As part of our Lunch & Learn webinar series, we were joined by Dr Tonye Wokoma of My Menopause Centre, who achieved OUTSTANDING on their Care Quality Commission report.
She explained more about testosterone and menopause, what it does and how to understand if it might be helpful to you.
Henpicked: Although we associate it with men, women have testosterone don’t they?
Dr Tonye Wokoma: Yes, women do have a bit of testosterone, not as much as men but enough for what they need it to do.
Henpicked: What does it do for women?
Dr Tonye Wokoma: It’s important for several things. The main evidence we have is that it’s useful for boosting libido. But when we talk about libido it’s important to know exactly what we’re referring to. What I’ve found in clinic is women are talking about low libido when it could be all sorts of other things going on in their lives. For example it could be lack of arousal, vaginal dryness making sex uncomfortable, or a problem with reaching orgasm.
There are some studies that suggest testosterone may be useful for energy, but the evidence isn’t as strong. Again, energy can be affected by a multitude of factors, so it’s sometimes trying to understand what else might be going on and if testosterone may be beneficial to women.
Henpicked: Does menopause affect our testosterone levels?
Dr Tonye Wokoma: Testosterone actually begins to fall from our late 20s and 30s up until menopause. Once we reach menopause the ovaries still produce a tiny amount, and for some women that’s all we need. It’s a fairly complex issue.
Henpicked: For someone taking HRT would they need it to be prescribed alongside oestrogen and progesterone?
Dr Tonye Wokoma: Not in the first instance. The guidance that we follow is that oestrogen alongside progesterone is the first thing to consider. If a woman is tired, sweating, has vaginal dryness or has put on weight she might not feel sexy and attractive. So we’d look at using oestrogen to address these symptoms to start with, before we move onto testosterone replacement.
Of course, we all have a lot going on in our lives, too. Many of us are stressed at work, have caring responsibilities for children or parents, relationship issues. We need to look at all of these things, rather than just adding in testosterone. But if it is needed then we’d do it separately, so we can see what’s working well and what might produce side effects.
Henpicked: There’s been more media attention given to testosterone of late, is this helpful?
Dr Tonye Wokoma: It’s important that women are aware it can be helpful, and for some people it’s the final piece in the jigsaw puzzle of hormone replacement management. But it’s not effective for everyone. So it’s important to understand exactly what we’re trying to use testosterone for and what it will do for us. Specialist advice is far more important than headlines.
Henpicked: What are the signs of low testosterone in a woman?
Dr Tonye Wokoma: Most of the time it’s low libido. Some people have read about testosterone and want to see if it will help with brain fog and concentration. But we don’t have the evidence for that. I would usually want a woman to be started on oestrogen and progestogen in the first instance and to make sure that is right. Not everyone will benefit from testosterone replacement and some people get side effects with it.
Henpicked: What are the side effects?
Dr Tonye Wokoma: Unwanted body or facial hair is quite frequent, as are spots and acne. This is why it’s key that we use it in the appropriate circumstances and in the right doses.
Henpicked: Would women take the same testosterone as men?
Dr Tonye Wokoma: There isn’t a preparation in the UK just for women, so we use off licence what we give to men, much more cautiously and with an adjusted dose. We’d carry out a blood test before starting and again a few months later to monitor levels.
Different brands come in different concentrations and it would depend which they’re using as to how much and how frequently they apply the testosterone gel.
Henpicked: Is it available on the NHS?
Dr Tonye Wokoma: Testosterone is available on the NHS, but in a lot of places it has to be initiated by a specialist. Women need to be referred to a specialist clinic before a prescription can be taken over by a GP in primary care.
Henpicked: Can women take testosterone without oestrogen and progesterone?
Dr Tonye Wokoma: Occasionally it has been given to women without using HRT but we do advise caution. A small amount of testosterone is changed into oestrogen in the body. For a lot of women who can’t use HRT it’s because they’re trying to avoid oestrogen replacement, so we have to be careful with this.
Henpicked: Is there anything to help as an alternative?
Dr Tonye Wokoma: Lifestyle management is important, so looking at making sure you’re having a healthy diet and including exercise and activity in your daily life. There is also good evidence that cognitive behavioural therapy (CBT) can be very helpful for menopause symptoms. We don’t have evidence of any natural ways to boost testosterone, but we do know that strength training can be very helpful during menopause.
If you’re still experiencing a low libido despite exercise and diet and you’ve tried oestrogen replacement, then testosterone could help. Do your research, ask at your doctors who is the best person to speak to about menopause. As I mentioned, it’s likely they’ll need to refer you to a specialist if you’re asking for a prescription for testosterone.
It’s an area which we do need much more research into. More women now are taking HRT and more are asking about testosterone, and it’s important we have the evidence to ensure we’re prescribing correctly.
Henpicked’s Deborah Garlick was joined by Dr Tonye Wokoma, menopause expert from My Menopause Centre.
Tonye is an experienced Consultant in Sexual and Reproductive Health and Community Gynaecology and a BMS-recognised menopause specialist. She was admitted as a Fellow of the Royal College of Obstetricians and Gynaecologists in September 2016.
Tonye holds the Faculty of Sexual Reproductive Health (FSRH) Advanced Menopause Certificate and is also the FSRH Menopause Guardian involved in the curriculum, logbook and training in menopause care basic and advanced certificate.
Watch the video here:
