Testosterone gel, while recognised to be a potentially beneficial treatment for low libido in menopausal women, is not yet licensed for this indication.
It was previously only issued via specialist menopausal clinics but due to recent increased demand and lack of a local NHS specialist service to adequately meet this demand, we have started to prescribe it in General Practice under strict safety conditions.
It is important that anyone considering this treatment as part of an HRT regime understands and accepts the associated risks of testosterone use in women.
There are a number of possible adverse effects some of which, while rare, are potentially irreversible. It is very important the user sticks to the correct dosing as overusing it will increase the risk(s).
Reported adverse effects are shown below; if thought to be linked to testosterone gel use, the dosage should be reduced, or the treatment stopped, and GP advice sought.
- Increased body hair at site of application – corrective measures could include spreading more thinly, varying the site of application and reducing the dosage
- Generalised hairiness (hirsutism)
- Male pattern hair loss or balding (alopecia)
- Acne and greasy skin
- Deepening of the voice
- Enlarged clitoris (this can be irreversible, and treatment should be stopped)
Randomised controlled trials and meta-analyses have not shown an increased risk of cardiovascular disease or breast cancer although longer term trials would be desirable.
The testosterone gel/cream should be to be applied to clean dry skin (on the lower abdomen or upper thighs) and allowed to dry before dressing.
Skin contact with partners or children should be avoided until dry and hands should be washed immediately after application.
The area of application should not be washed for 2-3 hours after application.
In addition to baseline blood tests for testosterone and free androgen index (FAI), one requires repeat blood tests 3 months after the first prescription and then 6 monthly long term. Scripts will not be issued unless this monitoring advice is adhered to and is necessary for patient safety.
In clinical trials, approximately 2/3 women responded positively to testosterone therapy (compared to 1/3 using placebo). The trials demonstrated that response may not be immediate, taking 8-12 weeks in some instances for the effect to become clinically significant. It is therefore advised that treatment should be trialled for a minimum of 3 months and maximally for 6 months and should be discontinued if there is lack of efficacy after this time.
If the event of any side effects, problems or concerns, it is important to contact your doctor.
Having read this information and once you have chatted to a doctor to ensure you have no contra-indications, if you would like to proceed with a trial of testosterone treatment, please complete the testosterone consent questionnaire. This is to acknowledge that you have read the information provided, understand and accept the risks and will adhere to the correct dosing and recommended monitoring.