Dr Juliet Balfour explains why testosterone is important for women – and can be the icing on the cake when it comes to HRT.
We often think of testosterone as a ‘male only’ hormone – but nothing could be further from the truth. It’s produced in our ovaries and adrenal glands and it’s often associated with our sex drive or libido level – but it does more than that – it can help regulate mood and support the health of our reproductive tissues and our bones.
“We produce less of it than men,” says menopause doctor, Juliet Balfour from the Wells Menopause Clinic in Sommerset. “Our levels start to go down in our 40’s, not as quickly as our oestrogen or progesterone levels, but they decline.”
Women who have had surgical or chemical menopause, however, do have a rapid drop and need to have their testosterone replaced as part of their HRT.
What does it do and why do we need it?
“It helps with the development of your reproductive organs and also with a lot of things that oestrogen helps with as well. So it helps with out brain function, our cognition, our bone and muscle strength, and a big one is our libido or desire for sex and our ability to organism. And that what it’s mostly know for and that’s what it’s licenced for on the NHS,” Dr Balfour says, adding that it can also help with energy levels, sleep and mood.
Dr Balfour says some may not notice a drop in their testosterone levels but others do and when they add it back in to their HRT regime it can make a difference. Generally you’ll start oestrogen (and progesterone if you have a womb or endometriosis) and stay on that for a few months to see how your symptoms settle. If you are still experiencing low libido, brain fog or and a lack of energy you might then consider adding the testosterone.
While it is prescribed based on symptoms sometimes a base-line blood test will be taken to determine your levels of ‘free testosterone’ – that is, the amount of testosterone circulating in your system that is available for your body to use. Some is bound to the sex-binding hormone globulin and isn’t available for your body to use, so a calculation is done to assess how much is available and a normal level is usually between 1% to 5%. This is the free androgen index. People with Poly Cyctic Ovarian Syndrome (PCOS) may be around the upper end, and many perimenopausal and menopausal women are around 1-2% so could benefit from testosterone.
Is it safe for women to use?
Dr Balfour says we have good evidence for about 5 years that shows that it is safe to use in terms of heart attack and breast health. When it comes to side effects she says they aren’t giving big doses.
“We’re just trying to put people back to where they were in the 30’s or 40’s and we do monitor it. So it’s rare to have side effects. Some people may find they have slightly oilier skin, maybe a little bit of extra facial hair. The rare and irreversible symptoms are a deepening voice, male pattern hair loss and very rarely enlargement of the clitoris. Some women find they can get a bit angry. But it’s just replacing what you had before so these things shouldn’t happen.”
The standard dose for women is 5mg/day and it can be adjusted if people are finding they are having issues.
It can take up to three months to see any difference and we’d usually take blood tests around 3 months to check levels and adjust the dosage if necessary, but if after 6 months you weren’t feeling any benefit Dr Balfour says you’d usually be taken off it.
It should be taken transdermally (through the skin) to avoid the liver, she says.
If you stay on it you need to have the levels monitored annually by you clinic – the home testosterone or hormone tests are not accurate yet, she warns.
How do you know if you need it?
If you have ongoing symptoms despite already being on HRT that include low libido, low energy, poor sleep and brain fog you may benefit from it, Dr Balfour says. It can be taken with local vaginal oestrogen as well, and if you are having painful sex, Dr Balfour says it’s vital to have this addressed.
There are precursors to testosterone like DHEA but Dr Balfour says it is better to have a regulated product, so stick to the testosterone. The exception, she says, is Intrarosa which is a DHEA pessary that is prescribed for vaginal atrophy symptoms.
Can I get it from my GP?
At the moment not all GPs are comfortable prescribing it as it’s ‘off licence’ and many don’t know much about it, Dr Balfour says – but this is improving. If this is the case a specialist may start the prescription and the GP can continue it.
In the UK there is no testosterone product specifically for women, but there is one that is available on a private prescription from Australia called Androfeme. It has a syringe that you can use to draw out the cream and apply it in the correct amount.
At the moment, if you’re lucky enough to get it prescribed for you your options are options for men including testogel, teston and tostran. The testogel is a sachet and you use it over ten days – applying a pea-sized amount to your lower buttock, outer thigh and alternate it daily to avoid hair growth in the area. Inner wrists are also ok. Make sure you don’t bathe for about 2-3 hours afterwards., Dr Balfour says. The tostran is a pump and it’s recommended to use it every second day.
What about if you have breast cancer?
The current guidelines say no to testosterone if you have breast cancer because some of it may be converted to oestrogen.
If you don’t have an oestrogen receptive breast cancer you specialist may prescribe it.
But there is interesting research that indicates that testosterone may play a role in preventing breast cancer, Dr Balfour says – but it’s early days and more research is needed.
You can’t take testosterone if you are pregnant, breastfeeding or have active liver disease or breast cancer (unless a specialist says so). And, beware if you are a competitive athlete, Dr Balfour says.
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