Rising numbers of menopausal women are going private to get prescriptions of testosterone to treat menopause symptoms, but doctors remain divided over its use.
The number of women taking testosterone to treat symptoms associated with the menopause has increased tenfold since 2015, with many more turning to private clinics due to the barriers faced accessing the hormone on the NHS.
Advocates of testosterone say they are “furious” that women are having to turn to private doctors for something they should be able to access on the NHS and argue that “medical misogyny” has prevented the development of robust research in the past.
However, some menopause specialists remain cautious about prescribing the hormone to women until randomised controlled trials can be carried out, as they argue the full effects of the treatment cannot be known until this happens.
This includes the chair of the British Menopause Society, Paula Briggs, who said there needs to be more regulation around the use of the hormone, as she fears women’s safety is being comprised by “unregulated” advice on social media.
An increasing number of women is being prescribed hormone replacement therapy (HRT) for a variety of symptoms associated with the menopause.
HRT typically involves taking oestrogen and progesterone, however more women are now taking testosterone to help alleviate symptoms including low libido, low energy and brain fog.
Testosterone is currently unlicensed for women in the UK, meaning no drug company has applied for a licence for a testosterone product for female use.
However official guidelines, set by the National Institute for Health and Care Excellence (Nice), state testosterone can be prescribed for women experiencing low libido, after other options, including traditional HRT, are exhausted.
Many GPs who specialise in the menopause believe the guidelines are too restrictive, as they argue there is growing evidence that testosterone has a wide range of benefits for their patients and should be more readily available on the NHS.
Dr Nighat Arif, a GP who also runs a private menopause clinic, said her patients have reported many benefits from using testosterone, including lifting their mood, brain fog, improved decision making and increased energy.
“The far-reaching benefits of testosterone therapy that I’ve seen clinically means that we have to consider testosterone as the third component of managing menopausal symptoms,” said Dr Arif, who has worked in the NHS for more than 15 years.
Dr Louise Newson, a GP who also runs a private menopause clinic, said she started prescribing testosterone for low libido about seven years ago and soon noticed women reporting a number of other benefits, including “mood, energy, concentration and stamina”.
“Obviously, in a very small study of my own patients then yes absolutely it does definitely help. People find that they actually have more energy,” agreed Dr Nadira Awal, a GP who also provides private care for menopausal women.
The GPs i spoke to said they face many hurdles prescribing testosterone on the NHS, which means it can take months for women to access the hormone.
Meanwhile, many GPs who do not specialise in the menopause refuse to prescribe the hormone entirely, meaning an increasing number of women are choosing to pay hundreds for a private prescription.
“Personally, I’m furious as a doctor that women have to go privately for something that they’re entitled to, because it’s Nice recommended and why should we have a disparity between those that can have and those that can’t have? That’s not the kind of healthcare system that I want to work for,” said Dr Arif.
‘I’m annoyed that there is a lack of information out there’
Alison Nockels had been taking traditional HRT for four years before she started taking testosterone last year.
“I spoke to one of my neighbours. We just got chatting and had a girl’s conversation about how we were feeling. She had done a lot of research and said that she had been put on testosterone and said read up on it basically,” she told i.
“I read loads and loads and loads on it and realised that I was lacking in probably not enough oestrogen, but absolutely some of the symptoms I was getting I was lacking in testosterone. It was pretty obvious.
“I felt knackered all the time. My libido had just disappeared. Tired, strength, libido – end of.”
Ms Nockels approached her GP who she said was “amazing” and prescribed the hormone immediately, however she was prepared to go private if her GP had said no.
“Within three weeks it had kicked it. I got a ridiculous benefit from it,” she said.
“I am annoyed that there is a lack of information out there. When you reach a certain age you are not given any information about the menopause and what’s available,” she said, adding that it would be “fabulous” if GPs ran Well Women Clinics for women going through the menopause.
Ms Briggs said the evidence on the benefits of testosterone for menopausal women is currently not robust enough for the British Menopause Society’s guidance around the use of the hormone to be changed. Like Nice, the British Menopause Society only recommends testosterone is used for low libido after other options have been exhausted.
Ms Briggs said she is not “anti-testosterone” and said it was “unlikely that women would have significant side effects if they use doses within the recommended range”, but said it is also possible that there is a “placebo” effect to taking the hormone.
She said: “Women’s expectations are being raised via social media platforms. There is not the NHS capacity to meet the demand and there’s no other place to go. So you could be very sceptical and see this as a money-making business.”
Dr Arif argues that a lack of research has been carried out on the use of testosterone in women due to “medical misogyny”.
“Testosterone has historically been seen as a male hormone. It’s almost seen like women just want their sexiness back. It’s so much more than that because I’m telling you as a doctor who has been doing menopause care for ten years that women just want to feel like themselves again at this stage in life because we’ve forgotten them,” she said.
Dr Newson agreed that the lack of research was “a reflection of women’s health”, adding that “no one has been that interested”.
She argued women should be trusted to make decisions about their health and said there are other medications that are prescribed before the full long-term effects are understood.
“I think when we don’t have randomised control studies, and we won’t for a long time because they take a long time to do, then as a doctor it’s about sharing uncertainty with patients. Let the consenting women decide what they want to do,” she said.
Ms Briggs said it is “not true” that women’s health has been deprioritised and that there has been “considerable input to various areas”.
“You can’t just say we give women things because it makes them feel better. That’s not evidence-based medicine,” she said.
She urged people to “calm down” and “allow the NHS to keep up” with the growing demand for HRT.
A spokesperson for Nice said it was working to update its menopause guidelines, but has not yet identified “any substantive new evidence on using testosterone beyond the current recommendations”.
They added: “Nice has discussed the need for evidence in this area with the National Institute for Health and Care Research (NIHR) who have agreed to scope new research.”