What do we Want? Testosterone!

Flagging libido? Brain fog? Low energy? We’re guessing a lot of you are nodding right now. Testosterone could be the answer. Our doctors explain why.

Are you one of the third of women whose libido fell off a cliff when she reached menopause? Or perhaps it’s slipped away without you noticing?

Although testosterone isn’t usually prescribed as a normal part of HRT, experts think it’s the answer for at least some women whose libido has flatlined. A global position statement from the International Menopause Society (IMS), after an investigation by experts, says that giving testosterone does help women rediscover their sexual desire after menopause.

This is not a small issue; 31 per cent of women experience a drop in desire (the medical name for this is hypoactive sexual desire dysfunction, or HSDD). If you haven’t got the energy or desire to have sex, you may be relieved to know you’re not alone. This is a hugely important issue too: women can really miss their sexual selves, it’s a huge part of the joy of life.

At the moment, HSDD almost always goes untreated, not least because most GPs don’t know about testosterone as a treatment, and there’s no product formulated for women in the UK. Until recently, almost all the testosterone being prescribed has been given to women at specialist menopause clinics on the NHS and private clinics, rather than the GP.

Hopefully, now the IMS has come out in favour of the treatment, as has the British Menopause Society, more women will be able to get the prescription they need. 

Here, Dr Stephanie Goodwin and Dr Louise Newson answer the questions about testosterone that come up the most often in consultations.

Isn’t testosterone a male hormone?

It’s best known as male hormone but in fact it’s vital for women, too. You make it in your ovaries and your adrenal glands. As you get older, levels decline naturally. Then, after the menopause, levels can drop to almost nothing. “To a certain extent, it’s been forgotten about,” says Dr Newson. “Doctors haven’t been taught about it. Now the evidence is clear that it can help some women.”

What does testosterone do?

Having enough testosterone is important for bone strength, urogenital health, mood and thinking. But what it’s mainly being prescribed for is low libido and for women who find it less easy to become aroused and orgasm.

How do I know if I need testosterone supplementation?

If you’ve tried regular HRT (oestrogen and progesterone), but not all your symptoms have gone away, that’s when a doctor will think about testosterone, says Dr Newson. The main indications are: you don’t want to have sex, you find it hard to get aroused or to orgasm. “But it’s also useful for women who feel tired, depressed, get headaches or have brain fog,” she says. “When they start taking it, women often tell me they feel improvements in their concentration levels, memory, joint pain, sleep and a drop in anxiety.”

Dr Goodwin has seen similar effects. “A lot of women say they feel more energised, they can focus and concentrate better, that their joie de vivre is back,” she says. “It gives a sense of wellbeing, and enhances the effect of other hormones too.”

What happens next?

You’ll be given a blood test before it’s prescribed. This is not to diagnose if you need testosterone – women’s levels naturally vary – but to make sure your levels aren’t too high when you have a second blood test three to six months after starting treatment. 

The medicine comes as a cream that you apply to somewhere hairless, eg your lower abdomen or upper thighs, then allow to dry. Don’t always apply it in the same place because there’s a very slight chance it can make you more hairy at the site of application. There isn’t a lot of long-term data showing other effects in women using testosterone but there is five-year safety data, which is why the IMS are happy to recommend it.

What is the proof it works?

In clinical trials of women with low sexual desire, two thirds of women found theirs improved after taking testosterone. It takes from two to three months to take effect. “Women notice the difference from taking oestrogen and progesterone quickly – in relieving hot flushes and poor sleep, for example,” says Dr Goodwin. “But the return of your libido and energy can be a slower, up to three to six months.”

How do I get testosterone prescribed?

In theory, your GP should be able to prescribe it. In practise, there are no products that are licensed for use on women in the UK. So your GP may be unhappy to prescribe it off licence. Or it may not be on the list of products their practice is allowed to prescribe.

That leaves two options that can be prescribed off label in the UK. The first is a gel that’s been formulated for men, usually Tostran. Some women find it tricky to use, as you have to use a tiny amount, half a pea in size – much less than men. The second, a cream that’s only available on private prescription, is an Australian product which has been made for women, called AndroFeme 1. “Hopefully, a female strength product will be licensed in the UK soon,” says Dr Goodwin.

Read more from Dr Stephanie Goodwin and find out about her clinic, at drstephaniegoodwin.co.uk. Find out more about Dr Louise Newson and the Newson Health Menopause and Wellbeing Centre at menopausedoctor.co.uk

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