Testosterone for menopause is already taken on private prescription by women such as Davina McCall to tackle brain fog and low libido and energy. Will trials of new testosterone patch mean it'll become more widely available - and should you consider it?
Millions of women are replacing their nosediving hormone levels in menopause with HRT, and for most, this means an NHS-prescription of oestrogen and progesterone. But what about the other hormone that tails off in midlife: testosterone? In women, this can manifest as loss of libido, strength, power and brain sharpness. Presenter and menopause campaigner Gabby Logan told us recently that when she started taking testosterone “my libido improved massively”.
Taken as a topical cream, it is currently prescribed on the NHS specifically to manage low libido. No specific female testosterone is as yet available on the NHS: doctors prescribe gels designed for men, with the dosages safely adjusted for women by the healthcare professional. But imminent clinical trials of the world’s first testosterone delivery patch aimed specifically at menopausal women might change this.
If the global-first treatment gets regulatory approval, it will be introduced first in the UK and is slated to be made widely available, likely through the NHS. It is designed, again, only to restore a flagging female libido - there are no plans to prescribe it for any other symptoms as yet. “The potential of this technology to improve women’s lives is huge,” says Professor David Haddleton of the University of Warwick, who will be leading the trials from this autumn.
With HRT (oestrogen and progesterone replacement) having been pushed into the mainstream, thanks to powerful educational campaigns by medical menopause specialists and everyday (and celebrity) women speaking up, testosterone is next on the list. Many women feel it's an option they should be able to explore.
Davina McCall who co-wrote her award-winning book Menopausing to help other women navigate difficult menopause journeys like hers (pictured above with her co-author Dr Naomi Potter) is a fan of supplementing the hormone. She, like most women who take it, obtains it privately in cream form (Davina revealed her full HRT routine here). She told us in 2021 that she takes: "Androfeme, which is the female testosterone cream licensed in Australia. I have to buy it privately which is really annoying." Androfeme is currently available privately in the UK as well.
But what is testosterone good for, and will it work for any woman? We spoke to Davina’s co-author, menopause doctor and founder of Menopause Care Dr Naomi Potter, to find out whether the hormone should be at the top of your (peri)menopause wish list.
Image: menopausecare.co.uk
Isn’t testosterone a male sex hormone?
Testosterone may be present in men at much more concentrated levels, but it’s still very much part of the hormonal makeup of the female body, says Dr Potter. And it starts to decline “from about the age of 20”, with a major dip during perimenopause.
It regulates important physiological processes, such as red blood cell production, fertility and muscle development. Everyone has different levels. “In the female body, the amount of testosterone and oestrogen varies enormously; testosterone varies from woman to woman and over time," says Potter.
What are the benefits of testosterone replacement for women?
“When testosterone levels fall sharply during perimenopause and menopause, it can manifest as loss of libido, strength, power and brain sharpness,” says Potter. But the good news is that the symptoms can be lessened or even reversed with “female physiological doses” (doses specific to women) of testosterone. It is, she says, thought to be very safe when prescribed in the correct dosage by a specialist.
And, indeed, effective: journalist Sarah Vine testified on this very site how testosterone dramatically improved her energy levels when she started taking in it in her fifties after the menopause had set in.
Will my GP give me testosterone on the NHS?
“If you are already on HRT and experiencing low libido, you can request it from your NHS doctor,” says Potter. “If you otherwise do well on HRT but your sex drive remains persistently and distressingly low, the evidence is that testosterone can help.” But your GP will not prescribe it if you think your lack of energy or low mood are due to a testosterone deficit. You may want to investigate other means of topping up your energy levels, reduce anxiety and balance mood.
Can testosterone help you lose weight?
Vine found that taking testosterone helped boost her hair, skin and nails, and says it could have an impact on cellulite (it is said to act as a counter to fat-storing oestrogen). Potter, however, says there is currently no evidence to support those claims. “Whether testosterone has an impact on women’s body composition is a grey area. We know that when abused, testosterone does help with laying down muscle, which is why it's banned in sport.” But this is not the aim with testosterone replacement, she points out.
And claims that testosterone helps you sleep better are similarly “not upheld by research,” says Potter. In fact, GTG editorial director Victoria Woodhall tried supplementing it and had to stop as her family complained she was “too antsy – and I found it very hard to sleep!”
What are the side effects of testosterone replacement for women?
The risks only manifest when you take too much testosterone, which is why it’s so important to have professionally prescribed supplementation, tailored to women. This is precisely what the new patch promises.
Taking too much “can lead to masculinisation - for example hair loss, unwanted hair growth and, in extreme situations, voice changes,” says Potter.
Mild side effects, such as the ‘antsiness’ Woodhall describes, can potentially be fixed with an adjustment of your dose, although some women just don’t get on with testosterone supplementation altogether.
Can you take testosterone if you are not on HRT?
On occasion, testosterone can be replaced for women not on HRT (for example for people undergoing gender reassignment), but this should be under specialised guidance only, says Dr Potter.
For everyone else, “the current guidelines for women are that testosterone replacement should be given in addition to HRT,” says Potter. This is because testosterone and oestrogen operate together in a delicate balance that must be carefully managed. Also, “if you improve somebody’s libido but they are not adequately ‘oestrogenised’, then intercourse and sexual activity can be uncomfortable due to the atrophy effects of low oestrogen on vulva and vaginal tissue,” says Potter.
What if I want to treat symptoms such as brain fog and aches and pains with testosterone?
Currently, you will have to go private. “Relief of other, non-libido-related symptoms such as low energy, aches and pains and brain fog as a result of testosterone replacement are as yet considered anecdotal, meaning they have not been supported by evidence,” says Potter. Currently the British Menopause Society does not recommend using it for those symptoms.
Hopefully with further research, she says, “the exact link between testosterone replacement and improvement of other symptoms will come to light, in which case the licence could well be changed.” This would make it easier to get a testosterone prescription for a variety of menopausal symptoms, even, potentially, on the NHS. If that happens, the new patch might become one of the options to discuss with your GP.
Potter confirms the only female testosterone product currently available privately in the UK is Androfeme.
Is a testosterone patch better than a testosterone cream?
With all the excitement about the new UK-first patch, you might think that it’s a better product than the female testosterone creams and gels currently privately available. But this is not necessarily the case: “It would simply be a matter of choice and convenience - some women prefer a patch delivery mechanism and others like to rub in a blob of product every day,” says Potter.
But because the new patch is being developed in the UK and for women, the feeling is that the chances of it in future being licensed for other indicated symptoms such as menopausal brain fog and available on the NHS are growing. You could say it's a step in the right direction for testosterone to become more understood and more readily prescribed. Currently, GPs might be reticent to prescribe it in the same way as some have hesitated to prescribe HRT. The soon-to-be-tested patch, it is hoped, could change all that.