Nick Panay answers questions on testosterone:
What is testosterone and what is its role in women?
Testosterone is a steroid hormone derived from the ovaries and adrenal glands in women and the testes in men. Women produce 3-4 times more testosterone than oestrogen although much less than men.
Important in development of reproductive organs, secondary sexual characteristics, sexual function, cognitive function, mood, bone and muscle mass
Testosterone levels decline through a woman’s life and particularly after premature and surgical menopause when 50% can be lost very rapidly.
Women who are sensitive to loss of testosterone can develop symptoms which will be discussed.
Is testosterone replacement effective in managing menopausal symptoms? What symptoms does it help with?
Testosterone can help with hot flushes, sweats and energy levels, but the main benefit is improvement of sexual desire, arousal, orgasm in women with distressing low libido.
Other causes of low libido such as medications e.g. antidepressants, physical debility and psychosexual issues should be considered before testosterone treatment is used.
Is testosterone replacement safe? How long could it be taken for?
Testosterone replacement at female physiological doses appears to be safe; side effects are minimal and studies have not shown heart or breast risks
There are no arbitrary limits on duration of usage but there should be a minimum of annual review, weighing up pros and cons of continuing therapy.
Are there side effects with testosterone replacement?
A small proportion of women can experience a little excess hair growth or spots at the site of application.
Side effects such as hair loss, deepening of voice and enlargement of the clitoris do not occur unless excessive doses are used. No beards or moustaches!
How is testosterone replacement given?
Testosterone replacement should be given through the skin rather than orally in order to avoid side effects, usually as a gel or cream, occasionally as implanted pellets.
What are the currently available options in the UK? (Please refer to off license use if possible)
This includes male gels e.g. Testogel used off license in female doses, at 1/10th of the male dose.
A pea sized blob is typically rubbed into the skin of the lower abdomen, thighs or bottom and each sachet is made to last 10 days.
Testosterone cream which is indicated for female use (AndroFeme) is being imported from Australia but is only available privately at present.
Unlicensed testosterone implanted pellets are available in specialist clinics. Testosterone patches (Intrinsa) licensed for women were available, but these were withdrawn for commercial reasons.
Further information for women is available from the Testosterone for Women Factsheet which can be downloaded from the Women’s Health Concern website.