You have given it a fair run, three months or more, applied it properly, and nothing has changed. That is a real and reasonably common outcome, and it is not a verdict on you. What matters now is that it gets reviewed properly rather than quietly continued, because staying on something that is not working has a cost of its own.
First: was it a fair trial?
- •Long enough. Three months from the current dose, not from the first prescription, if the dose changed along the way.
- •Applied consistently, to the right place, without the gaps that are easy to under-report.
- •With oestrogen optimised underneath it, since testosterone is not designed to compensate for that.
- •Against the right target. Desire, rather than energy or mood, which were never the likely wins.
If one of those was off, this may be a trial that has not happened yet rather than one that failed.
What a review looks at
A repeat blood test, to see whether levels actually moved and where they sit. Then the alternatives, again, with the benefit of what the last three months have shown: sleep, thyroid, iron, medication, pain, mood and life circumstances. Something that was ruled out at the start deserves a second look once a hormonal explanation has been tested and come back negative.
The possibilities, honestly
- •Levels never rose. Absorption varies, and this is fixable.
- •Levels rose and nothing changed, which is the genuinely informative result: testosterone was probably not the answer here.
- •Something else was always the driver, and it is now easier to see.
- •The problem is pain rather than desire, in which case a different treatment is the right one.
Stopping is a legitimate outcome
This is worth saying plainly, because it rarely gets said. If a properly conducted trial has not helped, stopping is the correct clinical decision rather than a failure or a giving-up. You keep the information: you now know one explanation has been tested. Continuing indefinitely because stopping feels like defeat means paying for, applying and being monitored for something that is doing nothing.
What often comes next
- •Revisiting HRT itself: dose, route or type, which is a much bigger lever than most people expect. See HRT not working.
- •Treating vaginal and urinary symptoms directly, which changes desire by removing pain.
- •Sleep, properly addressed rather than mentioned.
- •A frank look at medication, since some common prescriptions suppress desire.
How Solene fits
A review is part of the plan rather than another appointment to pay for, and we would rather stop something that is not working than keep billing you for it. See what is included.
Treatment not doing what you hoped?
Map your symptoms in under 10 minutes and get free, personalised advice, then talk to a nurse prescriber if you want to.
Frequently asked questions
How long before I can say testosterone has not worked?
At least three months from the current dose, applied consistently, with oestrogen already optimised. Earlier than that is usually too early to tell.
Should I just increase the dose?
That is a decision for your prescriber alongside a blood test. The aim is to stay within the range intended for women, so more is not automatically better.
Is stopping a failure?
No. If a fair trial has not helped, stopping is the correct decision, and you have ruled out one explanation in the process.
What else could explain low desire?
Sleep, thyroid function, iron, medication, pain from vaginal dryness, low mood and life circumstances are all common and all treatable.
