Why are women turning to testosterone?

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In our last episode, we looked at testosterone and why a growing number of men are searching out tests to check whether they have low table but the male sex hormone is very important for another group too. Women.

1:17

I think for a long time testosterone was just viewed as a male hormone and it had nothing to do with women. But women produce testosterone. It's an important part of our body function.

1:35

It's also used to make one of the primary female sex hormones.

1:46

Testosterone is the way our ovaries actually make estrogen. It's a way our brain makes estrogen.

1:51

And just like the guys, women are increasingly being told that those classic symptoms of middle age might not be just down to a busy schedule, kids and work.

1:58

Symptoms of low testosterone in a female low libido, lack of motivation, mid section weight gain, anxiety, depression, mood swings, brain fog, migraines, and the feeling that you just can't think straight.

2:08

Anyone who's going through the menopause will recognize some of those symptoms. And it's exactly that group of women who are able to get testosterone here in the UK they're taking it too. Between 2015 and 2022, there was almost an 1000% increase in the number of women aged 50 and over getting testosterone gel from the NHS. So today we're getting the facts on testosterone treatments. What does the evidence say and can it really relight middle aged women's fire? From the Guardian I'm Madeline Findlay and this is Science Weekly.

2:26

So I guess like many sort of women in their 40s, I'd been struggling with various symptoms. Some of it was like anxiety and Feeling a bit down. Some of it was feeling really, really, really tired and some of it was having really low libido. Just not really feeling like having sex. Finding it very difficult to become aroused if I was having sex.

3:15

Linda Geddes is a science journalist who writes for the Guardian and a familiar voice here on Science Weekly. Like a lot of women heading towards middle age, she found herself thinking, what's wrong with me?

3:41

I talked to friends of a similar age or a bit older about this and they were like, well, it's probably perimenopause.

3:55

After some investigations with her gp, Lynda was put on hrt and that helped.

4:02

Loads and loads with stuff like anxiety and brain fog and tired. But it still wasn't really helping with this libido issue. And you know, obviously there could be other causes like stress. I've got two teenage children, I've got a full time job, life is just busy. But I did speak to other friends who had tried taking testosterone and they said, you really should try it.

4:07

Being a science journalist, Linda looked into the research on testosterone and like any of us searching the web, she came across a lot of claims about what it could do for and menopausal women.

4:35

There's a lot of stuff online and lots of claims that are made on podcasts, that sort of thing, suggesting that it, it can help with all sorts of things from like low mood and poor concentration and memory, sleep problems. And you know, I had a friend who took it who swore that it's made her more energetic and she reckons that she's able to build more muscle, she goes to the gym.

4:47

It all sounds great, but is there any evidence linking the menopause to a drop in testosterone?

5:11

We don't know that the testosterone production changes after menopause because so far not a single study has shown that testosterone levels drop meaningfully during natural menopause.

5:19

Professor Susan Davis is a consultant endocrinologist and head of the Monash University Women's Health Research Program. She's spent decades researching the role of sex hormones across a woman's lifespan.

5:31

Testosterone blood levels decline by about 25% between the ages of 18 and 40 and then continue to slowly decline. And it looks like blood levels bottom out around the age of 60. And we've seen that in several different studies done by different groups after the age of 65 or 70 years, blood testosterone levels do start to increase. This probably explains why older women start to struggle with facial hair and balding.

5:45

So testosterone levels do decline until about age 60, but there's no evidence to suggest they drop during the menopause in particular. Still, women going through perimenopause and menopause may have low testosterone and they may have menopausal symptoms that, according to claims online testosterone therapy could help with. The trouble is, working out your actual levels is difficult.

6:18

Susan, Measurement of testosterone is very complicated for several reasons. Firstly, women have extremely low testosterone levels compared to men. And most platforms for measuring testosterone can't tell normal from low from very low. It's like trying to use a yardstick to measure millimeters under a microscope. And even if you measure testosterone with great precision, there's no evidence that women with low levels are different to women without low levels. We've looked at all the studies that have evaluated testosterone, blood levels and muscle and cognition and mood and found no association. There are no symptoms in women that have been shown to be associated with low testosterone in any reliable study. That doesn't mean that testosterone doesn't matter. It just means that blood levels are not predictive. There's no. No more.

6:46

Levels at either extreme might be accompanied by symptoms, but there isn't an agreed level of what normal testosterone looks like. And it gets even trickier after menopause.

7:56

After menopause, testosterone predominantly comes from the adrenal glands. So these other hormones are released by the adrenal glands and they go into cells and do their thing and get converted into testosterone. So what's circulating in the blood does not tell us anything about what's happening in a cell. So, for example, there might be two similar women with the same blood testosterone level, but one's got a real problem with being hairy and the other one hasn't. And that's because the testosterone is acting in her cells differently or she might be making more testosterone in her cells. It's not reflected in the blood test. So that's why blood tests are flawed.

8:09

So there are no symptoms associated with low testosterone and there's also no evidence that testosterone can help with any symptoms associated with the menopause, bar one.

