Testosterone and menopause: Everything you need to know

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:

• metabolism;
• muscle and bone strength;
• mood;
• 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 20^th 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.

None.

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;
• acne;
• 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

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