How does testosterone for women fit into the HRT regimen?
Sounds tempting doesn’t it? Add a tiny amount of testosterone gel to your HRT regimen and get your mojo back. Testosterone for women often gets left out, so who wouldn’t be tempted to try it?
It is mentioned in NICE Guidance on menopause, published in 2015, to guide health care professionals in assisting women. And yet still many women are told it is not available in NHS. There are no testosterone products made for women in the UK and the use of it after menopause often appears to be a well-kept secret. Available to those who know and those who ask. So what is it all about?
What are the truths and what are the myths of testosterone for women?
Testosterone is often perceived as a male hormone, yet a woman’s ovaries and adrenal glands produce it as well as oestrogen throughout life. It helps to influence mood, energy and sex drive as well as cognitive function, which means things like memory and concentration.
All of these may present as menopausal symptoms, for which testosterone as well as oestrogen therapy is sometimes offered. Levels of testosterone in your body gradually reduce as you become older, with many women not even noticing. Others are more sensitive to the changes and sometimes benefit from extra testosterone. Young women who have surgical menopause (removal of ovaries) may notice the change in testosterone more, perhaps because they are younger and because the drop is sudden. Young women with premature ovarian insufficiency (POI) may see a marked reduction in testosterone too, which if replaced can be beneficial.
The myths about testosterone
Myth 1: Testosterone is a male hormone.
Testosterone is a female hormone; women have testosterone throughout their lives. Testosterone contributes to libido (sex drive), sexual arousal and orgasm by increasing dopamine levels in the central nervous system. Testosterone also helps maintains normal metabolic function, muscle and bone strength, mood and cognitive function.
Myth 2: Testosterone always revives sex drive
Testosterone has been widely researched to see if helps improve sex drive and while the evidence is generally positive, it does not help everyone. Menopause symptoms themselves can leave you tired, irritable or sleep deprived, so sex goes to the bottom of your wish list and relationships may become strained. With your body changing too, you may not feel as sensual as you used to, however much your partner tries to encourage or reassure you.
Vaginal dryness may mean that lovemaking is uncomfortable or even painful so it’s not surprising if you are reluctant to start. Do you have a partner you want to have sex with? Testosterone alone won’t address these issues.
Myth 3: It will improve your memory and mood at menopause
Memory loss, concentration and tiredness are common menopausal symptoms. It may be that these are sometimes a consequence of other symptoms, e.g. not sleeping, feeling anxious or simply not feeling ‘like me’. There is some evidence that testosterone directly helps with mood and memory, but more research is needed.
Myth 4: It is not available in the NHS
Testosterone can be prescribed within the NHS. It falls into a category of medicines being used for something other than what it is licensed for. This is called ‘off label’ or ‘out of licence’ use. Whilst it is not uncommon to prescribe medicines outside of licence, there are often limitations or restrictions put in place for prescribers for safety reasons. It may need to be started by a specialist first and some clinicians will choose not to prescribe it. If your GP does not prescribe it, do ask why. There may be restrictions in place which are not the GP’s choice, or it may simply be they are not familiar with its use.
Myth 5: It is an ‘untested treatment’
Testosterone therapy has been used by women for a long time. This means there is plenty of scientific data to support its use and to understand doses and effects. Used at prescribed doses, it appears to be a low risk treatment with few side effects for most women. We know less about its use in women who have had breast cancer, so some are cautious with this group.
And some more facts about testosterone….
Young women may need testosterone
Young women who have surgical menopause may notice the change in testosterone more, perhaps because they are younger and because the drop is sudden. Those with POI see a marked reduction in testosterone too, which if replaced can be beneficial.
So women under 40 years who take HRT may benefit from a discussion around testosterone as well.
You may need blood tests before using it
You do not need a blood test to see if testosterone is needed because there is no level of testosterone that suits everyone. Sometimes blood tests will be recommended before and after starting testosterone treatment to monitor therapy. If done, it is to be sure that you stay within normal female range, minimising the chance of side effects and risk, especially if you stay on it long term.
Is there anything else to help sex drive?
Firstly, think about why you might feel the way you do about sex. Having a low sex drive is not in itself a problem unless it is causing you anxiety. Be honest and consider if other factors might also be affecting this. Relationships. tiredness, menopausal symptoms, work pressures, lack of time and so on.
Work first on these, building back intimacy with your partner and taking time to invest in your relationship together. Communicate with your partner, telling them how you feel and working together to build sex back into the relationship. You will want to feel good about yourself too. Investing time for yourself, doing whatever it is that makes you feel sensual and healthy, will enhance your feeling as a sensual woman.
Aim for the healthy diet and exercise which helps keep you feeling good. Ensure that love making isn’t painful: address vaginal dryness, either with non-hormonal moisturisers, good-quality lubricants or talk to your doctor about vaginal oestrogen treatment. This will address the underlying cause of vaginal symptoms and can be used with or without HRT.
So, do you need testosterone?
Certainly not all women need extra testosterone, even after the menopause. A healthy sex life before menopause often continues well into the years beyond, and into old age. If you have had a surgical menopause, you may notice the drop in testosterone and if you are under 40 years and POI, you might consider it too.
If you notice a decline in an otherwise healthy sex drive after the menopause and it worries you (and you have considered all the other issues discussed above), consider discussing the use of testosterone with your GP.