Llike many middle-aged women, i often feel tired, unable to concentrate and suffer from low libido. Conventional hormone replacement therapy (HRT) has helped a little, but according to friends in the know and social media, there’s something else that can help: testosterone.
Advocates claim that as well as boosting libido – the only thing it’s recommended for – testosterone replacement can improve a variety of menopausal complaints, from low mood, poor concentration and memory, to sleep problems, stamina and motivation. It can even protect women’s bones, muscles and brain, it is claimed.
If it sounds too good to be true, it may be because it is: medical guidelines emphasize that the only evidence-based indication for testosterone use in women is for low sexual desire, and there is insufficient data to support its use for other symptoms or diseases to support. prevention. As a result, few general practitioners are willing to prescribe it.
Still, women get it through private or – as I discovered for myself – online clinics.
I managed to buy three sachets of Testogel – equivalent to a month’s supply – from Superdrug Online Doctor after completing a short questionnaire about my sex drive and medical history and submitting blood test results showing levels of testosterone in my body. With the same prescription, I was then able to order a further 30 sachets from another online pharmacy.
According to Prof Annice Mukherjee, a consultant endocrinologist at Spire Manchester Hospital, I am not alone. “Testosterone evangelists on social media say it’s the missing hormone, and if you don’t feel good with HRT, it’s because you’re missing testosterone — which causes many women to feel desperate for it,” she said. “They know that the NHS or private practitioners won’t give it unless they can identify that they have a low libido, so they learn what to say. If you know which boxes to tick, you can get them. “
Mukherjee and other experts are concerned that women are not necessarily fully informed about potential risks and side effects, or how to apply testosterone safely. This is a particular problem in the UK because, unlike in Australia where a female specific formulation is approved, British women are usually prescribed the male formulation. Men with low testosterone should use one sachet of Testogel per day, but women should spread each sachet over 10 days, which is difficult to estimate.
Prof Susan Davis, the head of Monash University’s women’s health research program in Melbourne, Australia, said: “Even just a small amount more can lead to excessive amounts – so the chance of doing harm is much greater.”
Dr Paula Briggs, a consultant in sexual and reproductive health at Liverpool Women’s Hospital, said she saw a patient who ordered a Testogel from Superdrug and was upset that she could only get three sachets at a time. “It’s supposed to last 30 days, but she used too much,” Briggs said. “There are pamphlets designed to explain how to use it, but people either don’t understand or they access information elsewhere that says it’s OK to use more.”
Different women react differently to the same amount of testosterone gel, another reason why regular blood tests are necessary. Mukherjee said: “If women are not properly counseled and monitored and checked, they can end up taking what we call a supra-physiological dose, meaning their testosterone will rise above the female reference range.
“Basically, they use it as an anabolic steroid, like it’s used for drugs in sports. It increases performance, and can lead to increased energy and well-being, but it can also have some pretty terrible side effects in some people, and it carries long-term risks, which is one reason it’s banned as a performance-enhancing drug. in athletes.”
Dr. Stephanie Faubion, a medical director for the North American Menopause Society, said: “The fact that you can get this without any input from a provider is scary. The bigger concern is that no one is really looking at the big picture for these women. Women may look to testosterone to solve something that will never solve it, when it could be addressed in another way by a medical professional they see in person.”
A spokesperson for Superdrug Online Doctor said its testosterone service is aimed at peri- and post-menopausal women with distressingly low libido or sexual interest/arousal disorder who have not responded to oestrogen-based HRT, and all its doctors are trained in providing of remote online consultations and prescriptions. They said: “We are able to verify the diagnosis by asking a series of specific questions about sexual interest and arousal… in the same way that any clinician seeing a patient face-to-face would do.
“We provide detailed advice to our patients to support accurate and correct dosing regimens of these medications and provide a testosterone blood test service for additional monitoring if they are unable to do so elsewhere. Blood tests are required before starting treatment, and at regular intervals during treatment.”
Superdrug added that patients must confirm the veracity of the medical information they submit. “Misrepresentation of health information to obtain treatment is not only a violation of our terms, but it can result in harm,” they said.
Not everyone thinks the availability of testosterone from online clinics is a bad thing. Dr Nighat Arif, a GP with a specialist interest in women’s health who has posted a variety of content on social media discussing the wider benefits of testosterone, said: “At the end of the day you are using a hormone to replace what you feel is necessary to replace back to you.
“If you’ve had a blood test and you try it for six months to a year, it’s not the end of the world. If it works and you’ve spent a bit of money privately, that’s fine – just make sure you’re seeing or dealing with a clinician who has you doing blood monitoring.”
Arif prescribes testosterone to female patients in accordance with the National Institute for Health and Care Excellence guidancewhich says it may be considered for menopausal women with low sexual desire if conventional estrogen- and progesterone-based hormone replacement therapy alone is not effective.
Not all of her patients report an improvement. “I’d say about 20% come back and say ‘I didn’t notice any difference at all’; about 30 to 40% say ‘I noticed a difference, but the days I missed it I didn’t really notice much’; and the rest say ‘that was the bit I needed; I got my energy levels back and I managed to get my sex drive back too’.”
But Davis, who has studied the effects of testosterone in women for several decades, cautioned that observed improvements in energy levels could be a placebo effect. She said: “I used to believe that testosterone improved well-being and energy because my patients would come in and say, ‘I feel great,’ but when we did placebo-controlled trials, we didn’t see that. Women would report feeling more energy and that their fatigue was better, but the placebo was just as good. The placebo effect is big, but it doesn’t last.”
Even for libido, the impact is usually not dramatic, she said.
What almost everyone agrees on is that more research is needed on the impact of testosterone on the female body – including whether it can help protect muscle and bone health or cognitive function, as some claim. Here, the data is “just all over the shop,” Davis said.
She is involved in studies to determine whether testosterone benefits bone health and sexual function in younger postmenopausal women (under 55), improves muscle strength in older women, or protects heart health in women at high risk of heart disease.
Davis is also working to understand what “normal” testosterone levels look like in midlife women, and whether they change significantly during menopause — two other big unknowns.
