Testosterone and menopause

You may have heard people talking about the role of testosterone in helping relieve menopause symptoms and be wondering why they are recommending a ‘male’ hormone. However, men aren’t the only ones to make this hormone, women do too. In fact, women produce three to four times as much testosterone than oestrogen before the menopause. It is the same hormone – women just produce lower amounts than men. 

Testosterone is made in your ovaries and also your adrenal glands, which are small glands near your kidneys. The hormone plays an important role in sexual arousal, sexual response, libido, bone strength, cardiovascular health, cognitive performance, energy levels and wellbeing in women.  

Levels of testosterone in your body gradually reduce as you become older. If you have had your ovaries removed by an operation, then it is very likely that your levels of testosterone will become low very quickly. This is because your ovaries produce the majority of testosterone in your body.  

When your levels of testosterone reduce, you may find that you desire sex less often and when you do have sex, it is not as pleasurable as it used to be, even though you still desire and love your partner. You may also experience lower energy, brain fog, reduced energy and poor concentration.  

Testosterone and the menopause

Testosterone is usually given to women who are also taking hormone replacement therapy (HRT) and have persistent symptoms, especially reduced libido. Testosterone is usually given as a cream or gel, which is rubbed into the skin so that it goes directly into the bloodstream. Implants of testosterone are also sometimes available. This will usually restore blood testosterone levels back into the normal range for women, although sometimes it can take a few months for the full effects to come into play.  

Many women find that taking testosterone improves their stamina and energy levels; both physically and mentally – and that it often improves their libido and ability to orgasm.  

There are usually no side effects with testosterone treatment as it is given to replace the testosterone that you are otherwise lacking. Very occasionally women notice some increased hair growth in the area in which they have rubbed the cream. This can be avoided by changing the area of skin on which you rub the cream. As the dose is so low, testosterone used in this way does not usually increase your risk of developing facial hair, voice deepening or skin changes. It is usually recommended to have regular blood monitoring if you are using testosterone and this is often done annually. 

Testosterone for women is still not licensed on the NHS so currently it is only possible to obtain testosterone from the NHS by having the male testosterone prescribed to you that you will be recommended to use at lower doses. This urgently needs to change so there is a licensed preparation for women available. There is a female testosterone cream Called AndroFeme®1 which is currently only available on a private prescription in the UK. This cream contains almond oil so should not be used if you have an allergy to almonds. 

Preparing for your appointment

If your local surgery offers double appointments it’s a good idea to book one of these so that you’ll have enough time discuss your symptoms and concerns. Before your appointment, take a look at the symptoms list to record the menopausal symptoms that you’re experiencing.

Make a note of any changes to your periods, and bring a list of any medications that you’re taking, including herbal supplements. It’s also wise to jot down any questions or concerns, so that you don’t forget to mention them during your appointment. If you’re feeling anxious, you can bring along a friend or family member for moral support.

Your first appointment

According to the 2015 NICE menopause guidelines, your doctor should discuss the following:

  • the stages of menopause
  • common symptoms of the menopause
  • how the menopause is diagnosed
  • lifestyle changes that can help your health and wellbeing
  • benefits and risks of treatment
  • how the menopause can affect your future health

 

Your doctor may want to carry out blood tests to check your hormone levels, but this isn’t usually necessary as these can vary by the hour. Most women can start HRT without needing any investigations or blood tests.

Sometimes your doctor may want to carry out blood tests to rule out other underlying issues, such as an underactive thyroid, and they will also check your blood pressure.

If you would like to take HRT and you feel you would benefit from taking it then you should ask at your first appointment for a prescription of HRT. The majority of women benefit from taking HRT and women can start taking HRT during their perimenopause. No women is usually too old to start taking HRT, even if it is many years since your menopause then you should still be able to take HRT.

Try to leave the room with as many questions answered as possible, ask if your doctor has any leaflets or information they can share with you, and check if you need a follow-up appointment. NICE guidelines recommend a review three months after your first appointment, but you should ask for an earlier review if you are experiencing side effects or the treatment doesn’t seem to be working.

A second opinion

Unfortunately, some doctors and healthcare professionals still believe outdated reports that HRT is linked to cancer, blood clots and heart problems, so they may be reluctant to prescribe HRT. If there’s no medical reason why HRT is unsuitable for you, then it’s important to speak up and, if necessary, ask for a second opinion.

You could ask to speak to another healthcare professional at your surgery, or ask to be referred to a specialist. Alternatively, you could refer yourself to a private menopause clinic. In the UK, the British Menopause Society has a register of recognised menopause specialists at thebms.org.uk. If you live outside the UK, you can contact the International Menopause Society.

What happens if my doctor / nurse won’t give me HRT?

  • Informing your doctor about what you are wanting to discuss prior to the appointment or at the start of your consultation will help to ensure you get the most out of your consultation.
  • Know your rights as a patient. Doctors will be more likely to consider your views if you can show you are fully informed and understand what any risks are and explain clearly why you still wish to have that treatment option because of the benefits to your life and health you believe it would bring.
  • Be persistent but polite. If you do not get the desired outcome at the first appointment, try again another time. You can ask to see another doctor within your practice.

In general, your best approach when talking to your doctor about your menopause is to clearly state your reasons for what you would like, explain what information has led you to this decision, and that you know what the associated risks might be but that it is still what you choose to do. This information may need repeating on several occasions, to several doctors or nurses, but persistence often pays off when you can give a clear and rational argument that shows careful consideration of the evidence of the benefits to your health.