When I started training to be a doctor over 20 years ago, menopause was barely mentioned at medical school.

Thankfully, the tide is changing, and menopause has become one of the most common conditions I see in my GP surgery, making up to a third of my daily consultations.

But I often feel sadness when listening to elderly women share their stories of their struggles with menopause, some of whom are riddled with osteoporosis or had heart attacks or strokes in their late-fifties. Their relationships may have ended, they lost jobs, or felt they lost their sense of identity along the way. I do wonder what role the impact of estrogen deficiency and the resulting health conditions could have played in these life events.

Hormone replacement therapy (HRT) is primarily given to manage the symptoms of menopause, such as hot flushes/flashes, sleep disturbance, and mood changes. Some of the positive “side effects” of HRT include the protection of bone and heart health. But many of my older patients were put off HRT due to historic negative press linking it to an increased risk of breast cancer, which has since been disproven. Many suffered as a result.

I sometimes feel anxious myself about menopause as I slowly move towards this season of life. But I also feel encouraged by the awareness being raised about menopause and treatment options.

However, GPs like me are also feeling frustrated by the growing number of so-called “menopause experts” online and in the media whose advice, at times, can be both misinformed and misleading.

The latest trend comes in the form of testosterone, with claims proliferating on social media that it can improve cognitive symptoms associated with menopause such as memory decline, brain fog and mood variability, as well as enhance general wellbeing in postmenopausal women. Contrary to the advice from some health influencers and celebrities online extolling the benefits of testosterone, there is currently no evidence to support these claims. Testosterone in postmenopausal women has been shown to enhance libido but that is the only indication we have at present.

The National Institute for Health and Care Excellence (NICE) and the British Menopause Society do recommend testosterone as a medication for low libido, but only if everything else has been tried and failed.

The Pharmaceutical Journal has found 10-fold increase in women being prescribed testosterone since 2015, indicating a big surge in demand. This is a concerning trend. I have had patients shouting at me sometimes if I don’t offer them testosterone as a first line treatment. They threaten to go private, which they are entitled to of course, but this is currently an unlicensed drug in the UK and therefore not approved for use as part of regular HRT in the NHS.

It’s worrying because many private firms are some of the biggest champions of the use of testosterone for menopausal symptoms. Testosterone comes with several potential side effects, including acne and excess hair growth, which patients requesting it must be made aware of. Starting at £70 per script, it’s not cheap either. More importantly, we simply don’t have enough evidence to back the long-term and safe use of testosterone for menopausal symptoms.

It is fabulous that women, especially those with large and respected platforms, are speaking up about their experiences and bringing about change in attitudes to menopause. But this one-size-fits-all approach is resulting in difficult conversations between doctors and their patients. Going through the menopause does not make you an expert on it. Researching how best to manage your menopause symptoms doesn’t make you an expert on someone else’s experience. And if one treatment worked for you, it won’t necessarily work for another woman. Women need to be seeking guidance on how to manage menopause symptoms from experts such as doctors and nurses who are medically trained, not from women with public profiles or large social media followings but no medical qualifications.

HRT for many women is safe, effective and it’s often described by my patients as “transformative”. It can help them to continue with their life, have relationships, work and remain connected with their identities. HRT comprises of oestrogen in all cases, and if you have a womb you will also be prescribed progesterone alongside this, which helps protect you against endometrial cancer. There are a number of treatment options and preparations for HRT available. Sometimes finding out what works best for that particular woman is a bit of a trial and error approach and that’s perfectly normal.

Every woman will experience menopause differently depending on a variety of factors including family history, past medical history, and her lifestyle. While HRT can be helpful, other therapies can help too, and often it’s a holistic approach that makes the greatest impact, such as lifestyle changes, psychological therapies, seeking support, and non-hormonal medicines.

Understandably, women experiencing significant menopausal symptoms will want to feel better or more like themselves as soon as possible, so promises on social media of a quick fix can be appealing. But where is the evidence to say testosterone for menopausal symptoms other than libido is safe and effective to take in the long-term? We need to be clear about this: there isn’t any at present.

It’s really important to me that all women going through perimenopause and menopause are informed by the latest evidence based research and not by observational or anecdotal stories.

Dr Punam Krishan is an NHS GP in Glasgow, medical educator and director of the British Society of Lifestyle Medicine

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