We often think of testosterone as being a male hormone but it is produced by the ovaries in women along with oestrogen and thus it is also a female hormone.

Our ovaries produce around half of our testosterone. The other half is produced by the adrenal gland.

Do testosterone levels reduce dramatically at the menopause in the same way oestrogen does?

In short no- not in women experiencing a physiologically ‘normal’ menopause.

There is thought to be a gradual age-related reduction in testosterone levels over time- unlike the much more dramatic decrease in oestrogen seen at the menopause. Some women may not notice the drop in this hormone at all and experience no symptoms whilst others may be more sensitive to the change in testosterone levels.

In women who have had a surgical or medical menopause or had a hysterectomy (even if their ovaries are left in place) the levels of testosterone will drop very quickly by as much as 50% and certainly these women are more likely to experience more severe symptoms of testosterone deficiency.

When do we prescribe testosterone

Currently the recommended indication for testosterone is for women experiencing symptoms of low sexual desire that are causing distress after other possible contributing factors have been considered.

Some women report an improvement in cognition/ brain fog, mood and energy levels but the evidence for the use of testosterone for this in studies is currently limited.

Many factors contribute to our drive to have sex and reduced testosterone alone may not always be the cause of low sexual desire. It is important to talk to a doctor about other potential causes of low libido- certain medications, vaginal symptoms and mood disturbance can all interfere with sexual function.

What are the side effects of testosterone replacement

Excess body hair (particularly at the site of application), acne and skin reactions to the gel happen in around 1 in 10 women,

Other side effects are relatively uncommon at the doses used for testosterone replacement in women but include male pattern baldness, weight gain, enlarged clitoris and voice change.

Do I have to be on HRT to have testosterone?2023-01-23T13:27:07+00:00

Yes the current guidance is that testosterone should only be prescribed if a woman has adequate levels of oestrogen on HRT.

This is partly because replacing oestrogen to good levels often improves many of the symptoms (including libido) that may also have been attributable to low testosterone.

Whilst it has not been shown to be dangerous to use testosterone without being on oestrogen, the side effects mentioned above are more likely to occur if testosterone if used alone in peri-menopausal and menopausal women.

Do I need a blood test before starting testosterone2023-01-23T13:27:29+00:00

It is important to have a blood test before starting testosterone. This is to ensure that the levels of testosterone in your blood already are not high or at the higher end of normal where giving added testosterone is more likely to cause side effects.

How often do I need follow up?2023-01-23T13:27:57+00:00

It is important to have a blood test 3 months after starting treatment and then 6 monthly to monitor levels thereafter. Women on testosterone should have a clinical review at least annually whilst on treatment.

How long does it take to work?2023-01-23T13:28:19+00:00

It can take up to 6 weeks to start to notice the benefit from testosterone replacement and maximal benefit should be seen by 6 months.

What treatments are available?2023-01-23T13:28:39+00:00

No testosterone treatment is licensed for women in the UK.

The most commonly prescribed products are those that are licensed for men but are used at lower doses for women.

Testosterone comes in a cream, gel pump or gel sachet depending on which brand is prescribed and is applied daily or every other day (again depending on which preparation is being used).


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