Testosterone in women

Testosterone is one of a group of hormones called androgens. The British Menopause Society says women make both testosterone and estrogen before menopause, and that androgens are essential to the development and upkeep of female sexual anatomy, and to sexual behaviour. The European Menopause and Andropause Society (EMAS) adds that in women it is made by the ovaries and the adrenal glands.

In Urdu it keeps its English name, ٹیسٹوسٹیرون, as estrogen does in Urdu health leaflets.

Many women feel nothing at all. The BMS says many women with low testosterone levels have no distressing loss of desire, or any other symptom, even when asked directly. Women's Health Concern says some women are more sensitive to the change than others.

The symptom guidance links to testosterone is low libido that persists and causes real distress. The Pakistan Menopause Society describes this condition, hypoactive sexual desire disorder, as a persistent or recurring lack of sexual desire causing marked personal distress or difficulty between partners, not better explained by something else (1.5.3).

Levels drift down. The BMS says the fall seems to come with age, partly because the ovaries wind down, and can be sharper after a surgical menopause or a medical one, such as after chemotherapy. Women's Health Concern says young women who have had their ovaries removed, or who have premature ovarian insufficiency, may notice the change more.

Other causes first

Women's Health Concern says the causes of low desire around menopause are complex and rarely down to low testosterone alone. The BMS asks doctors to look at the whole picture first: the relationship, psychological causes, and medicines, giving some antidepressants, SSRIs and SNRIs, as an example.

It also says vaginal and urinary symptoms of menopause should be properly treated if testosterone is being considered. See vaginal dryness.

Estrogen before testosterone

The BMS says NICE NG23 and the BMS both recommend a trial of conventional HRT before testosterone is considered. The PMS recommendations say the same (5.9). The BMS adds that estrogen taken by mouth can reduce the testosterone available in the body, and that for some women, switching to estrogen through the skin can help without adding testosterone.

What it does not do

Women's Health Concern says there is not enough evidence to recommend testosterone for low energy, low mood, fatigue or brain fog. The BMS says trials so far have not shown benefits for thinking, mood, energy, or muscles and bones, and that the main reason to use it remains distressing low desire. EMAS says the same: low desire after menopause that causes distress is the only use with evidence behind it, and there the data show a moderate effect.

The treatment has its own page: testosterone therapy for women. In brief, Women's Health Concern says that on the NHS it is usually a gel rubbed into the skin, prescribed off licence, alongside HRT, with a trial of a few months and a recommendation to stop if there is no benefit. It lists greasy skin, acne, weight gain and slightly more facial hair as possible side effects, usually reversible.

The BMS says more long-term data on the heart and breast is needed, though short-term trial data is reassuring. In Pakistan, the PMS recommendations list one testosterone gel among the hormone products available (Table 10).

On DHEA, a hormone the BMS says the brain can convert into testosterone, the BMS says more research is needed before it can be recommended.

If losing your desire bothers you, or is causing strain at home, that is a reason to raise it. It is a recognised symptom with guidance behind it, not something to put up with in silence. Bring a list of the medicines you take, and mention any dryness or pain, because the guidance looks at those first.

For many of us, talking about desire with a doctor, let alone a husband, is hard. The Pakistan Menopause Society's recommendations name a husband's support as important, including honest talk about hormonal changes and respect for sexual health (4.2.6).

Women ask questions about intimacy and faith, and rarely get a straight answer. A scholar you trust is the right person for those.