Testosterone
Many women perceive testosterone as a hormone primarily associated with men. However, before menopause, women also naturally produce testosterone from their ovaries and adrenal glands, and it plays a crucial role in various aspects of female health, including sexual function, muscle and bone strength, cardiovascular health, cognitive function, and energy levels. Testosterone levels can decline gradually with age or drop suddenly if a woman undergoes surgical removal of her ovaries.
The 2015 NICE guideline NG23 supports the use of testosterone supplementation in women. Guidelines from the International Menopause Society endorse testosterone use in women who, despite adequate hormone replacement therapy (HRT), continue to experience symptoms of low libido, low sexual arousal, reduced desire, and decreased sexual satisfaction, causing distress (known as Hypoactive Sexual Desire Disorder).
It’s essential for all women to address symptoms of vaginal dryness before considering testosterone supplementation.
While current guidelines recommend testosterone supplementation primarily for persistent low libido in women, many users report more than just improved libido. They often experience enhanced muscle and bone strength, increased energy levels, improved cognitive function, mood, and concentration, reduced brain fog, and better sleep.
If you effectively manage other menopausal symptoms, have resolved issues related to vaginal dryness, but still suffer from low libido, low sexual arousal, diminished desire, and reduced sexual satisfaction, despite being in a supportive relationship, you may benefit from a trial of testosterone supplementation.
Libido can be influenced by various factors, including body image, partner relationship, work-related stress, and life events. Hypoactive Sexual Desire Disorder (HSDD) is diagnosed when a woman experiences a lack of interest in sex, absence of sexual thoughts, reluctance to initiate sex, reduced pleasure from sex, little interest in masturbation, and these symptoms persist for over six months. To evaluate your situation, consider the following:
Was your level of sexual desire or interest satisfying to you in the past?
- Have you noticed a decrease in your level of sexual desire or interest?
- Are you bothered by this decrease?
- Would you like to increase your sexual desire or interest?
Could factors such as surgery, depression, medical conditions, medications, pregnancy, childbirth, menopausal symptoms, other sexual issues, partner’s sexual problems, dissatisfaction with your relationship, stress, or fatigue be contributing to your reduced sexual desire or interest?
HSDD can be addressed in various ways, including reducing drug and alcohol consumption, dedicating quality time to connect with your partner and discuss personal needs, trying consensual sexual experimentation, and planning intimate moments. Seeking the help of a psychosexual counsellor can also be beneficial if connection is an issue.
HRT can provide relief as well. For women experiencing discomfort during sex, vaginal estrogen can restore vaginal health, making intercourse pain-free. A trial of testosterone supplementation may be beneficial for women who continue to have symptoms of low sexual desire, low arousal, and poor sexual satisfaction despite adequate HRT and the resolution of vaginal dryness. The diagnosis of HSDD is based on symptoms.
A blood test is typically recommended before starting treatment to ensure that adding testosterone to your HRT regimen will not elevate your testosterone levels beyond the normal range for women. This test is not used to make the diagnosis but to confirm that treatment is safe.
Testosterone Medication in Women
Testosterone is usually administered as a cream or gel applied once daily to the outer thigh. In the UK, there are no licensed testosterone preparations for use in women, so products intended for men can be used at a reduced dose and are prescribed “off-label” for women. This does not imply that they are unsafe; it simply means that no company holds a license for their use in women. Some examples include Testim® and Testogel®, which come in gel form formulated for men. Dosage adjustments are necessary for use in women, and in some regions, these products can be prescribed by the NHS.
AndroFeme® 1 is a testosterone cream with a license for use in women in Australia. It is imported into the UK under special MHRA guidance. Since it is designed for women, no dosage adjustment is needed. AndroFeme® is not currently available on the NHS and must be obtained through a private prescription. Testim® and Testogel® are generally less expensive than AndroFeme®.
It may take up to three months before women notice an improvement in symptoms. A trial of treatment for three to six months is standard. If there has been no improvement after six months, testosterone treatment is usually discontinued, and alternative causes for low libido are explored.
Women on testosterone treatment should have a repeat blood test after two to three months. If treatment continues, these tests should be repeated annually to ensure that testosterone levels remain within the normal female range. When testosterone levels are maintained within this range, side effects are rare.
Side effects are uncommon when testosterone levels are monitored and kept within the normal female range.
Some women may notice slight hair growth at the application site, which can be minimised by varying the application site and using a thin layer of cream. Other side effects such as acne, oily skin, hair growth, hair loss, voice changes, clitoral enlargement, etc., are rare if normal female levels are maintained.
While there is limited long-term data on testosterone use in women, studies covering up to two years have not indicated any adverse effects in healthy postmenopausal women.
Note that AndroFeme® 1 contains almond oil and should be avoided by women with almond allergies.
