Everybody’s talking about…..testosterone for women
You may have heard people talking about testosterone as the ‘third hormone in HRT’ (along with oestrogen and progesterone). You may also have heard that replacement can revitalise your sex-life, or even improve brain health – but what are the facts? How can testosterone help you? What are the risks? If you think it might be right for you, what’s the best way to get advice or treatment? In this article, we distil advice from international experts along with best practice from the UK and abroad to answer your questions.
Why might I consider taking testosterone as part of my hormone replacement therapy?
Studies of testosterone in menopausal women have shown that boosting it to pre-menopausal levels can increase sexual desire and satisfaction. As a result, it is a recognised, evidence-based treatment for low sexual desire which results in distress in women around the time of the menopause, medically termed ‘hypoactive sexual desire disorder’. In addition, the evidence strongly supports a benefit for younger women who go through menopause early or have to have surgery to remove their ovaries.
You may have heard that testosterone can help with other issues that can be really problematic for many women around menopause including brain-fog, reduced motivation, and stamina. While this has not been proven in scientific studies, many practicing specialists – and women themselves – say they notice a difference.
I thought testosterone was a male hormone?
Testosterone is often considered the ‘male hormone’ however it is also present in women and in greater concentrations than oestrogen or progesterone. Testosterone and other ‘androgens’ are made in the ovaries, adrenal glands and the fat stores of the body.
What happens to testosterone levels at the menopause?
Testosterone levels don’t drop suddenly during the menopause, they decline slowly from around the age of 30. By a woman’s mid-40s they are about half the level they were in her mid 20s. However, surgical menopause (caused by surgery to remove the ovaries) will cause a sudden drop in testosterone levels as this important source of the hormone is taken away.
So does low testosterone cause a lack of interest in sex?
It’s not quite as simple as that. Sexual desire is complex with emotional and psychological factors as much a part as physical factors. NICE recommends women considering treatment for low sexual desire have a holistic discussion with their doctor assessing the impact of all the influences.
It is worth noting that taking oestrogen by mouth as in the oral contraceptive pill or tablet HRT can significantly interfere with testosterone production by the ovary. Women experiencing low libido should speak to a doctor about alternative methods of hormone delivery (such as through the skin) if this is the case.
What do women say about sex and the menopause?
Many women report changes to their desire and experience of sex associated with mid-life. For some, it’s a positive experience of liberation that comes from age and confidence. For others, sex declines but this is not source of personal or relational stress. However, many more women report difficulties that can include a loss of interest in sex, an ability to stay aroused or new difficulty achieving orgasm. Sexual problems at this time can also be caused by vaginal dryness leading to pain during intercourse, relationship difficulties or problems affecting the partner.
If you’re struggling with your sex-life for any reason, you are certainly not alone. Many people still find it difficult to talk openly about sex but at One Woman Health we are here for you, to understand what’s happening for you and to help you navigate a way forward.
How do I take testosterone therapy?
Testosterone is usually prescribed as a gel which comes in a sachet or a tube. A tiny amount is rubbed onto the skin of the outer thigh each day. Experts advise avoiding the inner thigh, as the extra heat, particularly at night, can increase its absorption.
It is recommended that women taking testosterone therapy have their blood levels tested, at least every 6-12 months, to ensure they stay within the female range.
Are there any side effects for women taking testosterone?
Taking testosterone as a gel or cream applied to the skin is generally very safe and has few reported side effects. There can be increased hair growth at the site of application, but this can be minimized by using the gel in areas with low numbers of hair follicles, for example, the outer thigh, and rotating the site of application. A few women have reported skin changes such as acne, as androgens are known to affect the skin. Serious effects such as voice changes or facial hair growth, have not been reported in the studies of testosterone in women used at appropriate doses. Your doctor will want to monitor your response to treatment and blood levels to ensure they stay within the female range.
Can I have testosterone alone?
The British Menopause Society recommends that Testosterone is usually given once a woman is settled on the optimum dose of oestrogen (+/- progesterone) for her. Replacing the oestrogen after menopause can also improve libido and general wellbeing, which may improve a woman’s sex-life without additional testosterone. Oestrogen is a licensed treatment for women with a body of evidence about the risks and health benefits.
What else do I need to know?
- It can take 3-6 months for women to notice an effect, so it’s worth trialling for a period of time before reassessing the benefit. If you don’t find it helpful, it should be stopped.
- Some women report improvements in concentration or muscle strength with testosterone but the studies that have looked at this have not shown a convincing effect.
- In the UK, as there is no product that has been licensed for use in women. This means we either have to use licensed products imported specially from other countries e.g. Androfeme 1, licensed in Western Australia. Alternatively, menopause specialists and doctors with experience in the use of testosterone in women are able to prescribe formulations designed for men in lower doses. This is‘off-license’. Not all doctors will feel able to do this and that’s OK. Hopefully they will explain why and if possible, advise you in finding an alternative source of help.
If you’re struggling with sex in mid-life, talk to us at One Woman Health. Your doctor will listen to how this is impacting on your and your partner and explore the causes as well as the things that may help.
For further reading around relationships and sex, I recommend taking a look at the work of Esther Perel. A psychologist, she has devoted her career to understanding what ‘brings us alive’ in life. This has led her to study the paradox that exists in our most important and intimate relationships: balancing our need for excitement with our need for security.