Why the NHS must offer testosterone to women struggling with the menopause
As HRT shortages bite, the producer of Davina McCall’s landmark TV programme argues
The shortage of hormone replacement therapy (hRT) has caused uproar, igniting debates in Parliament and triggering the appointment of an hRT tsar. The lack of oestrogen gel means that thousands of menopausal women are going cold turkey and their symptoms are returning overnight. hopefully they’ll get their hormones and lives back soon. And then they may want something more: testosterone.
For as a new generation of menopausal women have discovered, they are missing not just two hormones — progesterone and oestrogen — but three.
Testosterone is a female hormone, too, and one we make in the largest amount; three times that of oestrogen.
Yet no one tells you that in school biology lessons. According to the British Menopause Society, it helps energy, mood, libido and cognition, plus it maintains muscle and bone.
While oestrogen and progesterone drop suddenly at menopause, testosterone gently peters out. But supplementing with testosterone at that time can help with debilitating symptoms, too.
I’ve been using testosterone cream for six years as part of my hRT.
The main difference it makes for me is in memory — before I began taking it I sometimes panicked and struggled to find the words for things. Now I can give a speech for an hour without notes.
At work, I felt like a clapped-out banger before I started testosterone. Now I know I’ll cruise smoothly through the day, like a Tesla.
It’s not just my experience — as part of a documentary I produced, Davina McCall: Sex, Mind And The Menopause, which was screened last night, we monitored a group of working women in their 50s who started taking testosterone on top of their regular hRT over three months. The results were astonishing.
‘I seem to have a sharpness back, a real focus and clarity about what I’m trying to say,’ said Joanne harding, a councillor. Before the experiment she’d been exhausted. ‘It’s tiring feeling so tired all the time,’ she’d told us. (It wasn’t just how they felt — blood tests showed all the women’s testosterone levels were low-to-zero at the start.)
Paula Fry, a senior manager in the City, had said of her libido: ‘Brad Pitt wouldn’t do it for me.’ After testosterone treatment her mojo was back, and in general she said ‘it just feels like a lift in mood, the missing piece of the jigsaw’.
Before our experiment, business manager Maggie Dennis just said resignedly: ‘What is libido? I’d almost forgotten about it.’
And after? ‘I feel more like myself. I can think more clearly. I’ve got my va-va-voom back!’
Yet as Dr Zoe hodson, a GP from Manchester and menopause specialist, said in the programme: ‘We lose three hormones and they give us back two. Whose bright idea was that?’
She also explained that women’s fears that testosterone supplements would make them hairy were largely unfounded. Menopause experts give women only a tiny bit of testosterone, and roughly the same amount as the average woman would have in her early 40s (women need a tenth of the amount men make).
Occasionally women don’t tolerate it well, and one report has suggested that some can experience mild acne and hair growth — particularly if they use too much.
But after six years, I haven’t grown a moustache. Dr hodson said: ‘As long as it stays within the normal female physiological range, we can discount the beards, we can discount the testicles!’
What was surprising is that testosterone in both women and men is commonly viewed as a sex hormone, ramping up desire.
But the tests with the women for our documentary — and what they emphasised themselves — showed that the hormone had brought back their mental agility as well as their ability to feel pleasure.
Carolyn harris, a Labour MP who has led the campaign in Parliament for a yearly payment for hRT prescriptions, is another who has experienced the brainboosting impact of testosterone.
She started taking testosterone on top of her regular hRT last year, and is delighted with the results: ‘Testosterone should be readily available on prescription for all women,’ she told me.
Many women in the spotlight take testosterone and are happy to talk about it, including Lorraine Kelly and Davina McCall, who has seen great results but admitted in last night’s show: ‘Testosterone was another hormone I lied about taking — I felt embarrassed and ashamed about it.’ Not any more.
The message is getting out there, but slowly: in a survey of more than 4,000 women for the programme, 61 per cent had never heard that testosterone could be part of hRT. Yet NhS guidelines approve it ‘for menopausal women with low sexual desire if hRT alone is not effective’.
Setting up our testosterone tests for the programme, we decided to go beyond just filming.
We wanted the women to have solid evidence for themselves about any changes, so they filled in a form rating the severity of more than 20 menopause symptoms, and a testosterone-specific test which asked about brain fog, energy and libido. Most found that after the testosterone treatment their general menopause symptoms, such as difficulty sleeping, had gone from extreme to rare or non-existent. And they were no longer misplacing objects around the house — the car-keys-in-thefridge syndrome had gone.
We didn’t have time to show all of this on TV, but our interviewees agreed to do other ‘before’ and ‘after’ tests, including memory checks. Again, there were improvements. ‘I can remember my husband’s mobile number now,’ said one tester.
Obviously, this was not proper science, and after you have done a test once you tend to get better at it. But it did give the women insight into their progress.
Menopause researchers are hoping to do cognitive trials on a larger scale, and academics at Manchester Metropolitan University are planning to investigate women and testosterone with data from the UK Biobank (a project involving 500,000 people).
There has been one trial comparing testosterone gel and a placebo on 92 women who were not already on hRT, conducted by Professor Susan Davis at Monash University, Australia.
It showed ‘a consistent finding of improved performance on tests of verbal learning and memory with testosterone therapy’.
Studies have shown that testosterone treatment does not raise
At work, it turned me from a clappedout banger into a Tesla
Few GPs feel confident about prescribing it to women
the risk of breast cancer — long-term risks remain untested, but using gel or cream is known to be safer than pills or implants.
Despite testosterone being approved by the NhS, very few GPs feel confident about prescribing it. Because it was once wrongly considered to be a male-only hormone, they were not taught about it at medical school.
A female testosterone patch was approved in the UK years ago, particularly for younger women with low sexual desire after a hysterectomy or removal of the ovaries, but was discontinued due to ‘lack of demand’. So now women are given male-sized sachets or pumps of testosterone gel on the NhS, and have to work out one tenth of the dose themselves.
I’m on a six-month waiting list just to apply to get testosterone gel at my NhS menopause clinic.
I get the rest of my hRT on the NhS but have to go private to buy AndroFeme, a testosterone cream for women that’s licensed in Australia and imported here. It costs me about £160 a year — but I’d rather have that than a cappuccino in the morning.
The British Menopause Society guidelines for doctors note that a lack of testosterone in women ‘can lead to a number of distressing sexual symptoms such as low sexual desire, arousal and orgasm.
‘Testosterone deficiency can also contribute to a reduction in general quality of life, tiredness, depression, headaches, cognitive problems, osteoporosis and muscle loss.’ Topping it up seems to be a no-brainer. As Davina McCall asks: ‘When will they give us our own hormone back?’