Testosterone to treat menopause symptoms in the UK

Why testosterone is helpful for certain menopause symptoms?

Testosterone plays a key role in women’s sexual function, muscle mass and red blood cell production. It increases our energy, drive and motivation, so if in short supply as we reach menopause, it may cause difficulties for some women.

Most women don’t require additional testosterone during menopause, but for those that do, it can be the final piece in the puzzle to feeling well.

Menopause Specialist Doctor Jane Wilkinson, from menopause Wellbeing, shares her expert advice about testosterone as a beneficial hormone for specific menopause symptoms.

Jane says “by the time women enter their 40s, they have approximately half the testosterone they had in their 20s”. That’s going to have an impact on libido for sure!

Women do produce testosterone in the post-menopause phase. Ovaries produce some, but it is a significantly reduced amount.  For many women, this amount is sufficient to ensure adequate sexual function.

Why does stress affect women’s sex drive?

A woman’s libido is affected when her body is under stress and, let’s face it, menopause can be super stressful for some women.  When tired, fatigued, suffering flushes, irregular periods or vaginal dryness, sex is not a woman’s No.1 priority; often she’d much prefer a good book and a comforting cup of hot chocolate!

As well as being produced in the ovaries, precursers of testosterone are made in in our adrenal glands (the small glands that sit on top of the kidneys).  However, these glands also make cortisol, our stress hormone.

When our bodies are under stress we produce more cortisol.  If we are making lots of cortisol, then fewer other hormones are produced, including precursers of testosterone.

What is the impact of low testosterone levels in menopause?

Female testosterone is important for energy, motivation and libido, as well as for musclWhat is the e strength and stamina.  Some reports suggest that low testosterone levels can also be associated with low mood and poor concentration.

Often women feel a pressure to perform in the bedroom even though their partner may not be pressurising them. Women still want to participate as it is a key part of their relationship and they miss the intimacy.

Sometimes a lack of sex drive causes relationship problems. Partners may perceive affairs are afoot, or worry that their female partners have just fallen out of love because of lack of sex drive.

Women’s psychosexual pathways are complex!

If sex becomes painful through menopause, then sex drive is likely to be reduced. There can be changes in the vaginal microbiome as a result of pH levels changing because of reduced oestrogen, and periods may change too, becoming heavier, lighter or irregular which doesn’t make for an active sex life! Other menopause symptoms like vaginal dryness are also likely to push sex to the bottom of the priority list. Why would we want to repeat something that was painful?

If we’re shattered, worrying about work or the ‘to do’ list, or just never getting any quality time with our partners, then it’s probably less likely we’ll feel inclined to have sex!

What should women do if their testosterone is low?

Menopause Wellbeing say it’s not solely about HRT!

It is important to understand the impact that nutrition has on libido. Women need healthy fats, for example: olive oil, nuts, seeds, avocado and oily fish, which can all help to restore hormone levels, including testosterone.

Women should focus on all aspects of their wellbeing.  Lifestyle changes are important to optimise hormone production; good nutrition, adequate sleep, regular exercise and relaxation are vital to overall wellbeing.

Does HRT help if testosterone levels are low?

Dr Jane Wilkinson says “HRT is one of the most effective treatments that as a doctor I will prescribe.”

For the vast majority of women, HRT, i.e. oestrogen and progesterone (if you have a womb), will improve libido and sexual function.  But there are a small group of women where menopausal symptoms are improved, but libido, energy and motivation are still reduced.

Who should be prescribed testosterone?

Doctors have to carefully assess patients and decide who is appropriate to take testosterone. This assessment will include a blood test.

“At Menopause Wellbeing, if a woman is on a tablet form of HRT, we would normally first recommend she transfer to transdermal HRT (patch or gel) as this may help improve libido”.

Menopause Wellbeing practice along the ‘Primary Women’s Healthcare Forum’ Guidelines. These guidelines only encourage testosterone use if a woman is in the lower quartile of what is referred to as the ‘free androgen index’ (measured in a blood test).  It is important that levels should not be too high.

Is testosterone prescribed for women in the UK?

The challenge in the UK is that we do not have a licensed product for women who want to be treated with testosterone on the NHS. However, menopause specialists do sometimes prescribe testosterone by using the products that are licensed for men in much smaller doses.

At Menopause Wellbeing, we prefer the safety of a product that IS licensed for women, but can only be prescribed on a private prescription currently.

Testosterone is mentioned in the NICE Guidelines for menopause care, for consideration if women have low sexual desire disorder, for whom HRT alone, hasn’t proved effective.

Is testosterone right for me?

For the vast majority of women, testosterone is not necessary.  Many women seen at Menopause Wellbeing benefit from HRT and lifestyle changes.  Often, effective management of stress for you and your partner, and simply spending more quality time together can have a significant effect on your relationship and your wellbeing.

However, if you think that despite HRT and other lifestyle changes your symptoms are persisting, then it may be worth speaking to your doctor and considering the use of testosterone.

Dr Jane Wilkinson is a menopause specialist at the Menopause Wellbeing Clinic, in Chester and Wirral.

October 2019