It is often described as ‘the missing piece of the puzzle’ for women going through the menopause.
Advocates say that, at the right dose, it can banish fatigue, revive libido and restore ‘va-va-voom’ – a phrase widely used by women themselves on social media. And testosterone therapy, championed by everyone from broadcaster Davina McCall to celebrity chef Dame Prue Leith and, most recently, former Cabinet Minister and Mail columnist Nadine Dorries, is having a moment.
NHS prescriptions for the hormone have surged eight-fold in five years, from 9,756 to 80,793 a year – a rise dubbed ‘the Davina effect’ after the presenter’s documentary and posts about her ‘pea-sized’ daily dose she takes alongside HRT.
Many claim it can turn back the clock on desire – or, as some women bluntly put it online, make them feel like ‘horny teenagers’ again.
Campaigners, celebrities and some private doctors also argue it can boost energy, mood and focus, and even improve muscle and bone health.
Many women say it has transformed their lives, saved their marriages and made them feel like themselves again. One Mail on Sunday reader said: ‘On testosterone, I was lean, my thought process was clear and my sex life had never been better. I lost interest in sex the minute I came off it and started putting weight on.’
But it doesn’t work for everyone, evidence for many of the claims is limited and side-effects can occur.
Another reader said it left her ‘aggressive and impatient’, while one added: ‘I was prescribed testosterone for low libido, but all I got was acne.’
So is it a miracle drug for midlife women, or are the benefits being overstated? The MoS has spoken to leading UK experts to help you cut through the noise and decide if testosterone may be right for you.
A rise in testosterone prescriptions was dubbed ‘the Davina effect’ after the presenter’s documentary and posts about her ‘pea-sized’ daily dose she takes alongside HRT
What exactly is testosterone? I thought it was a male hormone?
While testosterone is often seen as a ‘male’ hormone, women also produce it in smaller amounts in the ovaries and adrenal glands.
It plays a key role in sexual desire by boosting dopamine – the ‘feel good’ chemical linked to pleasure, decision-making, mood and focus. Levels peak in the mid-to-late 20s, then gradually decline with age.
Menopause specialist Dr Naomi Potter, founder of Menopause Care, says: ‘While testosterone levels don’t fall off a cliff like oestrogen does, they slowly decline.
‘The theory is that by the time women approach menopause, this can cause symptoms such as low libido, fatigue and reduced motivation – and replenishing levels may improve these.’
Standard hormone replacement therapy (HRT) typically tops up oestrogen and progesterone, with testosterone sometimes added.
Does that mean all women should take it in midlife?
No. Low testosterone on a blood test is completely normal, experts say.
Consultant gynaecologist Haitham Hamoda, trustee of the British Menopause Society, says 95 per cent of women have low levels in their 40s.
But he adds: ‘Messaging on social media suggests that if you have low levels you need to take a testosterone replacement, but without any clinical symptoms there is no need to act on it.’
Low libido, fatigue, anxiety, poor sleep and brain fog are often blamed on testosterone – but Dr Potter says these can just as easily be due to low oestrogen, ageing, relationship issues or life stress.
For that reason, NHS guidance says testosterone should be considered only after standard HRT has been tried, and for women with hypoactive sexual desire disorder – a persistently low libido.
Dr Paula Briggs, a reproductive and sexual health consultant at Liverpool Women’s Hospital, says: ‘It’s natural for sex drive to reduce with age. But if it’s causing distress and HRT hasn’t helped, it’s not unreasonable to try testosterone.’
So do I have to already be on HRT before I try testosterone?
Typically, yes. This is because standard HRT alone may be enough to resolve these symptoms, says Dr Briggs.
If they persist while on HRT, doctors must first be confident that you are on the correct dose of oestrogen – which can reduce hot flushes, night sweats and vaginal dryness – before starting on testosterone.
Dr Potter, co-author of Davina McCall’s book Menopausing, explains: ‘If you replace someone’s testosterone before you’ve replaced their oestrogen, the body will convert that testosterone to oestrogen and you won’t get the same benefit.’
