Testosterone HRT for women on the NHS, how to get it

What NG23 says about testosterone

NHS guideline NG23: Menopause: diagnosis and management (updated November 2024) includes testosterone in its recommendations:

• For women with low sexual desire despite optimised HRT, NG23 says consider testosterone.
• The evidence review found that testosterone improved sexual desire, arousal, and orgasm frequency in menopausal women.
• NG23 recommends this be initiated by a specialist — usually an NHS menopause clinic — with ongoing shared care from the GP.

This is an explicit, guideline-backed recommendation. A GP who refuses to engage with the possibility — or who refuses shared care after a specialist initiates — is going against NG23.

Why it is unlicensed

Testosterone is licensed in the UK for men with testosterone deficiency. No pharmaceutical company has sought a specific licence for testosterone in women — not because it is unsafe, but because the market is smaller and the regulatory process expensive.

"Unlicensed" does not mean "experimental" or "prohibited." It means the Medicines and Healthcare products Regulatory Agency (MHRA) has not evaluated it specifically for women. Off-label prescribing is legal, common, and NHS-endorsed when supported by guidelines like NG23.

Other commonly used unlicensed medicines in the NHS include: melatonin for sleep in children, amitriptyline for neuropathic pain, and gabapentin for hot flushes.

What the NHS actually prescribes

The standard NHS approach:

• Testogel — a male testosterone gel, sachet or pump. For women, the dose is approximately 0.5–1% of the male daily dose, applied to the thigh or lower abdomen.
• AndroFeme — a testosterone cream specifically formulated for women. Not universally available on the NHS; some clinics use it, others use Testogel.
• Compounded testosterone cream — made by specialist pharmacies. Not standard NHS practice and not recommended by NG23.

Your menopause clinic will choose the product based on availability, your preference, and local prescribing arrangements.

Why most GPs won't prescribe it

There are several reasons GPs hesitate:

• Licensing. GPs are trained to prescribe within licence. Prescribing an unlicensed medicine feels risky, even when guideline-backed.
• Lack of familiarity. Most GPs have never prescribed testosterone for women and do not know the dosing.
• Monitoring uncertainty. GPs may be unsure what blood tests to order or how often.
• Practice policy. Some practices have internal policies against initiating unlicensed medicines.

These are all surmountable. A clear shared care letter from a menopause clinic specifying product, dose, and monitoring removes most of the uncertainty.

How menopause clinics handle it

NHS menopause clinics are the standard route for testosterone initiation:

• They review your HRT to confirm it is optimised.
• They assess your symptoms and rule out other causes of low libido (relationship issues, depression, medication side effects).
• They check baseline testosterone and exclude contraindications (androgen-dependent cancer, severe liver disease).
• They start at a low dose and titrate based on symptom response and blood levels.
• They write to your GP with a shared care plan for ongoing prescribing and monitoring.

If your local clinic has a long wait, Right to Choose lets you pick any NHS-funded provider in England.

Safety and monitoring

At the low doses used for women, testosterone is generally safe. Monitoring includes:

• Baseline testosterone level (total or free).
• Review at 3–6 months with symptom check and repeat testosterone level.
• Ongoing annual monitoring — testosterone, lipids, liver function, haematocrit.
• Watch for acne, increased facial hair, voice change, or mood shifts. These are dose-dependent and reversible on stopping.

Voice deepening is rare at correct doses but may not fully reverse if it occurs — this is why starting low and monitoring is important.

Frequently asked questions