Testosterone is a hormone for any gender. It is important to note that there are guidelines for using testosterone in menopause transition patients. It is not a hormone just for men. The ovaries make testosterone too! Often, many clinicians and OB/GYN physicians say that they are not aware of using this at all and/or were taught not to. The more that we can prescribe testosterone responsibly, the less patients will go to unqualified providers. ISSWSH (International Society of the Study of Women’s Sexual Health) and The Menopause Society both have evidence-based guidelines and practice recommendations on this and they are both in alignment with each other. It is suggested for postmenopausal patients for HSDD (low desire) and to keep your total testosterone levels, the most reliable test to use for monitoring, within the physiologic normal range. More research is needed for sure.
Access to testosterone for women, is a huge issue. I could count 10 people to every 1 person that state they can’t find anyone to prescribe it versus those who can in our practice. A recent 2024 article out of the UK, essentially said that in women testosterone is neither proven to be long-term safe or unsafe. However, we do have some data that shows its benefits and safety. Yes, I agree, more and larger, long term studies are needed. Much of what is reported in the article regarding side effects is due to supraphysiological levels like what we see with pellets. Pellets achieve supraphysiologic levels of hormones that often lead to side effects or adverse effects. There is no FDA-approved pellet for women and thus more studies are needed. Side effects or adverse effects (some irreversible) include acne/oily skin, deepening of the voice, clitoral enlargement, unwanted hair growth, and hair loss from the head.
Testosterone is also a hormone that when you first initiate it, no matter the route, you need to follow blood levels closely (every 4-6 weeks initially) and then these levels can be spaced out thereafter once an established response to a certain formulation and route is seen. Levels are important for you to comply with as the patient, when requesting or starting a T prescription, and this can’t be stressed enough to follow blood levels as there is a lot of variability in absorption. We primarily use topical testosterone gels or creams in our practice, as they can be easily started, and stopped, unlike pellets which cannot be reversed, once placed. We suggest a trial of 3-6 months at therapeutic levels to assess for a positive response.
Dr. Moorhead and Dr. Reyes at Magnolia Gynecology are menopause experts eager to help you determine if testosterone is right for you, as not every menopausal patient needs it. However, many women benefit vastly from it. Responsible prescribing of this hormone for women, is a skill that we recommend a menopause expert do for you.
