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.

Testosterone plays an important role in women’s health by:

• maintaining a healthy hormonal balance
• maintaining sexual function

Testosterone may also play a role by:

• increasing blood circulation to the pelvic region
• maintaining musculoskeletal health (bone density and muscle mass)
• protecting cognitive function
• improving mood and energy

How do testosterone levels change during the menopause?

Testosterone levels in the body gradually decrease with age. When women go through the menopause, either naturally or due to the surgical removal of both ovaries, the loss of ovarian function leads to a further decline in testosterone levels in the blood. This can cause symptoms.

What are the symptoms of low testosterone levels?

Low testosterone levels during the menopause can cause:

• reduced libido (low sex drive and satisfaction)
• decrease in energy levels
• tiredness
• loss of muscle strength
• mood changes, such as increased irritability or sadness
• difficulty concentrating or brain fog

These symptoms can significantly impact a woman's day-to-day and quality of life.

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

Hormone replacement therapy (HRT) is usually offered first. This is because HRT includes a combination of oestrogen and progesterone (when there is a uterus), or oestrogen only (if the uterus has been removed) , which can help improve many of the symptoms of the menopause. If HRT isn’t enough, the specialist may recommend trying testosterone replacement alongside HRT.

Testosterone replacement comes as a gel or a cream, or as an implant that goes under the skin. It may take up to six months to fully restore testosterone levels to a more balanced state, but some of the benefits of testosterone replacement may be felt after three months.

Who should take testosterone replacement during the menopause?

Testosterone replacement during the menopause is not a one-size-fits-all solution. Its recommended use is restricted and includes postmenopausal women who experience persistent symptoms of testosterone deficiency, especially reduced libido or women who have had surgical menopause.

Women who had hormone-sensitive breast cancer or who have an active liver disease need to see a specialist for individualised advice.

Testosterone may be used off-license under specialist care.

Are there any side effects of testosterone replacement?

In the right amount, testosterone replacement doesn’t cause side effects. However, if they do occur, they can include:

• acne
• increased facial or body hair
• male type hair loss
• mood changes, such as irritability
• water retention, leading to bloating
• voice changes, such as deepening of the voice

Close monitoring is needed with testosterone replacement to check that each patient is taking the right amount of testosterone for them. For this reason, patients who take testosterone replacement will require a blood test before they start treatment, after two or three months of treatment, and another blood test usually after six months. Following this period, patients will need a blood test once a year to check that testosterone levels are still correct.