According to data analysed by The Pharmaceutical Journal, testosterone prescribing for women in the UK has increased 10-fold between 2015 and 2023. Behind this is a trend for testosterone being portrayed as a quick fix for complex issues faced by women going through perimenopause - the time when a woman's body prepares to make the natural transition to menopause. But there's no clinical evidence to support this and testosterone in women is currently unlicensed in the UK.
Pre-menopausal women produce testosterone naturally in the ovaries. It is required for the development and maintenance of female sexual organs and sexual behaviour. It is also important for muscle and bone strength, and growth of normal body hair. And it may have favourable effects on mood, wellbeing and energy in women.
Testosterone levels appear to decrease as you get older, not just during perimenopause. Although for those who go through induced menopause, such as by having their ovaries surgically removed, testosterone levels can fall suddenly by up to 50 per cent.
But there is no level of testosterone below which a woman can said to be deficient, and a ‘testosterone deficiency syndrome’ has never been clinically defined.
Testosterone is one of the hormones involved in female sexual desire and low circulating levels are associated with diminished libido. Research studies indicate that many women reporting loss of libido (clinically defined as Hypoactive Sexual Desire Disorder) benefit from testosterone therapy.
But libido is a complex multifactorial function, not ruled solely by hormones. It involves physical, psychological and practical aspects. Taking testosterone will alter the biological state, but is commonly insufficient on its own - as typically there are many other issues involved such as low self-esteem, relationship problems, time alone without children interrupting, and certain medications.
Why is there a rise in testosterone prescribing?
NICE, the National Institute for Health and Care Excellence, and the British Menopause Society recommend testosterone as a medication for low libido in some women. However, it should be used only when all other treatments, namely oestrogen, have been unsuccessful. So, although there are grounds for the use of testosterone treatment, its use in women is controversial.
Prof Susan Davis, a leading researcher in this field from Monash University, Melbourne, Australia, conducted the most comprehensive analysis to date of all research on testosterone treatment in women. It included 36 trials involving 8,480 women.
Testosterone in postmenopausal women, compared to placebo or other hormonal medications such as oestrogen, did significantly increase frequency of sex as well as sexual desire, pleasure, arousal, responsiveness and self-image. However, the review found no benefits for cognitive measure, bone density, body composition, muscle strength or psychological wellbeing.
It did also show side effects including acne and increased hair growth. And it is clear more research is needed before definitive answers can be given on the efficacy and dangers of testosterone treatment. NICE recognises this and has requested the National Institute of Health Research (NIHR) to scope out the research that needs to be done. To help this process, the NIHR is collaborating with the British Menopause Society to understand the topic further and plan clinical trials.
The ‘Davina effect’
So, testosterone treatment in women is a complex area that needs more research. But social media is now exerting a strong influence. It is promoting testosterone to solve many symptoms and issues for women going through perimenopause – such as low libido, but also low mood, tiredness and poor concentration.
This includes what the media calls the 'Davina McCall effect' thanks to a video on Instagram of Davina applying her testosterone gel and talking about its benefits. As she is the presenter of recent popular TV shows about menopause, this is fuelling the sudden demand for prescribed testosterone.
This is a problem, as medicine is evidence-based. And without adequate evidence, as is the case with testosterone therapy, doctors are left with just opinions and anecdotal user reports, which leaves women open to receiving a treatment that’s potentially dangerous. Anecdotal accounts from celebrities, or anyone, should not be used to inform women on the correct medical treatment for them.
A drug should be prescribed following a shared decision-making process between doctor and patient. The doctor’s role is to provide all the necessary evidence to inform the patient and help to make the right decision for them.
Personal opinions on social media shouldn’t be part of this. Let’s not forget that testosterone is a regulated drug - not something you pick up from the supermarket. That means robust evidence of its efficacy is needed.
This whole issue taps into a wider problem – that expectancy and acceptance surrounding non-evidence-based treatment for women’s medical conditions is on the rise. But women have the right to evidence-based healthcare.
The use of anecdotes rather than evidence devalues the importance of scientific data in women’s health and is at the core of a growing problem, as pharmaceutical companies may see that women are driving sales of hormone replacement therapy based on anecdotes and social media alone.
This means they have no incentive to run the trials that can prove or disprove the efficacy of medication. Consequently, this puts women’s health research and future treatment options at significant risk.
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