- Testosterone gel may be helpful for some women in the menopause who experience low sexual desire and who are on Hormone Replacement Therapy (HRT).
- As testosterone gel is designed for use by men, the instructions for women are different from the information contained in the manufacturer’s leaflet.
- While testosterone gel is not licensed for use by women, it is considered to be safe and effective.
- Testosterone gel might have some side effects, but these should be very few when used as prescribed.
- Testosterone gel can take several months to work and is not effective for every woman.
- The use of testosterone gel will need to be monitored (such as regular blood tests) to make sure the benefits outweigh the potential side effects.
What is testosterone?
You may think of testosterone as a male hormone, but women make this hormone too. It is one of the sex hormones that women produce, together with oestrogen and progesterone.
In women, levels of testosterone in the body gradually reduce as they become older, with many women not even noticing. Others are more sensitive to the changes and sometimes benefit from extra testosterone. Younger women who have surgical menopause (removal of ovaries) may notice the change in testosterone more, perhaps because they are younger and because the drop in levels is sudden.
Why use testosterone?
A low dose of testosterone can sometimes be beneficial in improving a person’s sex drive (or libido) when HRT alone is not effective. However, it does not help everyone. Research shows that there are no benefits for concentration, mood, energy, or muscle/bone health in using testosterone therapy.
What symptoms can testosterone help with?
The National Institute for Health and Care Excellence (NICE) suggests that, if women are experiencing low sexual desire related to the menopause, then testosterone may be helpful. This is why your menopause specialist has recommended you try this medication. Testosterone will normally be combined with standard HRT as it works best when there is oestrogen as well.
Can testosterone gel be prescribed for women in Mid and South Essex?
Yes, the local prescribing committee for Mid and South Essex Integrated Care System recommended that testosterone gel can be used for women with low sexual desire if HRT alone is not effective. Treatment must be started by a clinician with expertise in treating the menopause. Your GP will be able to refer you to a menopause specialist, who will assess if testosterone gel is suitable.
How is testosterone treatment given?
- Testosterone is usually given as a gel, which you rub into your skin.
- There are two products approved for use in Mid and South Essex, and your menopause specialist will discuss which is better for you.
You need to be aware that none of the products are marketed specifically for testosterone replacement in women. They are designed for hormonal replacement therapy in men. Due to this, the instructions for use in the menopause will be different from the information contained in the manufacturer’s leaflet. It is very important that you follow the instructions below, and not the manufacturer’s leaflet.
The desired female testosterone replacement dose is approximately 5mg a day.
Testogel® comes as a gel in a small sachet and you need to rub only a small amount of this gel into your skin daily. Testogel® was originally available as a 50mg sachet, but this is being discontinued by the manufacturer, and replaced with a 40.5mg sachet. Instructions for use of both strengths are below:
- One 50mg Testogel® sachet should last around 10 days. You should use the 50mg sachet sparingly over 10 days, rolling the top and sealing it with a clip between uses. The amount to apply each day is approximately equal to the size of the tip of a ballpoint pen lid (such as a Biro), approximately 0.7mm to 1mm size; your menopause specialist will discuss this with you further. The sachet should be kept in the fridge between uses.
- One 40.5mg Testogel® sachet should last around 8 days. You should use the 40.5mg sachet sparingly over eight days, rolling the top and sealing it with a clip between uses; your menopause specialist will discuss this with you further. The sachet should be kept in the fridge between uses.
Tostran® comes as a gel in a pump dispenser. The dose is usually one measured pump (which contains 10mg of testosterone) every other day.
How should testosterone gel be used?
The gel should be rubbed onto your lower abdomen or your thighs and allowed to dry before you get dressed.
There is a risk that testosterone gel can accidentally transfer to other people, and this can lead to increased blood testosterone levels in the other person. To reduce this risk, you should not have contact with any other person while the gel is drying (approximately 10 minutes), and you should cover the application site with clean clothing once it has dried. You should wash your hands with soap and water immediately after the gel has been applied.
The area that the gel is on should not be washed for three hours after application to allow the gel to be absorbed, however you should wash the application area with soap and water before physical contact with another person (adult or child). Your menopause specialist will explain this to you and answer any specific questions you may have.
Taking an ‘off-licence’ medicine
- In the UK, testosterone is not currently licensed for use by women, so it is said to be prescribed ‘off-licence’. Your specialist will explain this to you. It means that the manufacturer cannot advertise or make any recommendations about using the gel for women.
- It is not uncommon in clinical practice to use medicines outside their product licence as long as the use meets the specific requirements of the General Medical Council (GMC) and the government regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA).
- When using a medicine off-licence, it does not mean that it is unsafe, or that you are part of a clinical trial. Testosterone gel for women has been shown to be effective, and use is supported by expert groups.
- Off-licence medicines are only prescribed after careful consideration of other options and will only be used if it is the most appropriate medicine available.
Are there possible side effects?
If you use the recommended dose, side effects should be very few. This is because testosterone gel is given to restore testosterone to its level before the menopause. However, some side effects are dependent on the dose taken and can include:
- increased facial or body hair (common)
- hair loss (less common)
- acne and greasy skin (less common)
- deepening of voice (rare)
- enlarged clitoris (rare)
Very occasionally, women notice some increased hair growth or skin changes in the area in which they have rubbed the gel. This may be avoided by varying the area of skin on which you rub the gel.
Whilst there is a lot of information about long-term side effects of oestrogen and progesterone replacement therapy in the menopause, there is less information on any long-term effects of testosterone replacement therapy. Randomised studies have not shown an increased risk of cardiovascular (heart) disease or breast cancer with testosterone replacement although longer term follow-up studies are lacking. The doctor or nurse looking after you can always discuss your specific risks and benefits from using this therapy if you have further questions. You can also speak to them should you experience any of these side effects.
How long does it take to work?
The medicine can take several months to work, and it is not effective for every woman. Your menopause specialist will therefore prescribe your testosterone gel for the first three to six months. If the treatment is working, they will ask your GP to take over prescribing. Your GP will also continue to check that you are responding well, and that you are not experiencing any unwanted side effects.
You may also be advised to use vaginal oestrogen if it is needed to treat vaginal dryness.
Do I need a blood test?
Blood tests cannot diagnose whether you need testosterone but are used as a safety check to ensure you are not getting too much on top of your own natural levels. You will have a blood test before starting, repeated after three months and six months during treatment, and then every 12 months.
Your menopause specialist will carry out your blood tests until your GP takes over your care, which will be three to six months after you start treatment. Your specialist will let your GP know when your next blood test is due when they ask them to take over prescribing. Please also keep a record of when your tests are due so that you and your GP can work together to make sure your blood tests are done at the right time.
Who should not take testosterone for menopause?
There are some women who should not take testosterone. If you have had hormone sensitive breast cancer or if you have active liver disease, you should not take it.
Looking after your medicine
The instructions on how you should store your medicine will be on the pharmacy label. Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date stated on the packaging.
Should you have any questions or concerns, please do speak to the doctor or nurse looking after you.
- British Menopause Society toolkit for clinicians: Testosterone replacement in menopause (May 2022)
- Women’s Health Concern leaflet: Testosterone for women (February 2022)
South East London Area Prescribing Committee leaflet: Testosterone gel or sachets for the treatment of low sex drive in the menopause Hertfordshire and West Essex Area Prescribing Committee: Testosterone gel patient information leaflet for women experiencing menopause.
Author: MSEMOC working group
Approved by: MSEMOC
Date approved: March 2023
Review date: March 2028 or sooner if subject to national updates