Testosterone therapy for women
Testosterone is often thought of as a male hormone, but women naturally produce testosterone throughout their lives, albeit at lower levels than men. In women, testosterone is produced by the ovaries and adrenal glands (small glands near the kidneys). Decreased levels of testosterone in women can cause symptoms such as low mood, lack of energy, poor concentration, and low libido (lack of sex drive).
Testosterone levels gradually reduce with age, making it common for women not to notice any symptoms relating to low testosterone. However, women who have their ovaries removed are more likely to notice symptoms due to the sudden drop in testosterone levels.
Testosterone as part of HRT
Testosterone can be an integral part of a Hormone Replacement Therapy (HRT) treatment plan. It is usually prescribed when women continue to have symptoms while taking HRT (oestrogen and progesterone), particularly if they still suffer from lack of libido and fatigue. It is also prescribed for women experiencing symptoms after having their ovaries removed.
Forms and administration of testosterone
Testosterone is typically administered in the form of a gel or cream applied to the skin (upper outer thigh or buttock). Although testosterone is not licensed for use in women in the UK, it is prescribed by many menopause experts ‘off licence’ due to its effectiveness and safety. Androfeme, a testosterone cream licensed for women in Australia, is generally available in the UK through private prescription.
Testosterone gels such as Tostran and Testogel contain the same hormone but are only licensed for use as male HRT in the UK. These can also be prescribed for women at a much lower dose, usually 1/10th of the male dose.
Monitoring testosterone therapy
A blood test to measure testosterone levels is recommended before starting therapy and again three months after initiation to ensure that dosage levels do not exceed the normal range for women. Thereafter, 6 to 12-monthly blood tests are advised.
Side effects and management
The side effects of testosterone in women are uncommon if levels are maintained within the normal female range. The most common side effects include increased hair growth, acne, and weight gain, which typically resolve with dosage reduction or discontinuation. Rare side effects of physiological testosterone replacement include hair loss, a deepened voice, and clitoral enlargement. While more research is needed to understand the long-term effects on heart and breast health, recent short-term studies are reassuring.
Long-term data and safety
Further studies are needed to fully understand the long-term effects on cardiovascular and breast outcomes. However, short-term data from a recent meta-analysis provide reassurance regarding the safety of testosterone replacement therapy in women.
