Testosterone in women: a patient’s guide

As we age, we experience many changes, both physically and mentally, including a change in hormone levels. Leading menopause specialist Dr Theodora Kalentzi provides a patient’s guide to testosterone, including an explanation of its role in women’s health and the symptoms of low testosterone levels.

What is testosterone?

Testosterone is a sex hormone present in both women and men, although in different amounts. In women, testosterone is produced by the ovaries and the adrenal glands.

What role does testosterone play in women’s health?

Testosterone plays a key role in women’s health by maintaining sexual function.

It may also contribute to women’s health by maintaining musculoskeletal health (bone density and muscle mass), protecting cognitive function and improving mood and energy.

How do testosterone levels change during the menopause?

As we age, testosterone levels in the body decrease gradually and may plateau during natural menopause. When menopause happens due to surgical removal of both ovaries, it can intensify the drop in testosterone levels in the body, potentially resulting in symptoms.

What are the symptoms of low testosterone levels?

Low testosterone levels might lead to various symptoms including reduced libido, decreased energy levels, fatigue, loss of muscle strength, mood changes such as increased irritability or sadness, and difficulties with concentration, also known as experiencing brain fog. These symptoms collectively can significantly affect a woman's day-to-day and overall quality of life.

Is testosterone prescribed on its own or alongside hormone replacement therapy (HRT)?

Hormone replacement therapy (HRT) is typically the first line of treatment offered. HRT involves a blend of oestrogen, and progesterone (if the uterus is intact) or oestrogen only (if the uterus has been removed), which aims to alleviate many menopausal symptoms. If HRT alone proves insufficient, a specialist may suggest incorporating testosterone replacement therapy alongside HRT.

Testosterone replacement therapy can be administered as a gel, cream, or subcutaneous implant. It may take up to six months for testosterone levels to become more balanced, although some benefits may be noticeable after just three months.

Currently, testosterone replacement therapy is considered an 'off-label' treatment for menopausal symptoms, meaning it's not officially licensed for this purpose. Women seeking testosterone replacement therapy must consult with a specialist for a prescription.

Who should take testosterone replacement during the menopause?

Testosterone replacement during the menopause is not a one-size-fits-all solution. Its use is restricted, and is typically recommended for postmenopausal women with ongoing symptoms of reduced libido, or those who have undergone surgical menopause.

However, women with a history of hormone-sensitive breast cancer or active liver disease should seek personalised guidance from a specialist, as they may not be suitable candidates for testosterone replacement therapy. In certain cases, testosterone may be prescribed off-license under specialist care.

Are there any side effects of testosterone replacement?

When administered appropriately, testosterone replacement therapy generally doesn't induce side effects. However, if they manifest, potential side effects may include acne, increased facial or body hair growth and male-pattern hair loss.

It can also provoke mood swings like irritability, water retention, which leads to bloating, and voice changes. Due to these possibilities, vigilant monitoring is essential to ensure each patient receives the appropriate testosterone dosage.

As a result, individuals undergoing testosterone replacement therapy will undergo blood tests before beginning treatment and again after two or three months. Subsequently, it is important to have blood tests every 6-12 months to verify that testosterone levels remain within the acceptable range.

If you would like to book a consultation with Dr Kalentzi, simply visit her Top Doctors profile today.