The current controversy surrounding testosterone treatment is causing confusion amongst women and healthcare professionals alike. British Menopause Society guidance follows NICE NG23 which recommends that testosterone is used for low libido after other options have been exhausted.
The current controversy surrounding testosterone treatment is causing confusion amongst women and healthcare professionals alike. British Menopause Society guidance follows NICE NG23 which recommends that testosterone is used for low libido after other options have been exhausted.
Levels of testosterone in women decline between the ages of 20 and 40. By menopause the levels have plateaued out and are stable. Testosterone is produced by the adrenal glands and the ovaries in peri and post-menopausal women. Testosterone is not the third component of HRT and promoting misinformation is creating unrealistic expectations for women, some of whom have challenging social circumstances. Managing women with hypoactive sexual desire disorder, necessitates a biopsychosocial approach. It is important to consider contributory factors which include vulvovaginal atrophy and relationship issues.
In women already taking HRT, who have low libido and no other significant contributing factors, it is reasonable to trial testosterone once a baseline total testosterone level has confirmed that the level is not already at the upper end of the normal range for women, as this is what we try to achieve with testosterone gel/cream.
There are various preparations, all licensed for use in men in the UK, that can be used to treat women outside of product license. It is important that this information is recorded in the patients’ records.
A further total testosterone level should be checked at 6-12 weeks.
A review of the patient to assess response should then take place at 6 months, and where there is no improvement using a female physiological dose of 5mg per day, treatment should be discontinued.
Using higher doses in women, could lead to potentially irreversible side effects including clitoromegaly, deepening of the voice and male pattern baldness.
For women who have a beneficial effect from treatment and who are continuing with testosterone, a minimum of an annual review is recommended with a total testosterone level.
Please refer to the BMS Tool for Clinicians on “Testosterone replacement in menopause” for further information – available on the BMS website.