‘Scary’ how easily women can get testosterone, doctors say

Ilike many middle-aged women, i often feel tired, can’t concentrate and suffer from low libido. Conventional hormone replacement therapy (HRT) has helped a little, but according to friends in the know and on social media, there is something else that might help: testosterone.

Proponents claim that testosterone replacement not only increases libido – the only thing it’s recommended for – but can also improve a range of menopausal symptoms, from low mood, poor concentration and memory, to sleep problems, stamina and motivation. It can even protect women’s bones, muscles and brains, it’s claimed.

If that sounds too good to be true, it probably is: Medical guidelines emphasize that the only evidence-based indication for testosterone use in women is low sexual desire, and there’s insufficient data to support its use for other symptoms or disease prevention. As a result, few primary care physicians are willing to prescribe it.

Yet women do get access to it through private clinics or – as I discovered for myself – online clinics.

I managed to buy three sachets of Testogel – equivalent to a month’s supply – from Superdrug Online Doctor after completing a short questionnaire about my sexual desires and medical history, and submitting blood test results showing the amount of testosterone in my body. Using the same prescription, I was then able to order a further 30 sachets from another online pharmacy.

According to Prof Annice Mukherjee, a consultant endocrinologist at Spire Manchester Hospital, I’m not alone. “Testosterone evangelists on social media say it’s the missing hormone, and if you don’t feel good on HRT it’s because you’re missing testosterone – which makes many women desperate for it,” she said. “They know the NHS or private doctors won’t give it unless they can identify low libido, so they learn what to say. If you know what boxes to tick, you can get it.”

Mukherjee and other experts worry that women aren’t necessarily being fully educated about potential risks and side effects, or how to use testosterone safely. This is a particular problem in the UK because, unlike in Australia, where a formula specifically targeted at women has been approved, British women are usually prescribed the male formula. Men with low testosterone are supposed to take one sachet of Testogel a day, but women have to split each sachet over 10 days, which is difficult to estimate.

Prof Susan Davis, head of the women’s health research program at Monash University in Melbourne, Australia, said: “Even a little bit more can lead to excessive amounts – so the potential for harm is much greater.”

Dr Paula Briggs, a consultant in sexual and reproductive health at Liverpool Women’s Hospital, said she had seen a patient who had ordered Testogel from Superdrug and was concerned that she could only get three sachets at a time. “It was supposed to last 30 days but she had used too much,” Briggs said. “There are leaflets that are designed to explain how to use it but people don’t understand it or they look elsewhere for information that says it’s OK to use more.”

Different women respond differently to the same amount of testosterone gel, another reason why regular blood tests are needed. Mukherjee said: “If women are not properly educated, monitored and controlled, they can end up taking what is called a supra-physiological dose, which means their testosterone will rise above the female reference range.

“Basically they use it as an anabolic steroid, like it’s used for doping in sports. It increases performance and can lead to increased energy and well-being, but it can also have some pretty nasty side effects for some people and it has long-term risks, which is one of the reasons it’s banned as a performance-enhancing substance for athletes.”

Dr. Stephanie Faubion, medical director of the North American Menopause Society, said, “The fact that you can get it without any input from a health care provider is scary. The bigger concern is that no one is really looking at the bigger picture for these women. Women may be looking at testosterone to solve something that is never going to solve it, when it could be addressed in another way by a medical professional who sees them in person.”

A spokesperson for Superdrug Online Doctor said the testosterone service was aimed at peri- and postmenopausal women with worryingly low libido or sexual interest/arousal disorder who have not responded to oestrogen-based HRT, and that all its doctors were trained to provide online consultations and remote prescriptions. They said: “We can verify the diagnosis by asking a series of specific questions about sexual interest and arousal… in the same way that any clinician seeing a patient in person would.

“We provide our patients with detailed advice to support accurate and correct dosing schedules of this medication and offer a testosterone blood testing service for additional monitoring if they are unable to have this done elsewhere. Blood tests are required before starting treatment and at regular intervals during treatment.”

Superdrug added that patients must confirm the veracity of the medical information they submit. “Misrepresenting health information to obtain treatment is not only a breach of our terms and conditions but can also cause harm,” they said.

Not everyone thinks the availability of testosterone through online clinics is a bad thing. Dr Nighat Arif, a GP with a specialist interest in women’s health who has posted a range of content on social media discussing the wider benefits of testosterone, said: “Ultimately, you’re using a hormone to replace what you feel you need to get back.

“If you’ve had a blood test and you try it for six months to a year, it’s not the end of the world. If it works and you’ve spent some money on it privately, that’s fine – just make sure you’re seeing a clinician or dealing with a clinician who’s going to monitor your blood.”

Arif prescribes testosterone to female patients in accordance with the National Institute for Health and Care Excellence accompanimentstating that it may be considered in menopausal women with low sexual desire when conventional hormone replacement therapy based on estrogen and progesterone alone is not effective.

Not all of her patients report an improvement. “I would say about 20% come back and say, ‘I didn’t notice any difference at all’; about 30 to 40% say, ‘I did notice some difference, but on the days that I missed it, I didn’t really notice much’; and the rest say, ‘It was exactly what I needed; I got my energy back and I got my sex drive back.’”

But Davis, who has studied the effects of testosterone in women for decades, warned that any perceived improvements in energy levels could be a placebo effect. She said: “I used to believe that testosterone improved well-being and energy, because my patients would come in and say ‘I feel great’, but when we did placebo-controlled trials we didn’t see that. Women reported feeling more energetic and their fatigue was better, but the placebo was just as good. The placebo effect is huge, but it doesn’t last long.”

Even for libido, the effects are usually not dramatic, she said.

What almost everyone agrees on is that more research is needed on the impact of testosterone on the female body — including whether it can help protect muscle and bone health or cognitive function, as some have claimed. Here, the data is “just all over the place,” Davis said.

She is involved in studies to determine whether testosterone benefits bone health and sexual function in younger menopausal women (under age 55), improves muscle strength in older women, and protects heart health in women at high risk for heart disease.

Davis is also working to understand what “normal” testosterone levels look like in middle-aged women, and whether this changes significantly during menopause – two other big unknowns.