There is so much online about testosterone for women, but what is it exactly? Here’s what you need to know.
What is testosterone?
Testosterone is a hormone that people traditionally think just belongs to men, but it doesn’t! Women have it too.
In fact, women produce 3-4 more testosterone in their body than oestrogen during their fertile years!
It is produced in the ovaries and the adrenal glands. Unfortunately, when menopause starts, levels of testosterone start to decline. It isn’t as dramatic as oestrogen, but some women certainly feel it.
How does low testosterone feel?
Low testosterone is usually associated with low libido, and that’s the main reason why it is prescribed officially. However, there are plenty of suggestions from multiple sources now that show how low testosterone can cause low energy, low mood, lack of motivation and contributes to vaginal dryness. The clitoris can feel numb, and sex is no longer as pleasurable as it was. Life feels generally quite “joyless”.
What benefits are there of using testosterone?
The main indication for prescribing testosterone in women is to improve libido. Sex for women however is far more complex than replacing a hormone. It’s about our mental health, physical wellbeing, lifestyle and relationship too.
However, many women describe feeling more energetic on testosterone. They feel like they have the motivation back to exercise and do the things they normally would do. Women describe feeling happier, stronger and like the joy has come back into their life. It’s thought to help with poor concentration, brain fog and fatigue too.
Using testosterone is not thought to be linked to an increased risk of breast cancer.
What are the risks of using testosterone?
Generally speaking, if too much testosterone is given, or it is given when it isn’t needed, it can cause symptoms of hyperandrogenism:
- Scalp hair loss
- Hirsutism (unusual hair growing on the face/body)
- Oily skin
- Weight gain around the belly area
- Hair growth in the area the gel is applied
And in severe cases:
- Clitoral enlargement
- Permanent voice deepening
- Insulin resistance and diabetes (although the jury is out on this and thought more to be related to someone having naturally testosterone levels to begin with)
This is avoided by using tiny amounts of oestrogen – for example, women only need 1/8th of a 40.5mg/2.5g sachet of Testogel® compared to men who would use at least 1 whole sachet per day.
It is also important to make sure you are having regular blood checks for your levels. The first one needs to be 8-10 weeks after starting testosterone, and if it is stable, 6-12 monthly checks thereafter.
Caution also needs to be used in women with a history of conditions linked to hyperandrogenism, like polycystic ovary syndrome (PCOS). A pre-treatment blood test would be important in this case.
What blood tests are needed?
Currently The British Menopause Society (BMS) recommends a total testosterone level to be done. The result should be within the female range of testosterone in the body. Every lab is different, but the ranges they use will all be roughly the same. They say that this is the most accurate way to track testosterone levels.
Other specialists recommend instead to do a calculation called the Free Androgen Index (FAI) using levels of testosterone and a blood protein called SHBG. This calculates the levels of free testosterone in the blood as a percentage of what is available. The reason for this is that testosterone levels in women’s blood are thought to be too low for the tests to be as accurate as possible. The FAI needs to be between 2-3% to be safe, and certainly less than 5%.
Either way, if you choose to start testosterone, make sure your healthcare provider is checking at least one of these methods after you start.
How do I know if I need testosterone?
If you are on adequate HRT for menopause, perimenopause or premature ovarian insufficiency and you feel like something is missing, it could be testosterone you need. Not everyone needs to take this straight away, and it’s a good idea to make sure you have your HRT optimised first. Taking testosterone without this doesn’t help, because all that happens is that it is turned into oestrogen in the body through a process called aromatisation.
How do I take testosterone?
Testosterone is a clear, odourless gel rubbed onto the outer thigh. Brand names include Testogel®, Testim® and Tostran®. These are not licensed for women in the UK, but specialists will use these products off licence for use in women to help libido. Many medications are used off licence in the UK, so it isn’t an unusual thing to do.
There is a female-specific cream called Androfemme® that is produced in Australia and can be imported, but it is only available to buy with a private prescription.
Finally, it can be inserted into the vagina through a pessary called Intrarosa® and used for severe vaginal dryness. It is made with a plant-derived form of DHEA (a form of testosterone), combined with coconut and palm oils. As the pessary dissolves, these ingredients help to lubricate and reduce vaginal symptoms associated with the menopause.
Where can I get testosterone?
You will need a prescription from a healthcare professional to access testosterone. This can be through your NHS surgery, or privately. It can be a bit of a postcode lottery though, as some areas will not allow GPs to prescribe the medication without a specialist’s say-so.
Be very wary of buying testosterone online without involving a healthcare professional. You don’t know if the source is legitimate, and you need to be monitored while you use it to avoid causing long-term problems to your health if too much is used.
How can I boost Testosterone levels naturally?
Vitamins and minerals like B5, zinc and vitamin D are thought to boost natural testosterone production in the body.
This can be taken as supplements, or even better, through a healthy, balanced diet rich in avocados, salmon, broccoli, mushrooms and oysters with plenty of outdoor time and exercise.
There is no one “magic” medication to help with menopause symptoms, but many women do feel the benefits of being on testosterone alongside their HRT.
If you feel like there is something “missing” from your regime, then it’s worth having a chat with a professional who knows about testosterone and can help you to decide if it is right for you.
Until next time,
Dr Nikki x
- Scott. Alice, Newson. Louise, BJGP (2020); Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098532/
- Testosterone and women: https://www.menopause.org.au/health-info/resources/testosterone-and-women
- NHS – Testosterone: https://www.guysandstthomas.nhs.uk/health-information/testosterone-low-sex-drive-menopause
- Testosterone Booklet from Balance: https://www.balance-menopause.com/menopause-library/testosterone-booklet/
- Constantine Dimitrakakis, Robert A Jones, Aiyi Liu, Carolyn A Bondy Breast cancer incidence in postmenopausal women using testosterone in addition to usual hormone therapy: https://pubmed.ncbi.nlm.nih.gov/15356405/
- BMS – Testosterone Replacement in Menopause: https://thebms.org.uk/wp-content/uploads/2022/12/08-BMS-TfC-Testosterone-replacement-in-menopause-DEC2022-A.pdf
Jon J Rasmussen, Christian Selmer, Signe Frøssing, Morten Schou, Jens Faber, Christian Torp-Pedersen, Gunnar H Gislason, Lars Køber, David M Hougaard, Arieh S Cohen, and Caroline Kistorp (2020); Endogenous Testosterone Levels Are Associated with Risk of Type 2 Diabetes in Women without Established Comorbidity: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278278/
Nadia Vloemans BSc, Ma’en Al-Mrayat MBBS, FRCP (2023) Metabolic consequences of gender-affirming hormone therapy in transgender adult persons: https://wchh.onlinelibrary.wiley.com/doi/full/10.1002/pdi.2453
- Testosterone and aromatisation: https://www.blaineywellness.com/wp-content/uploads/2016/08/testosterone-and-aromatization-how-to-avoid-excess-estrogrogen-production.pdf
- Off licence/off-label use of medications in the UK: https://www.nice.org.uk/about/nice-communities/nice-and-the-public/making-decisions-about-your-care/information-for-the-public-on-medicines#:~:text=Unlicensed%20medicines%20and%20’off%2Dlabel,that%20stated%20in%20its%20licence.
- Menopause Matters, Androfemme: https://www.menopausematters.co.uk/forum/index.php?topic=45444.0
- Intrarosa: https://www.balance-menopause.com/menopause-library/what-is-intrarosa-and-how-do-i-use-it/
- Foods that increase testosterone in females during menopause: https://healthandher.com/expert-advice/loss-of-sex-drive/foods-boost-testosterone-menopause/