Before the menopause, women make three times more Testosterone than Estrogen
Testosterone is produced by our ovaries and our adrenal glands.
As we get older, the levels gradually decline and by the time we reach menopause we have only around one quarter the levels we had in our 30s.
For women who have a sudden menopause (for example if their ovaries are surgically removed) there is an abrupt drop in testosterone and this dramatic loss can cause significant symptoms.
What does Testosterone do?
Our bodies and our brains need Testosterone.
We have receptors for this hormone all over our body – in our bones, muscles, heart, even our eyes.
Testosterone plays an important role in sexual arousal, sexual response, libido, bone strength, metabolism, cardiovascular health, cognitive performance, energy levels and wellbeing in women.
What are the benefits of Testosterone replacement?
Many women find that adding testosterone into their HRT provides further improvements in their symptoms including:
- Improved energy and stamina
- Improved muscle mass and strength
- Improved concentration
- Increase clarity of thought and memory
- Increased libido and sexual arousal levels
Who needs Testosterone replacement?
Not every woman needs Testosterone as part of her HRT. Most of the research on the effects of this hormone has shown that women with a low libido are most likely to benefit.
Are blood tests needed before starting Testosterone?
It is important to do blood tests prior to considering testosterone to ensure your levels are in the lower end of the range.
Once you have started the treatment, another blood test is usually done at around 6 weeks to check the levels have improved and ensure they remain within the normal female range.
After this time, it is usual to then do blood tests every 6 months to yearly.
How is Testosterone prescribed for women?
There is a Testosterone product designed especially for women called Androfeme that is licensed in Australia.
This is a cream that contains Bio-identical Testosterone. It is rubbed onto the skin of the lower abdomen or upper thighs daily.
It is not funded or licensed yet in New Zealand.
From 1st April 2024, Pharmac will be funding a testosterone gel called 'Testogel" for use in New Zealand. Although this product has been formulated for men, it is possible to use it in smaller doses as part of menopausal hormone therapy.
See here for the Pharmac announcement about funding Testogel
Can Testosterone be taken alone?
It is usually advisable to give testosterone after a woman has already been established on ‘standard’ HRT – either estrogen alone if she’s had a hysterectomy, or estrogen and progesterone if she hasn’t.
This is because we need to make sure we have good levels of estrogen in our body before we add in the testosterone.
If our estrogen levels are too low, our body will simply convert the testosterone into estrogen.
How long does it take to feel the effects?
The benefits of testosterone are not usually apparent straight away – it can take several weeks or months to work and it is not effective for every woman. If there is no benefit by 6 months of use, it should be stopped.
Will taking Testosterone turn me into a man?
The short answer to this, is no.
Testosterone in HRT is given at doses that maintain testosterone levels in the normal female range.
We do blood tests before starting and then again at around 6 weeks to ensure we are keeping in the right range.
The aim of testosterone treatment is just to replace what is missing and the doses in the Androfeme product have been designed specifically for women.
What are the possible side effects of Testosterone?
Side effects are very rare – the most common side effect women get is a bit of extra hair growth only at the site they apply the cream.
This can be often by improved by rubbing it into places with few hair follicles (upper outer thighs and buttocks are the recommended sites) and regularly changing the area of skin on which you rub it in.
As the dose is so low, testosterone used in this way does not increase your risk of developing facial hair, voice deepening or skin changes. It is important to have regular blood monitoring to reduce the risk of any side effects occurring.
AndroFeme®1 contains Almond oil so should not be used if you have an allergy to almonds.
Does taking Testosterone increase the risk of Breast Cancer?
All of the research so far on using testosterone in women has not shown any increased risk of breast cancer.
What are the other health benefits of replacing testosterone in women?
Emerging evidence shows that it may reduce the risk of heart disease and dementia.
See the links below for more information on the use of testosterone in women.