Taking it without oestrogen can also increase the risk of side-effects – namely acne, greasy skin and increased hair growth.
Menopause specialist Dr Naomi Potter is the co-author of Davina McCall’s book Menopausing
Former Conservative Cabinet Minister and Daily Mail columnist Nadine Dorries used testosterone for fatigue
I think I could benefit. How do I get it?
Approach your GP to discuss your symptoms and whether you may be eligible.
They will first want to rule out other factors which may be causing a low libido.
Dr Potter says: ‘Sex drive isn’t just about a single hormone. A lot of it is about the health of your relationship, life stresses and other lifestyle factors – are you eating well, drinking too much alcohol, or are you overweight?
‘These things can contribute, so a doctor will want to make sure other causes are ruled out first.’
Some GPs are reluctant to prescribe testosterone because there is no product specifically approved for routine NHS use in women.
In simple terms, this means there is no formulation that has been fully assessed and recommended by NHS bodies for female patients.
As a result, when it is prescribed it is done ‘off licence’ – a common and legal practice where doctors use a medication outside its original approval.
In practice, this usually means that women are given small, carefully adjusted doses of testosterone products originally designed for men.
Some women may need to be referred to an NHS menopause specialist before a prescription is offered.
Others choose to seek a private prescription instead – but this can be expensive. A standard testosterone cream costs around £80 to £100 for a tube, which typically lasts three to four months.
Before prescribing it, a blood test may be used to check baseline levels and to ensure they are not already high, which could increase the risk of side-effects.
‘You could line up ten women, with ten different results, and the ones with the lowest testosterone readings might have the best sex drive,’ says Dr Briggs.
‘It’s complicated. You don’t want to give them too much.’ Levels are usually monitored after starting treatment – typically at around three to six months, and then periodically – to make sure they remain within the normal female range.
I’m worried about getting the right dose. How do I take it?
A testosterone product for women, Androfeme, finally received a licence for use in the UK last year – meaning it has been approved by the Medicines and Healthcare Products Regulatory Agency (MHRA) as safe and effective for women.
But it is still only available privately, as it is being appraised by the NHS watchdog, the National Institute for Health and Care Excellence (NICE).
It involves dispensing a pea-sized amount of cream using a plastic syringe on to the skin.
Generally, smaller doses of products already available for men, including Testogel and Tostran, are used.
Tostran comes in a pump-action cylinder and dispenses a 10mg dose which should be taken every other day. Testogel comes in sachets and involves squeezing out one-eighth every day.
Androfeme could be available on the NHS later this year in a pump-action format to make dispensing the correct dose easier.
What difference could it make to me?
This is the big question. The largest study to analyse the highest-quality evidence, published in The Lancet Diabetes & Endocrinology in 2019, suggests testosterone therapy improves sexual function, including libido, orgasm and arousal.
But many women report wider benefits – from clearer thinking and better memory to increased drive, mood and confidence.
On social media, women commonly say they feel ‘more like myself again’, while Davina McCall has said testosterone is ‘more than just about sex drive’.
Dr Potter says: ‘In my clinic, we’ve treated thousands of women with testosterone, and while it is by no means a magic bullet, and doesn’t work for everyone, women report they don’t have as much brain fog, they feel more switched on and more themselves.’
But she and other experts acknowledge there is ‘no solid evidence’ for this from trial data.
Mr Hamoda adds there is a strong placebo effect from hormone replacement therapy generally.
‘It’s a grey area beyond libido,’ he says. ‘Often women are upping their oestrogen levels and adding in testosterone at the same time, so the effect is hard to pick out.
‘The studies that have been done haven’t shown an obvious benefit – but there also haven’t been any big studies. There’s a lack of evidence, rather than conclusive evidence of a lack of effect.’
A new Welsh study, called Esteem and involving 400 women, aims to address the evidence gap and will investigate whether testosterone can reduce menopausal symptoms beyond libido alone.
