Women naturally produce oestrogen, progesterone and testosterone. The ovaries produce most of the oestrogen during the years leading up to menopause and levels then fall. Progesterone is produced after ovulation and stops once menstruation ceases and at the menopause.
Testosterone blood levels peak at the age of 20 and slowly decline with time. Testosterone is involved in preservation of bone density, has a positive effect on libido, sexual arousal and response, cardiovascular health, cognition and maintains energy levels. Testosterone therapy is often given to women already taking hormone replacement therapy (HRT) who have hypoactive sexual desire disorder, this can include loss of libido, reduced arousal and difficulty achieving orgasm.
Women who have undergone a surgical menopause (ovaries removed) or those with premature ovarian insufficiency POI (menopause before age 40) are most likely to experience testosterone deficiency as the ovaries produce the majority of testosterone in the body.
Clinical symptoms of low libido, sexual arousal and enjoyment are the most indicative of testosterone deficiency and your doctor or menopause specialist will take a detailed history to explore these and look at other issues which may affect your symptoms (for example
psychological issues, other medical conditions such as diabetes, thyroid disease, vaginal dryness/ soreness, other medication, smoking, alcohol, exercise).
If you would like to take testosterone therapy your GP or menopause specialist will arrange for a blood test to check the level of total testosterone. This is only done to check that the level is not at the high end of the female range, to be sure that if treatment is started your testosterone level is more likely to remain in the female range. Higher levels may associated with adverse side effects. Monitoring of your blood levels is advised within the first 3 months after starting testosterone and then every 6-12 months while treatment continues to ensure levels do remain in the female range.
Treatment
Testosterone is applied as a gel or cream which you rub into your skin so the hormone is absorbed directly into your bloodstream. You should apply a small amount of the gel/ cream as prescribed into the skin on your lower abdomen or outer thigh. You are advised to wash your hands thoroughly after using it. It can take 3-6 months for the full benefits of testosterone to work and for you to notice an
improvement.
Products
There are no licensed Testosterone products for women so testosterone 1% cream or gel is prescribed, off license to be used as prescribed.
Side effects
Most women have no side effects of testosterone treatment as it is merely replacing the testosterone that you are not already producing. Occasionally women notice some increase in hair growth where the gel/ cream has been rubbed in, this can be avoided by changing the place where you rub the gel/ cream into regularly. Acne, unwanted hair growth and weight gain are common side effects. Hair loss, voice change (deepening) and enlargement of the clitoris are rare with testosterone treatment at the dose recommended in women but important to mention.
Duration of treatment
If women notice an improvement in the symptoms mentioned within 3-6 months, testosterone therapy can be continued with regular monitoring, your specialist will advise about the frequency of monitoring blood tests. If there is no clinical improvement at 6 months, therapy will be discontinued. Testosterone therapy can be reduced/ stopped without any significant issues.
Other information for you:
Womens Health concern leaflets Testosterone treatment
British menopause society leaflet on testosterone treatment
Books to read:
Mind the Gap by Dr Karen Gurney
Come as you are by Emily Nagroski