Women in menopause don't just have to deal with declining levels of oestrogen and progesterone. The ovaries and adrenal glands also stop producing as much testosterone.
While most women know about hormone replacement therapy and can access it via an NHS doctor or a private consultant, testosterone replacement therapy isn't as common. But many females in menopause describe the addition of testosterone to their HRT routine the missing piece of the puzzle.
So here we're going to delve into why both men and women need testosterone, what testosterone levels look like, the effect lower testosterone levels have, testosterone gel, testosterone creams and testosterone sachets and if testosterone is the answer to low sex drive, motivation and energy levels in women.
What is testosterone?
Testosterone is a hormone produced by humans and animals. In humans the hormone is produced by the testes in males and the ovaries in females. Small amounts are also produced by the adrenal glands for box sexes.
The brain, specifically the hypothalamus stimulates the pituitary gland to stimulate testosterone production when levels are less than optimal. It is the dominant hormone in males.
Testosterone levels are at their most potent in adolescence and early adulthood.
- Females normally have around 10% of the amount of testosterone a male has and produce more testosterone when they're younger.
- Premenopausal females actually produce 3 times more testosterone than oestrogen.
- A woman's testosterone level at 40 is half the level she had in her 20's.
What does testosterone do in the body ?
In men testosterone is essential for the maintenance of bone density, sex drive, facial hair, muscle growth and strength, fat distribution, red blood cell production and sex drive. Lower levels can affect hair loss and sex drive.
A woman has testosterone receptors in her brain, breast and vulva. In women it's responsible for supporting sexual function, vaginal health, good energy levels, strong bones, lean muscle mass, memory and clear thinking.
As a woman gets older, less hormones are produced by the ovaries. Lower levels of testosterone can result in low libido, depression, low mood, brain fog and tiredness.
What Is hypoactive sexual desire disorder
Hypoactive sexual desire disorder (HSDD) affects around 9-15% of postmenopausal women. Symptoms include low libido, decreased sexual pleasure, fewer orgasms and vaginal dryness.
A survey by Women's Health Concern found that over half of respondents said that the menopause had made their sex lives worse, with around 40% saying that they just didn’t feel sexual since experiencing the menopause.
Testosterone therapy for low desire and tiredness
Many studies have shown evidence that adding testosterone to hormonal therapy can improve sexual function and wellbeing for menopausal women.
The National Institute for Health and Care Excellence (NICE) guidelines state that supplementation can be considered for menopausal females with low sexual desire if hormone replacement therapy (HRT) alone is not effective.
The British Menopause Society (BMS) 2016 recommendations advise that testosterone supplementation could be extended to include menopausal women with low sexual desire and tiredness.
In the UK, treatment is not licensed for women and is prescribed 'off label'. Although licensed for men, the licence for women was removed in 2012 for commercial reasons. The NHS prescribes the testosterone licensed for men to women.
March 2023 The National Institute of Health Research is looking to fund research on the benefits and risks of testosterone in women during the menopause. A team of clinicians is designing a trial to compare testosterone to a placebo (dummy treatment)
Do I need testosterone therapy?
Testosterone therapy may be beneficial to you if you feel a definite change in how you feel about sex or are experiencing a persistent low libido, feel really tired without any obvious cause, you start to become less alert, more forgetful ( brain fog) or your verbal learning is affected ( forgetting simple words)
While there is no definitive “normal” testosterone level for females , experts agree that between 15 and 85 ng/dL is optimal. Contact your doctor to discuss your symptoms.
They may very well test your testosterone levels with a blood test to decide whether treatment can help symptoms improve and support a sharper mind, energy levels, bone strength and muscle mass. Osteoporosis is a serious threat for women as they age.
What testosterone treatments are available for women?
Testosterone therapy can be prescribed by a private or NHS doctor for symptoms and this involves taking a gel or cream which you rub into your skin. It can be dispensed in tubes, pump dispensers or via a sachet. The dose can be taken every day or every few days will be advised by your doctor.
Women are advised to have enough oestrogen via a HRT routine before taking testosterone. NICE Menopause Guideline (NG23) and the British Menopause Society recommend a trial of conventional HRT is given before supplementation is considered.
How to use testosterone gel or creams
Testosterone gel or cream should be applied to the skin, skin which is free from body hair like the inside of the thigh or the forearm before putting on clothes. For best results keep the area dry and clean and allow at least three hours before you take another wash to allow the gel to be absorbed by the body. There are quote a few options.
Testogel comes as a gel in a small sachet and women need to split the amount of gel in a sachet across several days to avoid overdosing.
Testosterone gel (Tostran 2%) comes in a canister and women are advised to use 1 pump (10mg) a pea sized amount on the skin every other day.
Androfeme is a 1% treatment cream licensed for women in Australia and is available via private prescription in the UK .Women are advised to use a pea sized amount every day.
Benefits of testosterone treatment for women
Symptoms of low testosterone include low sex drive, lack of focus, headaches, low energy and for some women, low moods. When the body has access to more testosterone these symptoms can be reversed. There is, however, no guarantee it will work for everyone.
Benefits of the treatment include an increase in libido, sexual arousal and orgasm due to an increase in dopamine levels as well as supporting normal metabolic function, urogenital health, bone and muscle strength, energy and cognitive function.
How long does testosterone treatment take to work
People using a supplement are advised that it may take up to 6 months to take effect.
What are the side effects of testosterone therapy for women?
Adverse side effects of testosterone treatment in women are uncommon if levels are maintained within the female physiological range. The most common side effects are acne, excess hair growth, weight gain. Side effects can be reversed by a reduction in dosage or discontinuation.
More side effects, which are more rarely experienced are a deeper voice, alopecia ( hair loss) and an enlarged clitoris can be experienced with testosterone replacement.
There are still question marks when it comes to the effect of testosterone treatment on cardiovascular and breast health. More trials and data collection are being conducted.
Do I need to take testosterone if my levels are low?
No you don't necessarily need testosterone therapy if you have low levels. For some women, no interest in sex isn't a problem. Other symptoms in relation to energy and brain fog can be discussed with your doctor and managed with lifestyle changes. Dry skin changes or psoriasis can be managed with topical applications or other supplements.
Eve Biology Meal Replacements have been formulated to target energy levels, brain fog and weight gain experienced during women in menopause and can be used with or without HRT.
What about heart health and low testosterone?
Without adequate testosterone levels older women may be at more of a risk of heart disease, heart attack and stroke as they are more likely to have a build up of fatty tissue in their arteries. Again, regular check ups and monitoring heart health may be something your doctor will do to keep you healthy.
The bottom line
Testosterone treatment for women, whether a cream or gel is still not as easy to access as oestrogen or progestogen hormones. The evidence from various studies and recommendations from organisations like NICE and BMS advocate women can benefit hugely from an increase in their testosterone levels during menopause. It isn't just about increasing sex drive, energy and memory but also about helping to protect women from heart disease and osteoporosis and menopause