Testosterone during the Menopause

Testosterone deficiency symptoms

Levels of testosterone in your body gradually reduce as you become older. Your ovaries produce the majority of testosterone in your body but it is also produced by the adrenal glands.

When you are in menopause even if you take Hormone Replacement Therapy (HRT), you may still have the symptoms of lack of testosterone such as lack of libido and when you do have sex it is not as pleasurable as it used to be even though you desire your partner. This can be down to the following:- lack of energy, increased tiredness, difficulty concentrating, depressed mood, muscle weakness or headaches.

However, Testosterone’s abilities to strengthen bones, improve muscle strength, or live up to its other proposed benefits—which include better mental function and mood—are unproven in women.

What is Testosterone?

Testosterone is one of the sex hormones that women produce. Many people think of it as the “male hormone”, but women need to have it too. In fact, women produce three times as much testosterone than oestrogen before the menopause.

How is testosterone treatment given?

Testosterone preparations are not approved by the Food and Drug Administration (FDA) for use in women. So if it is prescribed, it’s for off-label use (used for a different purpose than the one originally intended for).

However, in the NHS Testosterone is usually given as a gel, which you rub into your skin. It comes as a gel in a small sachet and you only need to rub a pea- size amount of this gel into your skin. One 50mg sachet should last around 10 days. It should be rubbed onto your lower abdomen or your thighs.

Testosterone may be given to some women as an implant, but in the UK, these are not easily available.

Privately, you may be given a type of testosterone which is not generally available on the NHS but is licenced in Australia for women. This is called AndroFeme 1. This comes with a measure and is used daily. It is only available on special order and a private prescription. This costs approximately £80 per tube which should last about 4–6 months.

Testosterone medication can take several months to work and it is not effective for every woman. A 3–6-month trial is often recommended.

Blood test monitoring is not essential but can be useful to identify levels of Testosterone in the body.

Side effects

Side effects are highly variable. This is most likely due to absorption rates, metabolism and sensitivity to testosterone. However, the most reported adverse effects are:

Increased body hair at the site of application (occasional problem) – spread more thinly, vary the site of application, reduce the dosage.
Generalised *Hirsutism (uncommon)
Alopecia, male pattern hair loss (uncommon)
Acne and greasy skin (uncommon)
Deepening of voice (rare)
Enlarged clitoris (rare)

* Hirsutism is a condition in women that results in excessive growth of dark or coarse hair in a male-like pattern — face, chest and back. With hirsutism, extra hair growth often arises from excess male hormones (androgens), primarily testosterone.

Interesting opinion by Dr Rebecca F Dunsmoor-Su MD MSCE – Obstetrician Gynaecologist

“Testosterone is an anabolic steroid, so will make you feel good and energetic at first, but probably does more harm than good for most women. There is minimal evidence for low dose regimens (brief) for hypoactive sexual desire disorder, but the effect doesn’t last. We see lots of testosterone used, off label, and I see a lot of endometrial cancers and masculinisation as a result.

Fundamentally if you understand women’s desire cycles and the **Basson model** you’ll know there is no magic sex pill for women. We are more complicated than that!”

** The Basson model clarifies that the goal of sexual activity for women is not necessarily orgasm but rather personal satisfaction, which can manifest as physical satisfaction (orgasm) and/or emotional satisfaction (a feeling of intimacy and connection with a partner).

Resources:

https://thebms.org.uk/publications/tools-for-clinicians/

https://www.healthline.com/health/

https://www.womens-health-concern.org/