Testosterone and POI

Testosterone and POI: What You Need to Know

When we talk about hormones in women’s health, oestrogen and progesterone often take centre stage. But there’s another hormone that plays an important role too: testosterone.

Most people think of testosterone as a “male hormone,” but women also make it — mainly from the ovaries and adrenal glands. In fact, it’s important for sexual desire, energy, muscle strength, and even mood.

For women with Primary Ovarian Insufficiency (POI) or early menopause, testosterone levels can fall earlier than expected because the ovaries stop producing it. This can add to the symptoms you already face, including low libido, fatigue, or loss of motivation.

What does testosterone actually do?

Research shows the clearest benefit of testosterone for women is in treating low sexual desire that is causing distress (called hypoactive sexual desire disorder, HSDD).

✅ It can help improve libido and sexual satisfaction if other causes (like vaginal dryness, pain, or relationship issues) have been addressed.

❌ There isn’t strong evidence that it consistently boosts energy, mood, memory, or overall wellbeing. Some women do feel these benefits, but the science isn’t conclusive yet.

Where does testosterone fit in HRT for POI?

The first step in POI treatment is always replacing oestrogen (and progesterone if you still have a womb). This protects your bones, heart, and long-term health until around the natural age of menopause (50–51).

If you’re still struggling with low sexual desire after that, adding a small amount of testosterone can be considered. It should always be done alongside your usual HRT, not instead of it.

How is it given?

There are no testosterone products for women licensed on the NHS, so doctors usually prescribe tiny doses of male gels or creams, adjusted to give female-level replacement.

Options include:

• Tostran® 2% gel – one pump every other day.

• Testim® 1% gel – about half a tube daily.

• Testogel® sachets – a small fraction of a sachet daily.

• AndroFeme® 1% cream (only available privately in the UK) – 0.5 mL daily.

These are rubbed into the skin (outer thigh, buttock, or lower abdomen) and absorbed slowly.

Safety and monitoring

The aim is to keep testosterone levels in the normal female range – never higher.

• A blood test is usually done before starting, then again at 2–3 months and every 6–12 months.

• If there’s no benefit by about 6 months, it’s usually stopped.

• Side effects can include mild acne or extra hair growth. At higher doses (if levels go too high), more serious effects like voice deepening or hair loss can occur — which is why regular monitoring is essential.

When used carefully at female doses, studies show it is generally safe. But because long-term data on heart and breast health is limited, doctors recommend reviewing it each year.

Testosterone and cognition

• Some studies suggest testosterone might influence parts of the brain involved in memory, focus, and spatial ability.

• However, clinical trials in women have not shown consistent benefits. A few small studies in postmenopausal women found slight improvements in verbal learning or memory, but others found no difference.

• The 2019 Global Consensus on Testosterone Therapy (endorsed by menopause and endocrine societies worldwide) concluded there is no strong evidence that testosterone improves cognition in women — whether in natural menopause or POI.

• Current guidance is: don’t prescribe testosterone specifically for memory or “brain fog” because we just don’t have proof it helps.

Testosterone and energy / fatigue

• Many women with POI or early menopause report fatigue and loss of vitality. Because testosterone plays a role in muscle strength and general metabolism, it’s reasonable to think low levels might contribute.

• But again, the research is mixed:

    ◦ A few trials in postmenopausal women suggested modest improvements in “energy” or “wellbeing” scores when testosterone was added.

     ◦ Larger studies haven’t been able to confirm this reliably.

• The consensus statements (BMS, Global Consensus, NICE) are clear: testosterone should not be prescribed for fatigue or low energy alone, because evidence is not strong enough.

Key points to remember:

• Women make testosterone too — it’s not just a “male hormone.”

• In POI/early menopause, testosterone may fall earlier than expected.

• The main proven use for women is improving low sexual desire that causes distress.

• It should only be added after oestrogen replacement is optimised.

• Regular monitoring is vital to keep levels safe and effective.

The Bottom line

If you’re living with POI and feel your libido has vanished, you’re not imagining it — hormones are part of the picture. Testosterone may be an option, but it’s not a one-size-fits-all solution. The best approach is a personalised discussion with a menopause or POI specialist who can guide you safely through whether a trial of testosterone could help.