Libido and testosterone

Introduction
Testosterone is the main male sex (androgen) hormone, but it is also a vital hormone in the everyday balance of a woman’s system.

Symptoms due to female androgen deficiency e.g. low libido and energy is still a condition that some doctors do not recognise as a medical condition. More research is required, but treatments can be used to alleviate symptoms that are associated with a low testosterone level.

Why is testosterone important?

In women, testosterone is most commonly linked with libido. In premenopausal and perimenopausal women, libido often decreases. This can be due to a number of reasons:

  • Lack of sleep
  • Stress
  • Chronic tiredness
  • Depression
  • Vaginal dryness
  • Relationship issues

However, some of these causes may be managed by other approaches rather than testosterone. However, if they are not successful then testosterone may be considered as an option.

Other benefits of testosterone treatment

Other benefits of testosterone include increase in energy levels, improvements in bone and muscle strength and a restoration of “joie de vivre!”

Usage & side effects

How is testosterone used?

A simple blood test will determine whether a woman has a low level of testosterone.

Then, as with other types of HRT, a low dose of testosterone will be used initially, and then increased if further benefit is required and no side-effects are being experienced.

Testosterone is prescribed as either a cream or a patch.

The use of testosterone to manage libido is not licensed in the UK. However, as testosterone is a licensed medicine, the specialist doctor can prescribe testosterone in specific circumstances. Consequently, it is vital that patients seek help from specialist doctors.

What are the side-effects of testosterone?

Testosterone treatment at the correct dose is not associated with a significant level of side-effects.

Testosterone is not recommended for the following groups of women:

  • Pregnant women
  • Acne sufferers
  • Women with excessive hair growth or with scalp hair loss
FAQ's (by Nick Panay)

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

Further information for women is available from the Testosterone for Women Factsheet which can be downloaded from the Women’s Health Concern website

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