But testosterone may also have no effect at all – those voices are, understandably, less often heard.
Dr Briggs believes just one in ten women experience a benefit.
‘Women should limit their expectations as, while testosterone can be transformative for some, it is not the answer to everything, or for everyone,’ she says. ‘It’s one piece of a very big jigsaw. I get women crying in my clinics who expected to feel amazing, just like Davina McCall, and it’s just not going to happen. Normal ageing has to be factored into this too.’
I’ve heard it could stop me getting dementia. Is it true?
There is no proof of this. While some experts have suggested testosterone may play a role in long-term brain health, the British Menopause Society says there is no evidence it improves cognitive performance in the short term or reduces dementia risk.
Dr Briggs says: ‘It hasn’t been used long enough, for a start.’
Any data that does exist is either unreliable or shows no clear benefit, experts say. ‘The studies often give oestrogen and testosterone at the same time, and are not always compared with placebo,’ says Dr Hamoda, ‘so it’s hard to work out any beneficial effect.’
Androfeme could be available on the NHS later this year in a pump-action format to make dispensing the correct dose easier
What are the risks – and will I grow a beard?
Testosterone is generally safe and well tolerated when kept within the normal female range. Most women develop some hair at the application site, and it can cause greasier skin, acne, hair loss and slight weight gain, while some may feel ‘a bit more aggressive’, says Dr Potter.
Some women who notice facial hair may blame testosterone, but Dr Briggs says this is often a normal part of ageing.
But taking too much can cause more serious problems, including a deepening voice, male pattern baldness and even genital changes.
‘A significant number of women come through my clinic where well-meaning GPs have prescribed testosterone but have given them too much,’ Dr Potter adds.
‘I see irreversible voice changes, hair loss and even clitoromegaly [the abnormal enlargement of the clitoris]. That’s why we’re so cautious.’
There have also been concerns about heart risks, as anabolic steroid use in men is linked to heart disease and strokes. But the British Menopause Society says short-term data on these risks is ‘reassuring’.
How long should I take it for?
There is no fixed time limit as long as testosterone is helping to manage symptoms, the side-effects are acceptable and there is regular monitoring, experts say.
But the benefits should be properly assessed after six months. Dr Briggs recommends women are ‘very honest with themselves’ and to consider stopping if there has been no noticeable improvement.
What if I don’t want to take testosterone?
There are lots of other factors which contribute to low libido.
For some women, taking vaginal oestrogen to address dryness and pain can prove transformative, while antidepressants and couples therapy can also prove useful.
Mr Hamoda adds: ‘Many studies now show exercise can help reduce symptoms, and stopping smoking and drinking less alcohol can also be beneficial. That holistic, all-round approach will certainly have added benefits.’
TESTOSTERONE HELPED ME ENJOY LIFE AGAIN
‘I didn’t feel like me any more,’ says Jo Moran of experiencing menopause symptoms
Jo Moran endured 12 years of debilitating menopause symptoms that affected her family life and career.
She began HRT aged 49, which ‘saved my marriage’ by easing hot flushes, improving sleep and reducing joint pain – but it was adding testosterone last December that proved ‘life-changing’.
The mother-of-two from Malmesbury, Wiltshire, had blamed her worsening memory, extreme fatigue and plummeting libido on the pressures of her job in financial services. She woke up each morning already feeling exhausted and relied on alarms to do basic tasks.
While HRT helped some symptoms, her brain fog and low libido worsened, contributing to her taking redundancy last year. ‘I didn’t feel like me any more,’ says Jo, now 57. ‘It was unbearable.’
After researching online, she sought a private prescription for testosterone – something she says had never been suggested to her.
Within three weeks, she says, it transformed her life.
Now running her menopause coaching business EmpowHer Path, she adds: ‘My memory is so much better, my libido is back, I have more energy and I’m enjoying life more because I’m not constantly exhausted.
‘If I think too much about the years of my life that were wasted, I get angry – I feel like I was failed.’