Testosterone is often considered a male hormone. If you’re like many women, you only become aware of its relevance to you when you hit perimenopause. In fact, before menopause, women are producing 3 times as much testosterone as they are oestrogen!

Why is testosterone important?

Testosterone is an important factor when it comes to sexual arousal, libido and sexual function. However, it also plays a part in muscle and bone strength, metabolic function and energy levels. When testosterone levels are low, this can mean you find it hard to get turned on, no matter how much you want to. It can also affect your general quality of life by causing tiredness, headaches and cognitive issues.

Who is it for?

For many women, HRT will help with symptoms. If your symptoms have improved but you still have have difficulty with arousal and/or low libido, you might benefit from supplementation of testosterone. As with many hormone blood tests though, it is difficult to determine from a blood test result alone, whether low testosterone is the issue. It is often useful to take a test though to determine the effectiveness of testosterone treatment once you’ve been on it for 2 – 3 months. NICE guidelines (you can find them here) also recommend supplementation of testosterone. This is for women on HRT who continue to have low libido and no blood test is recommended in the guidance.

Will I be eligible for it?

In the UK, guidelines only support women being prescribed testosterone for symptoms of low libido or sexual function. The guidance also stipulates that women should only be offered testosterone after they have tried conventional HRT. If symptoms persist, testosterone supplementation should be considered.

What about other benefits?

There is a lot of anecdotal evidence to suggest that many women using testosterone have other benefits such as improved cognitive function, mood and energy levels. However, there is no clinical data to support this. Hence why it would not be considered for these issues alone.

Is testosterone supplementation safe?

At the time of writing this, there are no testosterone products specifically licensed for women. However, there is enough data and information available to show that it is acceptable to use products licensed for men. This is usually called using a medication “off-license” or “unlicensed”. This can sound scary and make you think the worst but honestly do not let this put you off. All medicines are originally produced and licensed for a particular condition or set of symptoms. However, it is not uncommon to find that they can have other benefits for other conditions and can be used safely but it is not part of the original license. It could also mean that it is licensed in other countries for use but not your home country. Hence the off license term.

Although there is a lack of long term safety data for cardiovascular and breast health, an equally important factor is the reluctance of the pharmaceutical industry to finance further clinical studies to achieve licensing of female androgenic products.

How do I take it?

Testosterone is usually prescribed as a cream or gel. It will depend on what is available as well as what the local NHS guidance on prescribing is. All authorities have their own formulary committees. This is a group that decides what medications can be prescribed as first line or standard treatments. This is determined by a number of factors but cost and availability are usually pretty high on the list!

Current common preparations are:

• Testogel [made by Besins Healthcare UK] (1% testosterone gel in 5.0g sachets containing 50mg testosterone): Starting dose 1/10 of a sachet/day = 5mg/day i.e. each sachet should last 10 days.
• Tostran [made by Kyowa Kirin Ltd] (2% testosterone gel in a canister containing 60g ) : Starting dose 1 metered pump of 0.5g = 10mg on alternate days – each canister should last 240 days.
• AndroFeme [made by Lawley Pharma] (1% testosterone cream in 50ml tubes with screw cap): Starting dose 0.5ml/day = 5mg /day i.e. each tube should last 100 days. AndroFeme is not currently available in the NHS and is being imported from Western Australia by special license from the MHRA. It is designed specifically for female usage though.
• Testosterone Implants [made by Smartway Pharma] (100mg implanted pellets) This is currently unlicensed and imported from the USA. They can only be used privately or through agreement of the local formulary committee with monitoring of hormone levels and any adverse effects. They are designed specifically for female usage.

The gel or cream is usually applied to clean, dry skin on your lower abdomen or upper thigh. You should wash your hands after applying.

Are there any side effects?

Most women do not have side effects. This is because, in theory, you are replacing what is missing. However, some can be noted but this is often due to varying absorption levels, metabolism and sensitivity to testosterone. Application is also not an exact science as you can see from the information about the different preparations. For example, if you’re using Testogel sachets, it is difficult to see how much you are using in order to spread the amount in equal doses to last 10 days. This is why metered pumps are useful in dispensing the exact amount needed.

Some women have noticed increased hair growth in the area where they apply the cream or gel. This can be avoided by alternating the sites you apply it to. The dose is quite low so it isn’t likely to cause you to have a 5 o clock shadow or start talking like Barry White so no stress there!

So there you have it, it quick guide to testosterone. If it’s something you think you would benefit from, it is worthwhile to speak to your GP about it. If you want more information or to discuss your personal situation with regard to testosterone supplementation, drop me a line here. If you’ve had experience of using testosterone and are comfortable to share, please leave a comment below.