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Recent years have seen an explosion of Menopause information in the media, from TV documentaries to talking points on daytime shows it appears we are all now talking Menopause...FINALLY! However, it is important to ensure the information is correct and following appropriate, evidence-based, guidelines.
Some of the media and celebrities have been highlighting Testosterone in the treatment of Menopause along with regular, scientifically-proven medication. As a result many women see Testosterone as maybe a "cure-all" treatment and an essential addition to their ongoing treatment regime, and many clinics are seeing a massive increase in demand for the medication.
Although a lot has been reported in the media about Testosterone use in Menopause, in truth, little is known about the real effect on the female body for the simple reason there has been little research in this area. Testosterone does not form part of conventional Hormone Replacement Therapy, (HRT).
In Peri and Post Menopause the natural levels of Oestrogen and Progesterone drop suddenly and dramatically leading to many adverse symptoms throughout the whole body. In contrast, Testosterone, which is produced by the ovaries, falls steadily from ages 20-40 years levelling out in peri and post menopause.
Testosterone has an effect on libido and reduced levels can cause this to drop. So it is natural to believe introducing Testosterone will solve the problem. However, in Menopause, low libido can be caused by a number of different reasons. Lack of sleep, vaginal dryness, painful sex, low mood/depression and anxiety are all causes of low libido which can be helped with regular HRT and may just require dose adjustments to resolve the problem.
The British Menopause Society (BMS) advocates trying Testosterone for low libido only after dose adjustments have been tried and no relief has occurred. The dose should be dependent on baseline blood Testosterone levels taken prior to starting the medication and monitored at 3-6 monthly intervals. If levels are within range of normal, female levels, Testosterone should be avoided. If after 12-weeks of treatment the patient is not feeling any improvement, the BMS and NICE Guidelines advise stopping treatment as it is unlikely to help.
The dose should not be increased if the individual gets no relief as this can lead to unwanted side effects, such as, unwanted hair growth across the body; male-pattern baldness; deepening of the voice amongst others. Some of these side effects can be irreversible even after stopping treatment.
Most Testosterone treatments are now only licensed for use in male patients and Testosterone prescribing for women is "off-licence", many healthcare professionals with limited knowledge and experience in this area may be reluctant to prescribe it. There is only one licenced Testosterone product for use in women and is currently not authorised for use in the NHS but can be obtained on private prescription.
There is very little information on other effects of Testosterone in the treatment of Menopause other than anecdotal evidence from patients. If someone gets relief from other symptoms using Testosterone, whether that is a placebo-effect or actual, is great for the individual but should not be taken as solid evidence for everyone.
More research is needed in this area and the BMS are in the process of commissioning a piece of research into Testosterone use in Menopause. If anyone has the time please complete a short survey on this subject by visiting: https://forms.gle/YrCN1FedQ55MttgDA by doing so it will assist the research team in moulding the project to be most relevant for womens' future treatment.
References
British Menopause Society, (2023) BMS Statement on Testosterone. BMS Statement on Testosterone - British Menopause Society (thebms.org.uk)
National Institute for Clinical Excellence, (2015; 2019) Menopause: Diagnosis and Management. Overview | Menopause: diagnosis and management | Guidance | NICE
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