8:54

There is very good, consistent, repeatable evidence that in postmenopausal women and testosterone can improve libido in the majority of women with low libido.

9:08

And that's exactly what Linda was having trouble with.

9:21

I looked at the NICE guidelines, which really strongly say that it could be considered for menopausal women with low sexual desire if conventional estrogen and progesterone based HRT alone isn't effective.

9:25

After checking her estrogen and HRT dose, Linda found herself in the group that could be considered for testosterone. But even then, getting it wasn't straightforward.

9:41

A lot of GPs won't prescribe testosterone. They want to refer you to a specialist clinic. So then I had to go on a waiting list for an NHS menopause clinic and eventually I was prescribed the testosterone.

9:52

Coming up, what did testosterone do for Linda? And what happens when women take too much?

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10:28

So I've been taking it for just probably just over a year now and I do think it's made a bit of a difference.

10:56

Despite good evidence that testosterone therapy can be effective in menopausal and postmenopausal women with low libido, currently there's no female specific formulation of testosterone in many countries, including the uk, although last year one was approved by the Medicines and Healthcare Products Regulatory Agency and may become available this year.

11:02

And until then, Linda, women are prescribed male testosterone products. So in my case I get these little sachets of testa gel, I store them in the fridge and I think if you're a man, you'd be told to put one of these on a day. Whereas I've basically got to just use a little pea size amount every day and kind of eke it out over about eight days. Otherwise the risk is that you're taking too much. Once I've got my pea size blob out, I then use a clothes peg to close the packet back up because there's no other way of sealing it.

11:25

It's important to have levels monitored. Although there have been no long term safety studies of testosterone in women, experts regard it as safe within the premenopausal range. Beyond that, there may be health risks.

11:58

We have absolutely no evidence for the safety of testosterone at very high doses in women. We don't know the cardiovascular effects of giving high doses. We don't know the cancer effect or the brain effects or the mood effects.

12:12

Despite these unknowns, there are some well documented symptoms.

12:28

So I've seen over the course of my many years of practice. Women on high doses of testosterone have experienced voice changes which are not reversible, hair loss, body hair Growth enlarged clitoris, extremely high doses, increase in muscle mass, and when they come off it, they can't lose it. The other thing is it seems to sort of have brain effects. A lot of women find that they feel agile, agitated or irritable. While some women say they feel more in control, women can often, when they stop the testosterone, actually then feel quite flat.

12:33

Even on a lower dose, women can experience increased body hair spots and weight gain. But the promise of a renewed libido and all kinds of other unproven effects is a powerful draw. Whether through the mum group grapevine or on reality shows like Real Housewives, stories about women falling back in lust with spouses and long lost sex drives returning with a vengeance are enticing more and more women to give it a try. Do you notice a difference with it?

13:11

I do. Me too. My libido is bad. Yeah, I know. And I have more. I found it again. I found my libido.

13:42

Right.

13:49

Isn't it good when you find that again?

13:50

It's really good.

13:51

It was MIA for a little while. And inevitably, when high demand meets access issues, people who can afford it go private or even turn to unregulated sources with risks of receiving much higher doses than recommended. Yet head online and you'll find women who swear by testosterone therapy. It highlights one of the many gaps in women's healthcare.

13:52

Susan, you know, this is an area I've worked in for over 30 years and you start talking about testosterone in women and people just roll their eyes at you and it's only become sort of an acceptable area to work in in the last few years. I mean, I've got, I've done over 20, 25 large clinical trials of testosterone in women and measured blood levels in thousands and thousands of women. But until recently, no one's really valued the work. I guess there are lots of questions I want to understand. Why do testosterone levels appear to increase after the age of 70? Is there a longevity benefit? We're really interested in this. We're also interested in looking at female appropriate doses and the effects of testosterone on things like bone, muscle, cognition mode. So we're very open to conducting these studies and we are conducting them as fast as we can.

14:19

And it's worth remembering, just like for the men, it's never going to be a magical elixir. Back to Linda.

15:18

Based on my experience, if you're expecting testosterone to have a big impact on your mood, on your brain fog, you're going to be disappointed. I haven't really noticed anything, to be honest. And even the libido thing. It's very mild and minor. It's not like I'm suddenly, not like I'm suddenly super horny and trying to jump on my husband. It's more just a very kind of very subtle difference.

15:27

Still, even subtle effects can be meaningful.

15:53

I've been married for 20 years and like I said, I'm a busy working woman with kids in her late 40s now. And sex isn't necessarily the kind of highest priority in my life. But you know, that kind of when things are not working, it's, it's distressing. I'm, I'm really glad I'm on it. It's been great and continues to be great. So I am really happy with the testosterone. But yeah, I have to do some more waxing. The hair is vibrant with me, but it's, you know, it's managed.

15:57

A big thanks to Professor Susan Davis and to Linda Geddes. You can find her writing on theguardian.com and that's it for today. This episode was produced by me, Madeline Finlay. It was sound designed by Joel Cox and the executive producer is Ellie Burie. We'll be back on Thursday. See you then.

16:43

This is the Guardian.

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17:29