Introduction,
Testosterone, often associated with male strength and vigour, is quietly emerging as a potential game-changer for women’s health, particularly for menopausal women. While hormone replacement therapy (HRT) primarily focuses on estrogen and progesterone, advocates like Kate Muir are calling for greater recognition of testosterone’s unique benefits for women. Despite its critical role in libido, bone density, muscle health, memory, and possibly even heart health, testosterone is prescribed to only about 8,000 of the 13 million women of menopausal age in the UK through the NHS. But with new research and patient testimonies, experts are pushing for broader use of testosterone to address the overlooked needs of menopausal women.
The Unseen Hormone, Why Testosterone Matters for Women
Contrary to popular belief, testosterone isn’t just a male hormone. Women naturally produce more testosterone than estrogen before menopause, and it plays a significant role in their health. Levels peak in a woman’s early twenties, then gradually decline, halving by her forties and further dwindling in her sixties. This gradual drop can leave many women feeling drained, mentally foggy, and experiencing a lower libido. In some cases, supplementing testosterone to pre-menopausal levels can counteract these effects, restoring energy, sharpness, and intimacy.
While testosterone is primarily seen as a treatment for male health issues, its benefits for women are gaining attention. According to the National Institute for Health and Care Excellence (NICE) guidelines, testosterone supplementation can help women with low sexual desire when conventional HRT isn’t enough. Testosterone therapy may also be an ally in the fight against muscle loss, osteoporosis, and even cognitive decline.
Testosterone’s Impact on Libido and Beyond
One of testosterone’s well-known effects is on sexual desire, a significant concern for many women going through menopause. According to a 2022 survey by the Fawcett Society, about half of women aged 45 to 55 reported “low to no interest in sex.” Testosterone, alongside estrogen, can help restore libido. Professor Susan Davis of Monash University, an expert on the hormone’s role in sexual health, explains that testosterone works directly in the brain to influence sexual desire, fantasies, and thoughts while also improving blood flow to the genitalia, enhancing sensations of arousal.
But testosterone’s impact extends beyond the bedroom. Women who add testosterone to their HRT regimen often report enhanced energy and mental clarity, suggesting that the hormone may play a vital role in cognitive health as well. In a small 2013 study published in Menopause, Davis found that testosterone alone significantly improved verbal learning and memory in postmenopausal women, a benefit many women say helps relieve “brain fog.”
Protection for Bones, Heart, and Brain
Testosterone’s effects on bone and muscle health are perhaps its most overlooked benefits. Research indicates that testosterone strengthens osteoblasts, cells that form bone, thus improving bone density when combined with estrogen HRT. In a randomized study of over 300 women, those on combined estrogen and testosterone therapy showed greater spine and hip bone density than those on estrogen alone. Given that osteoporosis disproportionately affects women, this hormone could be an essential piece in preventing fractures and preserving mobility in older women.
In addition to bone health, testosterone may have cardiovascular benefits for women. A study in The Lancet Healthy Longevity revealed that older women with low testosterone levels had double the risk of heart disease. Researchers, including Davis, are calling for large-scale trials to explore testosterone’s impact on heart health in women, especially since heart disease risk increases post-menopause as estrogen and testosterone levels decline.
Perhaps most promising is the role testosterone might play in preventing cognitive decline. Studies suggest that lower levels of testosterone correlate with higher risks of developing Alzheimer’s, particularly among women with the APOE-4 gene variant. Dr. Lisa Mosconi at Weill Cornell’s Women’s Brain Institute is studying how testosterone might help protect the brain against the buildup of amyloid plaques, which can lead to Alzheimer’s. For women concerned about cognitive health, testosterone may be worth considering as part of a broader strategy that includes nutrition and exercise.
Limited Access and the Need for Tailored Treatments
Despite these potential benefits, access to testosterone therapy remains limited. Many general practitioners lack training in prescribing testosterone for women, so patients are often referred to specialists or forced to seek private treatment. In the UK, NHS testosterone prescriptions are largely reserved for menopause clinics or gynaecologists, and the options are restricted. No testosterone creams or gels specifically formulated for women are available on the NHS, so women must use male preparations like Testim or Testogel, carefully measuring a fraction of the dose intended for men.
Australia offers Androfeme, a female-formulated testosterone cream approved for menopausal women, but it’s only available privately in the UK. While transdermal options (patches, creams, or gels) are the safest form of testosterone, women in the UK who wish to access testosterone often face barriers due to the lack of tailored options and training among healthcare providers.
A Safe Option? The Evidence on Cancer Risk and Side Effects
For women considering testosterone therapy, safety is a key concern. Research suggests that transdermal testosterone is safe, with minimal side effects when used in physiological doses. Studies have not shown an increased risk of breast cancer with testosterone therapy. In fact, a recent observational study of over 20,000 women found that testosterone use was associated with a 50% lower risk of breast cancer compared to non-users. This finding offers some reassurance, although experts note that HRT generally attracts healthier users who may already have lower cancer risks due to lifestyle factors.
Testosterone therapy may cause mild side effects in some women, such as increased acne or body hair, though these issues are often dose-dependent. The international menopause experts’ panel recommends testosterone at doses that replicate pre-menopausal levels, rather than the high doses associated with masculinizing effects. This careful approach minimizes risks, ensuring that testosterone supplements remain a feasible and beneficial option for women.
A Call for Clinical Trials and Broader Awareness
Despite mounting evidence, testosterone’s potential for women remains underexplored due to a history of gender bias in medical research. Until recently, the hormone was considered irrelevant to women’s health, resulting in a lack of comprehensive studies and standardized treatment options. Advocates like Muir, supported by researchers like Davis, are pushing for more rigorous clinical trials to establish evidence-based guidelines and make testosterone therapy more accessible to women in menopause.
As testosterone therapy becomes more recognized, experts hope to see a shift in the medical community’s approach to menopause treatment. Wider access and greater awareness could empower women to make informed decisions about their health and benefit from treatments that address the full spectrum of menopause symptoms. By broadening the focus of HRT beyond estrogen and progesterone, healthcare providers can better support women through the complexities of menopause and promote a healthier, more resilient aging process.
An Overlooked Ally in Women’s Health
As the conversation around testosterone therapy gains momentum, women are beginning to ask more questions about this once “male-only” hormone. With the potential to improve bone, muscle, brain, and cardiovascular health, testosterone may indeed play a crucial role in women’s longevity. For those who feel their current HRT isn’t meeting all their needs, testosterone could be a valuable addition.
However, access remains a challenge, and more research is needed to understand its full potential. As Muir puts it, “It’s time we demanded more knowledge” about testosterone’s role in women’s health. For now, testosterone stands as an overlooked yet promising option for women navigating the challenges of menopause, one that could redefine our approach to HRT and women’s wellness.
References
- Davis, S., et al. “Testosterone’s Role in Female Sexual Health.” Menopause, 2019.
- “Testosterone and Bone Density in Women.” Journal of Clinical Endocrinology & Metabolism, 2023.
- Mosconi, L., et al. “Hormones and Cognitive Health in Women.” The Lancet Healthy Longevity, 2024.