Hormone Replacement Therapy (HRT) is now routinely prescribed for women suffering adverse effects during perimenopause and menopause. What HRT doesn’t address is the decline in testosterone production. That’s right, the hormone that is often considered to be male is produced in females too, albeit at a much lower level. According to Newson Health, three times as much testosterone as oestrogen is produced by women during their reproductive years, but symptoms of testosterone deficiency in perimenopausal and menopausal women are often overlooked.
What is testosterone?
Testosterone is one of the androgen sex hormones that is produced in the ovaries, adrenal glands, fat and skin cells in women. Along with other hormones, it is important in maintaining fertility, libido, tissue and bone health, cognitive health, breast health, red blood cell production, regulation of the menstrual cycle, quality of sleep and vaginal health.
Why do women develop testosterone deficiency?
As women age, the declining function of the ovaries results first in fluctuations (perimenopause) and then a drop (approaching menopause and post-menopause) in the hormones it produces, including testosterone. According to the BetterHealth Channel of the Victorian Government in Australia and US Pharmacist, age-related decline in androgen levels starts as early as age 20, with blood testosterone levels dropping to about half of their value by the time women reach their 40s.
Other factors can also cause testosterone levels to decline, e.g. surgical removal of the ovaries, chemotherapy, problems with the adrenal glands, certain medications, the contraceptive pill and eating disorders. Whilst the symptoms of oestrogen and progesterone deficiency in menopausal women are routinely treated with HRT, testosterone deficiency receives less consideration.
What are the symptoms of testosterone deficiency?
The symptoms of testosterone deficiency are low/decreased libido, difficulty reaching orgasm, fatigue, reduced concentration, loss of muscle strength and low mood or mood swings. It is important to realise that not every perimenopausal or menopausal woman will experience symptoms of testosterone deficiency; similar to the menopausal symptoms that HRT treats, some women will suffer and some will not. Every woman experiences menopause differently.
How can I get a diagnosis?
Testosterone deficiency is frequently misdiagnosed. Medical professionals have often received insufficient training in menopausal health. Additionally, many of the symptoms caused by low testosterone mimic those caused by declining oestrogen levels or other issues like anaemia or depression. Many doctors will ascribe the symptoms variously to stress, relationship issues or anxiety. It doesn’t help that research in this area has mainly focussed on the effects of low testosterone in men. Similar research of its impact on women’s health is lacking, with some doctors disagreeing over the effects of low testosterone.
If you suspect your testosterone levels are impacting on your quality of life, particularly if you are already taking HRT but still suffering from menopausal symptoms, it is important to speak to a doctor experienced in hormone issues (an endocrinologist) or a menopause specialist.
Blood tests are used to determine free testosterone levels. They are usually performed in the morning when levels are highest. A second test may be performed at a later date to verify the initial result. Symptoms are key; a low measured level without accompanying symptoms is considered meaningless.
What treatment options are available?
Testosterone supplements are not licensed for use in women in the US or UK, meaning it is only prescribed off-label, usually by menopause experts. Most supplements have been designed for men and are taken by women at much lower doses. In the UK, they typically come in the form of transdermal creams and gels. In the US, additional methods of supplementation are available in pills, patches and pellets.
Benefits of treatment
Studies have shown improvements across a number of health markers for women taking testosterone. According to Newson Health, benefits of testosterone replacement therapy taken along with HRT include improved energy, stamina, muscle strength, concentration, memory, sleep, libido and sexual arousal levels. A 2013 study found improvements in memory and verbal learning in postmenopausal women who received testosterone gel treatment, which confirmed results from two previous, smaller studies. This result was also significant because postmenopausal women are at higher risk of dementia than men. The women’s testosterone levels increased during treatment but stayed within the range normal for women, and they reported no major side-effects. A 2019 review of 36 clinical trials found that testosterone replacement therapy significantly increased sexual function.
Can all women take testosterone?
In general, testosterone replacement is only prescribed to postmenopausal women suffering from hypoactive sexual desire disorder (HSDD), a condition resulting in zero or low sex drive. Some menopause specialists are sympathetic to other symptoms of low testosterone, particularly if standard HRT is not alleviating them, and some will also treat perimenopausal women. Due to the potential for birth defects if a pregnancy were to occur, some doctors will not prescribe testosterone to perimenopausal women. Women with high cholesterol, cardiovascular disease, liver disease or a family history of certain cancers may be contraindicated for treatment.
Safety and side effects of treatment
Safety data are only available from short-term studies. Based on these, a number of sources state that testosterone replacement has little, if any, side effects. These include Newson Health, Women’s Health Concern and this 2013 study. While acne, facial hair, weight gain and an enlarged clitoris are listed as side effects of testosterone therapy on EndrocrineWeb, My Menopause Centre states that these are generally only seen when taking high doses.
No medication is risk-free. It is important to review your medical and family history with a qualified medical menopause specialist when discussing the suitability of testosterone treatment. It is also vital that you maintain regular check-ups with your doctor, to monitor your testosterone levels, symptoms and general health to ensure the treatment is working safely for you.
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