Do you know everything there is to know about the menopause? Dr Phillipa Kay wrote the book The M Word and here are some reviews.
Women have three sex hormones: oestrogen, progesterone and testosterone and levels of all three of these hormones fall after the menopause.
Testosterone is made in the ovaries but also in the adrenal glands which are found above the kidneys and the levels gradually fall throughout adulthood, even before the menopause.
Now, although the levels of testosterone are lower after the menopause there still is some present and without the opposing effect of lots of oestrogen the effects of the testosterone can be ‘unmasked’, leading to hair on your face or hair loss on your scalp.
Testosterone is involved in your libido, your sex drive as well as your sexual responses themselves, in arousal and ability to reach orgasm.
Aside from sex it also has role to play in your energy level or fatigue, in memory and concentration, in muscle mass and metabolic rate. In fact when it is prescribed as part of HRT, women often say they feel more back to their normal selves again, that they just ‘feel better’.
While blood tests are generally not used in the diagnosis of the menopause and perimenopause if you are over the age of 45, your doctor may request a blood testosterone level if your symptoms could be related to low testosterone. This isn’t required for diagnosis and treatment but can be used to monitor your response to testosterone replacement.
Testosterone replacement is not given on its own, only as part of hormone replacement therapy (HRT) involving oestrogen and progesterone, or oestrogen alone if you do not have a womb.
For many women, the replacement of oestrogen relieves their symptoms, but if you have any of the symptoms described above and these have not improved with HRT then testosterone can be useful.
Testosterone is given as a cream or a gel, and currently there are no formations licensed for use in HRT in the UK. There used to be, and they were removed from the market for commercial reasons, not safety ones and all the previous safety data is still available. Whether or not your GP can prescribe testosterone will depend on the local formulary and guidance, currently unfortunately this seems to vary across the country.
To apply the gel or cream rub it into clean dry skin on your tummy and thighs and don’t wash the area for a couple of hours. The Australian brand AndroFeme is available in the UK and comes with an applicator to measure the correct amount of cream, though other brands are available.
People are often concerned about potential side effects and worry that they may develop voice changes or other symptoms.
Your doctor will arrange blood tests to monitor that you are on the correct levels as if we simply bring up your low testosterone to normal (female) levels side effects are unlikely. If too much is given side effects such as acne or excess facial hair can occur. Some women notice that if they rub the cream into the same place each day that hair growth can occur but if you regularly move the application site it can help.
It is recommended that a three month trial of testosterone is given as it can take up to two or three months to see an effect. If it hasn’t made a difference to your symptoms after six months you will be advised to stop it, but if it has there is no set end point. Just as with HRT, as long as the benefits continue to outweigh any risks you can continue.
Testosterone isn’t the answer to everything, for example if your libido has fallen because sex is painful due to vaginal dryness you are more likely to respond to vaginal moisturisers and topical oestrogen than testosterone. But it can be the answer to getting your ‘oomph’ back, so do discuss with your GP.
Lots more about testosterone and all aspects of the menopause in my book The M Word by Dr Philippa Kaye which is available now!
Read even more about Dr Phillippa Kaye’s book the M Word here.
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