Testosterone and the Menopause

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For most of us, testosterone is a “male hormone” and often neglected in the field of women’s health. However, women also produce testosterone – just a smaller amount. And just like oestrogen declines during the menopause, our levels of testosterone also gradually reduce.

In addition to standard hormone replacement therapy (HRT), testosterone can be prescribed too. It is currently off-licence in the NHS but is usually prescribed for symptoms including reduce libido.

In this short blog, our menopause nurse, Karen, has answered some questions about testosterone.

Q&A with Karen

Is Testosterone a female hormone?

Yes it is, in fact female Testosterone levels are only 10% different to levels in men. Testosterone is made in the ovaries and also the adrenal glands (small glands near the kidneys).

What happens to Testosterone levels in Peri-menopause and Menopause?

Testosterone levels start to decline during peri-menopause and menopause along with the hormones Oestrogen and Progestrone, this is partly to do with loss of ovarian function as we get older but can be caused by premature ovarian insufficiency (menopause that occurs before age of 40) or due to surgical intervention where a women has had both her ovaries surgically removed.

What are some of the symptoms of low Testosterone in women?

Women may experience symptoms such as reduction or loss of libido, low energy or fatigue, decrease in muscle mass even in women who regularly work out and cognitive deficits such as poor memory/forgetfulness, loss of concentration, reduced verbal memory and brain fog.

How do we solve Testosterone imbalance?

One of the best ways to treat this imbalance is with Testosterone replacement therapy. Testosterone is usually given as a cream or a gel which is rubbed into the skin so that it goes directly into the blood stream, this will usually restore blood Testosterone levels back to the normal range for women but it can take a few months to notice the full effect. Testosterone for women is still not licensed on the NHS but can be prescribed unlicensed by private menopause clinics with careful monitoring.

Benefits of normal Testosterone levels

Normal Testosterone levels contributes to a healthy sex drive and enhances the mood, it can help with sexual response and the ability to orgasm during sexual intercourse. Proper Testosterone levels can play a large part in determining your level of energy, quality of your mood and mental function. Normal Testosterone can help maintain muscle health and helps to regulate muscle mass.

Can Testosterone be prescribed on its own?

Testosterone is usually given to women who are also taking Hormone Replacement Therapy (HRT) and are experiencing ongoing persistent symptoms of loss of libido, fatigue/low energy and cognitive symptoms. A baseline Total Testosterone blood level should be taken prior to considering starting on Testosterone replacement therapy to ensure that the level is low, also an Oestrogen blood level is useful in determining that there is absorption of current HRT, as Oestrogen level should be optimised before considering commencement of Testosterone replacement.

What are the current treatment options?

The most commonly used Testosterone replacement treatments are Androfem Cream, Testogel, Tostran and Testimgel these are all currently prescribe off license for females. Testosterone cream or gel should be applied to clean dry skin usually abdomen, upper thighs or forearm and should be allowed to dry completely before dressing always wash your hands straight after applying and the area of application should not be washed for 2 – 3 hours after application. Dosage will vary depending on the product, your practitioner will discuss this with you.

When should Testosterone be avoided or used with caution?

Women with active liver disease or a hormone sensitive breast cancer should avoid Testosterone replacement. Women with an upper normal or high baseline Total Testosterone level should not be started on Testosterone replacement. Competitive athletes must take care to maintain Total Testosterone levels within normal female range.

What are some of the side effects and risks of Testosterone replacement?

Adverse effects of Testosterone in women are uncommon if levels are maintained within female range. The commonest are excess hair growth, acne and weight gain which are reversible with reduction in dosage or discontinuation. Alopecia, deepening of voice and clitoral enlargement are very rare.

Do we need to monitor Testosterone levels?

It is recommended that Testosterone levels should be checked and assessed 2 – 3 months after commencing Testosterone replacement therapy to minimise any adverse effects. It is important that monitoring continues every 6 – 12 months to ensure that levels remain within the female range. Always inform your practitioner of any side effects that you may be experiencing so that adjustments/changes to dose or product can be made.

How we can help

We have experienced nurses who will take the time to provide you with relevant information and answer any questions you have. We want to work with you to better your health. Initial appointments are 45 minutes long allowing you enough time to speak to your assigned practitioner

Reach out and talk to somebody, whether that is a friend, colleague, family member or health care practitioner.
Ellen Hart RN

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The ability to speak to someone who was not only knowledgeable, but sympathetic and completely understanding of the menopause was brilliant. The GP and NHS are superb, but they have limited time and resources for this issue, so having alternative option available has been an absolute godsend.

Happy patient who visited the Menopause Clinic

Keran made me feel comfortable and explained all the procedures to me very happy with the service

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