Testosterone for women

Testosterone is often thought of as a male hormone, but women produce it too, and it plays a part in sexual desire, energy and wellbeing. Levels fall with age and more sharply after surgical menopause. For some women, replacing it has a clear and worthwhile effect. For others it does little. This article explains where it helps, how it is used, and how it is monitored.

What the evidence supports

The well-established use of testosterone in women is for low sexual desire that is causing distress, known as hypoactive sexual desire disorder, where standard HRT has not resolved it. The evidence here is good. For other hoped-for benefits, such as energy, mood, or muscle and bone, the trials so far have not shown a reliable effect, so we are honest that desire is the indication with real support behind it. A large UK trial is under way on wider quality of life, and the picture may develop.

How it fits with HRT

Testosterone is usually considered after a trial of conventional HRT, not instead of it. There is also a useful first step: if a woman is on oestrogen tablets, switching to oestrogen through the skin can raise the amount of active testosterone in her own body, sometimes enough to help without adding anything. Where testosterone is added, it sits alongside HRT rather than replacing it.

How it is given

There is one product made specifically for women, a 1 percent cream, and there are men's products used at about a tenth of the male dose, applied to the skin. It is a small daily amount rubbed into clean, dry skin on the lower abdomen or thigh. It is not taken as a tablet, because oral testosterone is hard to monitor and can affect cholesterol. The aim throughout is to keep your level within the normal female range, not above it.

Monitoring

A blood test for testosterone is taken before you start, to make sure your level is not already high, and again a couple of months in, then every six to twelve months. The purpose is to confirm the dose is doing its job without pushing your level too high, which is what keeps side effects, such as unwanted hair growth or acne, uncommon and reversible. This monitoring is exactly why testosterone is prescribed and followed by a doctor rather than ordered from a form. With us, repeat supplies are checked against your latest levels so the treatment stays in the safe range.

Who it is not for

Testosterone is avoided in pregnancy and breastfeeding, in active liver disease, and generally where there is a history of hormone-sensitive breast cancer, though in that last case there can be carefully considered exceptions for women with severe symptoms not helped by anything else. If your baseline level is already in the upper range, more is not the answer.

An honest expectation

When testosterone helps low desire, the effect can be meaningful, but it usually takes three to six months to judge fully, and it is not a certainty. We will tell you plainly if your picture suggests it is unlikely to add much, and we will look at the other contributors to low desire, which are often more than hormonal, rather than reaching only for a prescription.

Read next

• body identical hrt explained

• what happens in a menopause assessment

• early menopause and poi

Ready to start?

If you want to move from reading to acting, the next step is a short assessment with a GP who has specific menopause expertise. It takes about ten minutes and tells you what will help.

Begin your assessment at this link. Online or in person at Westfield London.