Introduction
When we think of testosterone, the image that comes to mind is usually tied to male health, strength, and virility. However, testosterone plays a key role in women’s health too, affecting not only libido but also overall well-being. Unfortunately, many women are unaware of its significance or struggle to access accurate information and appropriate care.
Dr. Anna Cantlay, a GP and menopause specialist, brings her expertise to shed light on this often-overlooked hormone. In a recent discussion, she demystified the science behind testosterone in women, its critical functions, and the therapies available.
Testosterone: Not Just a Male Hormone
Despite its strong association with men, testosterone is a crucial hormone for women as well. Dr. Cantlay challenges this gendered stereotype, noting how online information often neglects its role in female health. “Testosterone is produced in our ovaries, adrenal glands, and even our peripheral tissues,” she explains. Peripheral tissues, like fat, contribute through a process called aromatization, where testosterone is converted to or from estrogen depending on the body’s needs.
Dr. Cantlay also highlighted emerging research showing that brain cells might produce testosterone, classifying it as a neurosteroid. This fascinating discovery underscores testosterone’s potential role in brain health, particularly in memory, mood regulation, and motivation.
How Testosterone Works in Women’s Bodies
In premenopausal women, testosterone is produced at levels comparable to estrogen, highlighting its importance. Its functions are far-reaching:
- Reproductive and Sexual Health: Testosterone enhances sexual arousal, boosts libido, and aids in achieving orgasm.
- Bone and Muscle Support: It is vital for maintaining bone density and muscle strength, reducing the risk of osteoporosis.
- Brain Function: Testosterone interacts with androgen receptors in the brain, influencing cognitive clarity, motivation, and even protection against neurodegenerative diseases.
- Cardiovascular Health: While still under-researched, testosterone may support heart health by improving vascular function and reducing inflammation.
Despite its essential roles, testosterone’s impact on women’s health remains understudied, leaving many questions unanswered.
Changes in Testosterone Levels Over Time
Women’s testosterone levels follow a predictable pattern throughout life. Dr. Cantlay explains that production peaks in the twenties and thirties, gradually declining with age. By menopause, levels are significantly reduced, though the ovaries remain hormonally active and continue to produce small amounts of testosterone.
Interestingly, there’s an unexplained spike in testosterone levels between the ages of 70 and 80. “We don’t know why this happens,” Dr. Cantlay admits, emphasizing how much more there is to learn about women’s hormonal health.
Why Testosterone Therapy Matters
Testosterone therapy remains a contentious topic, often shrouded in stigma and misinformation. For women, it can be life-changing, particularly when addressing symptoms like low libido that persist despite adequate estrogen replacement therapy.
Testosterone therapy is recommended in the NICE (National Institute for Health and Care Excellence) guidelines for managing distressing low libido in menopausal women. Yet, as Dr. Cantlay points out, cultural taboos and outdated attitudes have slowed its adoption.
Its role in managing other menopausal symptoms, such as brain fog and energy, do not yet form part of International Menopause Society guidelines and we need more research in these areas.
“Many women feel unsure about whether they need testosterone therapy or how to ask for it,” she says. “This conversation reminds me of the whispers around HRT years ago—‘Do I need it? Should I try it?’”
How to Start the Conversation
Dr. Cantlay encourages women experiencing symptoms of distressing low libido, otherwise known as Hyposexual Desire Disorder to speak with their GP. While blood tests are often part of the process, they’re not used to identify a “deficiency.” Instead, the tests ensure levels remain within a normal physiological range to avoid side effects from overuse.
“Symptoms are the key driver for treatment,” she explains. “If a woman has been taking HRT for several months, at a good dose, and still has troubling low libido, testosterone therapy may be worth exploring.”
Navigating Myths and Misconceptions
Misunderstandings about testosterone therapy abound, with some women hesitating due to fears of side effects. Dr. Cantlay addresses these concerns:
- Hair Loss or Hair Growth: While some androgenic effects like hair growth at the application site are possible, they’re uncommon with proper dosing. Hair loss, another concern, is rare and usually linked to high doses or sensitivity in women predisposed to male-pattern thinning.
- Voice Changes and Clitoromegaly: These structural side effects, including deepening of the voice or clitoral enlargement, are extremely rare and occur only with prolonged excessive doses. Dr. Cantlay reassures that careful monitoring minimizes these risks.
“The majority of women tolerate testosterone therapy well,” she says, emphasizing the importance of working closely with healthcare providers to balance risks and benefits.
Applying Testosterone Correctly
Application methods play a crucial role in therapy success. Dr. Cantlay recommends applying testosterone creams or gels to areas such as the supra-pubic region, outer thigh, or inner wrist. She advises that skin should be clean, dry, and free of lotions or moisturizers to ensure optimal absorption.
For women prone to dry skin, exfoliation may help remove dead cells and improve absorption rates. Additionally, it’s important to rotate application sites regularly to avoid skin irritation.
Challenges in Accessing Therapy
One of the biggest hurdles for women seeking testosterone therapy is the lack of female-specific products. In the UK, all available testosterone products are designed for men and prescribed to women off-label at lower doses.
“Women are often asked to use male products like Testogel sachets, which require subjective measurements, such as applying a pea-sized amount,” Dr. Cantlay explains. “This approach is far from ideal and leaves room for dosing errors.”
Androfeme, a female testosterone replacement licensed in Australia, offers better dosing precision with a built-in applicator. It can be imported in the UK and is available, however, it’s only privately and costs around £90–£100 for a three-month supply, making it inaccessible for many.
Dosing: Avoiding Pitfalls
Dr. Cantlay emphasizes the importance of accurate dosing, particularly with male-oriented products. Overuse can lead to temporary side effects, but long-term excessive use might cause irreversible changes. She encourages women to follow their physician’s guidance and ask questions if they’re unsure about their prescribed dose.
“Blood tests can help monitor levels, but women should avoid applying testosterone on the day of their test to prevent contamination,” she advises.
Is Testosterone Therapy for Life?
The question of long-term use often arises. Dr. Cantlay stresses that hormone replacement therapy, including testosterone, should be personalized and reviewed annually.
“There are no arbitrary cutoff limits,” she says. “It’s about assessing individual benefits and risks, and making a shared decision about continuation.”
Unfortunately, testosterone is not included in the Prepayment Certificate (PPC) for Hormone Replacement Therapy, adding another layer of financial inequity.
The Future of Testosterone in Women’s Health
Dr. Cantlay calls for systemic changes to improve access and affordability for women. Greater investment in research is also crucial to understand testosterone’s full potential and develop female-centered therapies.
“Women deserve better options,” she says. “It’s time to challenge outdated guidelines and advocate for equitable healthcare solutions.”
To Sum Up
Testosterone is far more than a male hormone—it’s a vital component of women’s health. From its role in sexual and reproductive health to its broader effects on brain and bone health, testosterone deserves greater recognition and research.
By breaking down myths, advocating for better therapies, and fostering open conversations, Dr. Cantlay is helping to reshape the narrative around testosterone and women’s health.
For women curious about whether testosterone therapy might be right for them, Dr. Cantlay’s clinics offer both NHS and private consultations. Together, we can ensure that all women have the knowledge and resources to make empowered decisions about their hormonal health.
