Testosterone and HRT

Understanding Testosterone in Hormone Replacement Therapy (HRT) for Menopause

Testosterone is often associated with male hormones, but it is also an important hormone for women. During menopause, women experience a natural decline in testosterone levels, which can contribute to symptoms such as low libido, fatigue, mood changes, and reduced energy.

Testosterone replacement therapy (HRT) can help address these symptoms when oestrogen and progestogen treatment alone may not be sufficient. However, the use of testosterone in menopause treatment is not always straightforward and involves specific considerations. This guide explains the options available, how to use testosterone as part of HRT, the risks and benefits, and why it may be prescribed off-label (non-licensed use).

What Is Testosterone and Why Is It Important?

Testosterone is an androgen, often thought of as a "male hormone," but women also produce it, primarily in the ovaries and adrenal glands. In women, testosterone contributes to:

• Sexual desire (libido)
• Mood and mental clarity
• Energy levels
• Bone health
• Muscle strength

As women approach menopause, the production of testosterone declines, which can lead to a range of symptoms, including:

• Reduced sexual desire
• Fatigue or lack of energy
• Decreased sense of well-being
• Difficulty concentrating or mood swings

In some women, replacing testosterone can help manage these symptoms.

Testosterone Medications for Menopause

1. Testosterone Gel

Testosterone gel is a topical medication that is applied directly to the skin. It is typically applied to the arms or upper body.

• Benefits:

  • Easy to apply and can be absorbed quickly through the skin.
  • Allows for flexible dosing, as the amount of gel used can be adjusted.
  • Can be easily incorporated into daily routines.

• How to Use:
  Apply a thin layer to clean, dry skin (usually on the arms or abdomen). The exact amount will be determined by your doctor. Be sure to allow the gel to dry completely before putting on clothes, and wash your hands after application to avoid transferring the gel to others (such as children or partners).

Non-Licensed Use of Testosterone in Menopause HRT

Testosterone is not currently licensed for use in menopause in the UK by the Medicines and Healthcare products Regulatory Agency (MHRA). This means it is not formally approved for managing menopause symptoms like oestrogen and progestogen HRT. However, testosterone can still be prescribed off-label (i.e., for a use not specified in the product’s official licence) to women with low libido or other menopausal symptoms if their doctor deems it appropriate.

While it is not licensed, many healthcare professionals have found testosterone to be an effective treatment for certain menopause symptoms, especially in women who continue to experience symptoms like low sexual desire despite being on standard HRT.

Risks and Benefits of Testosterone in HRT

Benefits:

• Improved libido: Testosterone can help increase sexual desire, which can often be a concern for women experiencing menopause-related symptoms.
• Increased energy: Some women report feeling less fatigued and more energized after starting testosterone therapy.
• Improved mood and cognitive function: Testosterone may help improve mood, reduce feelings of irritability, and improve concentration or mental clarity.
• Support for bone and muscle health: Testosterone plays a role in maintaining bone density and muscle mass, which can be important for women post-menopause.

Risks:

• Excessive hair growth: High doses of testosterone can lead to unwanted hair growth on the face or body (hirsutism).
• Acne or oily skin: Testosterone may increase oil production in the skin, leading to acne or a more oily complexion.
• Voice deepening: Prolonged use of testosterone can cause voice changes, such as a deepening of the voice.
• Scalp hair thinning: Some women may experience thinning hair or male-pattern baldness.
• Mood changes: As with any hormone therapy, changes in mood such as irritability, aggression, or anxiety can occur.
• Increased risk of cardiovascular problems: There is some evidence suggesting that long-term testosterone use may have an impact on cardiovascular health, but the evidence is not yet conclusive. Ongoing monitoring is necessary.

How Long Can Testosterone Be Taken for Menopause?

The duration of testosterone therapy will depend on your individual needs and how well you respond to the treatment. Testosterone therapy should be reviewed regularly with your healthcare provider to assess whether it is still effective and appropriate for you. Some women may continue using testosterone long-term, particularly if it effectively manages symptoms like low libido or fatigue, while others may find they only need it for a short period of time.

In general:

• Short-term use (1-2 years) may be recommended for some women to address immediate symptoms such as low libido.
• Long-term use may be considered if benefits continue to outweigh the risks, but periodic reassessments by your healthcare provider are essential.

How to Use Testosterone for Menopause

1. Follow the prescribed dosage: Always adhere to the prescribed dose as recommended by your doctor. Starting with a lower dose and gradually increasing it is often a strategy to minimize side effects.

2. Monitor for side effects: Be mindful of any changes to your body, such as unwanted hair growth, acne, or changes in mood. Report these to your doctor, who may adjust your dose accordingly.

3. Regular reviews with your healthcare professional: Since testosterone is not licensed for menopause treatment, regular follow-up appointments are crucial to monitor your symptoms and assess the long-term safety of the treatment. This will ensure that any potential risks (such as cardiovascular effects or hormonal imbalance) are managed appropriately.

4. Avoid transferring the gel or cream to others: If you are using testosterone gel or cream, ensure that it is fully absorbed before making contact with others, especially children or partners, to prevent unintended exposure to testosterone.

Summary

Testosterone replacement therapy can offer significant benefits to women experiencing menopause, especially when low libido and energy levels are a concern. Though testosterone is not licensed for use in menopause, it is a viable treatment option prescribed off-label to many women. As with any treatment, it's important to understand the potential benefits and risks, and to regularly monitor and adjust your treatment in consultation with your healthcare provider.

For more information, you can visit the following trusted resources:

• Menopause Matters: Testosterone and Menopause

Always discuss with your healthcare provider whether testosterone therapy is suitable for you and how it fits into your overall menopause management plan.