Testosterone: your questions answered by a menopause doctor

Testosterone can be a game changer for perimenopausal women but many of us are still apprehensive. Is it safe? Will it make us hairy? And should we really be taking something GPs aren’t keen to prescribe? Dr Shahzadi Harper - private menopause doctor - answers your most commonly asked questions.

ISN’T TESTOSTERONE A MALE HORMONE? HOW DOES IT HELP WOMEN?

Testosterone is actually one of the sex hormones that women produce. Many people think of it as a male hormone and relate it to masculinity, hairiness and a deep voice but in fact, prior to the menopause, women produce three times as much testosterone than oestrogen. 

Women need testosterone for libido, sexual satisfaction, metabolism, energy, stamina and brain clarity. It can also benefit skin and hair.

Following the menopause, testosterone levels decline rapidly especially in those who’ve had a surgical menopause (ie. had their ovaries removed). Women with low levels often experience lack of libido, tiredness, difficulty concentrating, headaches, lack of energy, loss of muscle and excess weight around the middle - none of which are welcome!

I’M SUFFERING FROM MANY OF THE SYMPTOMS YOU MENTION. DO I NEED A BLOOD TEST TO DETERMINE IF I’M DEFICIENT?

My personal belief is a blood test should generally be done to confirm a diagnosis and to know what a woman’s testosterone levels are like before commencing treatment. However, some doctors make a diagnosis solely based on a patient’s history.

HOW IS PRESCRIPTION TESTOSTERONE ADMINISTERED?

Testosterone is usually prescribed as a gel or a cream to be rubbed into the skin. There are also implants available, which are inserted under the skin. However, most doctors will prescribe the gel or cream.

I’VE HEARD TESTOSTERONE ISN’T LICENSED IN THE UK. IS IT SAFE? ARE THERE ANY SIDE EFFECTS?

That’s correct. Unfortunately in the UK there’s no licence for female use testosterone.

So what does that mean exactly? It means the manufacturer hasn’t specified that the medication can be used for women, however, there is evidence from clinical trials that testosterone can be very beneficial for women and their symptoms.

The NICE guidelines suggest (read the 2019 Lancet review here) that if women are suffering from menopausal symptoms such as decreased libido and sexual satisfaction, testosterone may be helpful and can be tried. Usually testosterone is prescribed alongside oestrogen and/or progesterone.

Usually there are no side effects as it’s simply replacing the hormone that you’re lacking. However, there’s a chance of increased hair growth in the area that the gel or cream is applied. I usually tell women to move where they apply the cream around the tummy area.

Acne, increased facial and/or body hair, alopecia and an enlarged clitoris are all extremely rare side-effects, especially in the tiny doses that are prescribed for women. Regular blood monitoring will help to assess levels and reduce the risks of unwanted side effects.

MY GP IS RELUCTANT TO PRESCRIBE. WHAT CAN I DO?

If your GP is reluctant it may be because he/she isn’t trained in the menopause. Try asking for an appointment with another GP in the practice who has an interest in the menopause or, alternatively, ask for a referral to your local menopause clinic. Another option is to pay to see a private menopause doctor.

HOW LONG DOES IT TAKE TO FEEL THE BENEFITS OF TAKING TESTOSTERONE?

Women usually start to see the effects of testosterone 4 to 8 weeks after taking it. On the whole, my patients’ experiences of taking testosterone have been very positive.

IS IT POSSIBLE TO TRANSFER MY PRIVATE TESTOSTERONE PRESCRIPTION TO ONE FROM THE NHS?

It is difficult as many doctors don’t feel comfortable prescribing off-license medication but it’s always worth asking and printing out evidence such as the NICE guidelines to support your case.

I’M TAKING TESTOSTERONE. DO I NEED TO HAVE MY LEVELS MONITORED REGULARLY?

When my patients initially start taking testosterone I measure their levels after a month and then usually every 3 to 6 months.  If after three months there is no change, I generally recommend women stop taking testosterone. 

WHEN SHOULD TESTOSTERONE BE AVOIDED OR USED WITH CAUTION?

Caution should be taken in those patients with polycystic ovarian syndrome and patients who have a history of hair loss and/or acne.