For many women, their libido falls off a cliff when they reach menopause. For others, it slips away gradually, without them really noticing. If this sounds familiar and you want your libido back, what can you do? Testosterone could be the answer.
Testosterone for women isn’t usually prescribed as a normal part of HRT. However, experts think it’s the solution for at least some women whose libido has flatlined. A global statement from the International Menopause Society (IMS), says that giving testosterone does help women rediscover their sexual desire after menopause.
If you are one of the 31 per cent of women who experience a drop in desire (the medical name for this is hypoactive sexual desire dysfunction, or HSDD). testosterone might be for you.
If you haven’t got the energy or desire to have sex, you are not alone. You also don’t have to put up with this feeling, as this is an important issue. Women can really miss their sexual selves, it’s a huge part of the joy of life.
At the moment, HSDD almost always goes untreated. Most GPs don’t know about testosterone as a treatment, and in the UK there’s no product formulated for women. Until recently, almost all the testosterone being prescribed has been given to women at specialist NHS menopause clinics rather than by GPs. Private clinics also offer it.
Hopefully, now that the IMS has come out in favour of the treatment, as has the British Menopause Society, more women will be able to get the prescription they need.
This fact sheet, compiled by Women’s Health Concern, is a brilliant overview of how testosterone can help you in your midlife years.
This paper, from the British Menopause Society, gives clear guidance for GPs on how testosterone can be used as part of HRT treatment, and how to prescribe it. As some GPs are unsure about prescribing it, it’s worth printing this paper and taking it to your appointment.
Here, Dr Stephanie Goodwin and Dr Louise Newson answer the questions about testosterone that come up the most often in consultations.
Isn’t testosterone a male hormone?
It’s best known as male hormone but in fact it’s vital for women, too. You make it in your ovaries and your adrenal glands. As you get older, levels decline naturally. Then, after the menopause, levels can drop to almost nothing. “To a certain extent, it’s been forgotten about,” says Dr Newson. “Doctors haven’t been taught about it. Now the evidence is clear that it can help some women.”
What does testosterone do?
Having enough testosterone is important for bone strength, urogenital health, mood and thinking. It’s mainly being prescribed for low libido and for women who find it less easy to become aroused and orgasm.
How do I know if I need testosterone supplementation?
If you’ve tried regular HRT (oestrogen and progesterone), but not all your symptoms have gone away, that’s when a doctor will think about testosterone, says Dr Newson. The main indications are: you don’t want to have sex, you find it hard to get aroused or to orgasm. “It’s also useful for women who feel tired, depressed, get headaches or have brain fog,” she says. “When they start taking it, women often tell me they feel improvements in their concentration levels, memory, joint pain, sleep and a drop in anxiety.”
Dr Goodwin has seen similar effects. “A lot of women say they feel more energised,” she says. “They can focus and concentrate better, and their joie de vivre is back. It gives a sense of wellbeing, and enhances the effect of other hormones, too.”
What happens next?
You’ll be given a blood test before it’s prescribed. This is not to diagnose if you need testosterone, as women’s levels naturally vary. It is to make sure that your levels aren’t too high when you have a second blood test three to six months after starting treatment.
The medicine comes as a cream that you apply to somewhere hairless, like your lower abdomen or upper thighs, then allow to dry. Be careful not to apply it in the same place because there’s a very slight chance it can make you more hairy at the site of application. There isn’t a lot of long-term data showing other effects in women using testosterone but there is five-year safety data, which is why the IMS are happy to recommend it.
What is the proof it works?
In clinical trials of women with low sexual desire, two thirds of women found theirs improved after taking testosterone. It can often take several months to have an effect. “Women notice the difference from taking oestrogen and progesterone quickly, in relieving hot flushes and poor sleep, for example,” says Dr Goodwin. “Taking testosterone for the return of your libido and energy can be a slower, up to three to six months.”
How do I get testosterone prescribed?
In theory, your GP should be able to prescribe it, but that doesn’t tend to happen. In practise, there are no products that are licensed for women in the UK. This means your GP may be unhappy to prescribe it off licence, or it may not be on the list of products their practice is allowed to prescribe.
However, there are two options that can be prescribed off label in the UK. The first is a gel that’s been formulated for men, usually Tostran. Some women find it tricky to use. You only apply a tiny amount, half a pea in size, which is much less than a man would apply.
The second option is a cream that’s only available on private prescription. Called AndroFeme 1, it’s an Australian product which has been made specifically for women. “Hopefully, a female strength product will be licensed in the UK soon,” says Dr Goodwin.
You can read more from Dr Stephanie Goodwin and find out about her clinic, at drstephaniegoodwin.co.uk. Find out more about Dr Louise Newson and the Newson Health Menopause and Wellbeing Centre at menopausedoctor.co.uk.
