Testosterone and menopause has been filling my Twitter feed and DMs this week. Because testosterone for menopause isn’t available for women on the NHS, I hadn’t planned on covering it in my round-up of hormones, but the discussion made me think again – mainly because more of us should be shouting for it.
I was advised to take testosterone when I appeared on the BBC’s Health: Truth or Scare. But despite being advised it by Mr Haitha Hamoda – now the head of the British Menopause Society – the first doctor I saw at my surgery knew next-to-nothing about it and then my own doctor called to tell me it wouldn’t happen.
“These specialists have leftfield ideas,” he said, making me feel stupid for suggesting it.
Why do we have to put up with this?
Anyway, if you’re wondering why women need testosterone, here’s my jargon-free guide. And if you want to read about the other menopause hormones, this is my guide to oestrogen and here’s everything you need to know about progesterone.
What is testosterone?
Testosterone is an androgen – a sex hormone that makes men “male”. And that means? Well, androgens are chemical messengers that control the male reproductive system, as well as being responsible for the likes of facial hair, Adam’s apple, hairy chests and deeper voice.
Testosterone is the primary androgen and it controls the start of puberty, sex drive and sperm production, among others.
So why are you writing about testosterone for women?
Well, because it’s an important hormone for us, too, but we have it in much smaller quantities. In women, it contributes to our:
- sex drive;
- ability to be aroused,
- and our orgasms.
It also helps our:
- muscle and bone strength;
- thinking and reasoning skills,
- and our urinary system and reproductive organs.
A healthy woman produces around 100-400mcg a day – around a tenth to a 20th of the amount a man makes, and is produced in the ovaries, adrenal glands (on top of your kidneys) and fat and skin cells.
What happens in menopause?
As we age, the amount of testosterone we create starts to fall. It’s not the dramatic decline of oestrogen and progesterone that comes with menopause, but a gradual process. Some women will not notice anything.
However, for others, by the time they menopause, when they also have the impact of falling oestrogen and progesterone, the drop in testosterone can cause:
- a lack of energy;
- muscle weakness;
- fatigue and tiredness;
- sleep problems;
- lower sex drive;
- lower sexual satisfaction;
- weight gain,
- and vaginal dryness.
The reduction could also hit bone density – check out my article on menopause and bone loss for why this is important.
There can be other causes behind these symptoms, so please get them checked out with your GP if you feel this way.
Mr Hamoda recommended testosterone because I was so fatigued. Some days, even my fingers felt exhausted. But hand on heart, my old sex drive has certainly taken a whack, too, I was just too embarrassed to say it at the time.
What treatment is available for testosterone in menopause?
Sit down. Please.
Well, that’s not 100% true. Private clinics will prescribe it, but there are no testosterone products for female use licensed in the UK. Despite this, the NICE guidelines, which are the recommendations about what healthcare should be given, say that in menopause, it can be considered if a woman needs it.
That means if your GP is willing to prescribe it for you, they’ll have to do it “off-label”, giving you testosterone that’s used to treat something else. It is safe as it will have undergone clinical trials, just not for your particular treatment.
Testosterone used to be available for women suffering with their sex drive on certain types of HRT following a surgical menopause (I’ve written here about all the different forms of menopause if you’re confused what that means). But it also proved effective for natural menopause and with other forms of HRT.
It was taken off the NHS for commercial reasons – the bean counters didn’t think it worth it. So when you’re feeling flat-out exhausted and your GP thinks testosterone is a “leftfield idea”, shout at the accountants. I did. And my GP. When I got off the phone, that is.
So that’s it?
No. Your NHS GP may be open to giving you testosterone or as I said, private menopause clinics will prescribe it for you. You can get gels or creams or – and this is highly unlikely on the NHS – implants.
You apply the gel or cream on your lower abdomen or your inner thighs and that’s it. It can take eight to 12 weeks for the effects to be felt.
Not everyone can use testosterone, however. It’s to be avoided if you are
- pregnant or breastfeeding;
- have acute liver disease;
- have a history of hormone-sensitive breast cancer, although there are exceptions so check;
- an athlete (your testosterone has to fall within certain limits),
- and have high testosterone levels anyway.
