Testosterone for menopausal women
Tuesday, 11 October 2016
Last weekend, various newspapers reported on a presentation that Nick Panay, a gynaecologist and menopause expert, gave at the RCGP’s annual conference. In this presentation, he stated that women suffering from a loss of sexual desire should be offered testosterone on the NHS.
Reduced or lack of libido is very common in menopausal women and the NICE guidance on the management of the menopause clearly states that women with low libido should be considered for testosterone.
Testosterone can also improve women's energy, mood and concentration. However, in the UK, testosterone is not licenced for women, unlike in other countries (including Australia).
Interestingly, women produce three times more testosterone than oestrogen before their menopause. It is an important hormone which is often overlooked. Adequate levels of testosterone are important for the maintenance of musculoskeletal health and also possibly vascular and brain function. Observational studies indicate that testosterone has favourable cardiovascular effects measured by surrogate outcomes; however, associations between endogenous testosterone and the risk of cardiovascular disease and total mortality, particularly in older women, are yet to be established. Reassuringly, adverse cardiovascular effects have not been seen in studies of transdermal testosterone therapy in women.
Numerous studies have shown that adding testosterone to hormonal therapy can improve sexual function and general wellbeing among women during their menopause. In addition, using transdermal testosterone can improve cognition and also improve verbal learning and memory.
Testosterone appears to be safe when used transdermally and in low doses. Its use is not associated with breast or endometrial cancer. It appears to offer some bone protection and also reduces the incidence of sacropenia.
Testosterone levels do not actually correlate well with female sexual function or overall wellbeing as it is difficult to accurately measure the free and total testosterone levels at the lower end of the female range.
It can sometime take several weeks, even months for a woman to notice the beneficial effects of testosterone. If they have not noticed an improvement after six months, then it is unlikely to be beneficial. However, for most women taking testosterone can really make a huge difference to the quality of their lives.
We should have a lower threshold for talking to women about their sex drives and then for considering giving testosterone for those women with low libido.