in postmenopausal women not taking estrogen (APHRODITE). N Engl J Med. 2008;359(19):2005-2017
Davison SL, et al. Androgen levels in adult females: changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab. 2005;90(7):3847-53
British Menopause Society. Tool for Clinicians: Testosterone replacement in menopause. Updated 2026. https://thebms.org.uk/publications/tools-for-clinicians/testosterone/
International Menopause Society. Testosterone for women with HSDD: where are we now? 2022. https://www.imsociety.org/2022/02/16/testosterone-for-women-with-hypoactive-sexual-desire-disorder-where-are-we-now/
North American Menopause Society. Testosterone use for hypoactive sexual desire disorder. NAMS Practice Pearl. 2023. https://journals.lww.com/menopausejour
nal/Abstract/2023/07000/Testosterone_use_for_hypoactive_sexual_desire.14.aspx
Shifren JL, Monz BU, Russo PA, et al. Sexual problems and distress in United States women: prevalence and correlates (PRESIDE). Obstet Gynecol. 2008;112(5):970-978
Written by Dr James Coleman, GP and founder of Brooksby Medical. Dr Coleman is a practising General Practitioner who founded Brooksby Medical to give patients direct access to the blood tests and clinical interpretation they need, without waiting lists.
Medically reviewed: March 2026 | Next review due: March 2027
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Blood test results should always be interpreted by a qualified healthcare professional in the context of your individual symptoms, medical history, and clinical picture. If you have concerns about your health, please consult your GP.