Are there any side-effects?
A few, but they’re usually quite rare as the dosage you’ll be given will be small. But they include:
- body hair growth;
- male pattern baldness;
- a deeper voice,
- and an enlarged clitoris.
However, these are all quite uncommon. Some women may find they grow hair where they actually rub the gel or cream in, but this will stop if you vary the area, spread the gel or cream thinner or reduce the dosage.
Have you tried to get testosterone? What happened? Let me know in the comments below. And don’t forget to subscribe for regular updates and to download your free guide to menopause and midlife
10 thoughts on “Testosterone and menopause: Everything you need to know”
I spoke to my GP about this & asked if it was available after doing lots of reading. She told me it wasn’t licensed in the UK to prescribe for women. I told her it wouldn’t be the last time I would be asking. When I have my 3 month review for HRT (which by the way has changed my life) I will be broaching the subject again.
That’s the attitude I like to hear! No, it’s not licensed – but NICE says it can be used!!!!! Go for it, Mags x
UPDATE: I have an appointment in two weeks with my local menopause clinic to discuss testosterone – I’ll let you know how it goes (been on the waiting list for about five months).
Oh I do think I’ll up my persistence in asking for it. Had the ‘No our NHS Trust doesn’t do it’, three times now. I’ve always had a high libido, energetic, ‘male’ in my thinking patterns and strong. I think the lack of testosterone has had a bigger effect than the lack of oestrogen in my menopause. Thanks for normalising these conversations
Be careful with T – you can metabolize it oddly. I had a low dose prescribed in a combination cream of estrogen, progesterone and testosterone. I had my hormone levels tested and my testosterone level was 10x what it should be, even at the lowest dose, equivalent to that of an adolescent male. Not what I was looking for! Also had fluid on inner ear resulting in vertigo which went away when I stopped.
Thanks Christine. An important message – and I’m glad your vertigo has gone x
This sounds like bio-identical hormone mix- not tested, licensed or approved for use in the U.K. you need body identical HRT. Progesterone cannot be created to effectively be absorbed from a cream- hence your balances wouldn’t be right. (I’ve read of this same problem from others. Also, triggered fibroids, bleeding etc). When prescribed correctly, your oestrogen level must be at a good level, before adding testosterone. Your progesterone needs to be delivered effectively- either from a tablet or patch. Your oestrogen transdermally- either patch, gel, spray. This will possibly explain the issues you had.
NHS GP in Scotland actually suggested I take Testosterone. After trying patches for a few weeks (did not go well!) then taking kliofem continuous combined HRT for 3 months many of my peri symptoms improved, but I was left with low mood, anxiety and no energy. I regularly ran 50 miles a week in 2018/2019, cycled, lifted weights and did gym and yoga classes but could barely climb the stairs to bed late 2020/ early 2021. GP asked about libido and when I said I had none I was prescribed Testogel. Been using it for 5 weeks. Mood and anxiety are much better, energy levels are getting there and I’m optimistic I’ll be back running soon. I haven’t had any side effects, so far…
If the GP hadn’t suggested testosterone I would have fought to get it as all the research I’d done up to that point indicated that it would help my debilitating fatigue.
I know HRT isn’t for everyone but it’s given me my life back and it seems that testosterone was the missing piece.
That’s such a lovely post to wake up to, Gill. Thank you for sharing. This will help so many women xxx
I’m hoping to be prescribed testosterone through the menopause clinic next month.I had severe menopause symptoms,I am on HRT therapy.my symptoms are better controlled now but if I’m honest I still struggle with energy, low mood and fatigue.I was a very keen runner, running 1/2 marathons and running 8 Mike after work.I haven’t run for over a year and 1/2.I feel frustrated and sad that I worked so hard at keeping fit and not only has menopause taken away who I once was but it’s taken away the one thing I loved in life, my running.I still don’t feel right something is missing and I’m hoping it’s the testosterone I finally need.Good luck on your HRT journey I hope the day comes soon for you to throw on your running trainers on and get back out there.