Testosterone replacement in females during the Menopause
Testosterone replacement in women for low sex drive in the Menopause
Testosterone is a sex hormone that both women and men produce. Many people think of it as the male sex hormone, but women also need testosterone. In fact, women produce 3 times more testosterone than the female sex hormone oestrogen before menopause.
If you have a low sex drive during menopause, you can have testosterone as a treatment. We can give this to you as a gel or cream applied to the skin. We usually start testosterone after you have settled on the standard hormone replacement therapy (HRT) of oestrogen and progesterone.
This replaces hormones that are at a lower level as you approach menopause.
Testosterone works best when you are being given oestrogen as well. Testosterone medicine can take several months to work. It's not effective for everyone. Younger women who had early menopause often notice more pronounced benefits from using testosterone.
Low testosterone levels
Your testosterone levels gradually reduce as you get older. If you have surgery to remove your ovaries (an oophorectomy), your testosterone levels become lower quickly. This is because your ovaries produce most of the testosterone in your body.
The symptoms of low testosterone levels are:
Low sex drive (libido)
Less pleasurable sex (the ability to get aroused and have an orgasm)
Lack of energy
Finding it hard to concentrate
There is some evidence that lower testosterone levels can also affect your mood and increase your chance of being depressed.
Testosterone Blood Tests
NICE guidelines recommend we complete baseline testosterone levels before starting treatment and then 6-10 weeks after starting testosterone replacement to ensure levels are within the therapeutic range. On the day of your testosterone level check we advise you not to apply the testosterone until after your blood test has been taken to prevent cross contamination and higher levels being reported.
Your body can use testosterone to increase your sex drive. It can turn some testosterone into oestrogen, which can help with your other symptoms.
Do not follow the manufacturer’s leaflet that comes with your medicine. It's important that you follow our instructions instead. The medicine is labelled as hormonal replacement therapy for men and not testosterone replacement for women. This means the instructions in the manufacturers’ leaflet are different from the instructions that your medical team gives you. Our instructions and those on this page are for use in the menopause.
Testosterone is a gel that you rub into the skin. It is applied to either the inner forearm or the upper outer thigh area. We advise you apply your testosterone in the morning.
There are different products that you might use. You need to put the gel onto clean, dry skin. Let the gel dry before you get dressed. Wash your hands after rubbing it into the skin. Do not have contact with any other person while the gel dries. This takes about 10 minutes. Do not wash the area where you have put on the gel for 3 hours. This allows your skin to take in (absorb) the gel.
Androfeme cream – licensed female product imported from Australia. 0.5ml daily
Testim Gel 50mg transdermal gel – a pea -sized amount to be applied. One tube to last 10 days
Tostran 2% is a gel in a pump dispenser. 1 pump has 10 milligrams (mg) of testosterone. One pump on alternate days
Testogel 40mg is a gel in a sachet. Apply a pea-size amount daily. On sachet to last 8 days
Testim, Tostran and Testogel are unlicensed (not officially approved) to treat low sex drive. The manufacturer of the medicine has not specified that it can be used in this way. However, there is evidence that the medicine works to treat this condition. They are licensed medicinal products in the UK, designed for testosterone replacement in males. As we do not have a licensed product available in the UK for female replacement, we use these products as the amounts in the products are standardised and have been through the UK governments licensing regulations for medicines.
Side effects of using testosterone
There are not usually any side effects from taking testosterone. Your medicine is intended to make testosterone return to levels that you had before the menopause. However, there are some possible side effects. You usually only get these side effects if you have a large dose of testosterone.
more facial or body hair (hirsutism)
pattern hair loss (hair loss that happens in a specific pattern or alopecia)
acne and greasy skin
a deeper voice
an enlarged clitoris (a sexual organ above the vagina)
Rarely, you may notice more hair growth or skin changes in the area where you put on the gel. You can avoid this by rotating the area of skin where you rub the gel.
We have a lot of information about long-term side effects of oestrogen and progesterone HRT in the menopause. However, there is less information on long term side effects of testosterone replacement therapy. In males there is some evidence that testosterone at higher doses may alter Liver function and cholesterol levels. We normal completed cholesterol and liver function tests at the same time as checking your testosterone levels after starting treatment.