For midlife ladies on social media final week, there was one sizzling subject of debate: testosterone.
The ‘male’ intercourse hormone – additionally produced at decrease ranges in ladies – has quick change into the newest buzzword in menopause care.
Medication containing testosterone have been championed by each non-public clinics and campaigners akin to TV presenter Davina McCall. It is typically described because the ‘lacking piece of the jigsaw’, taken alongside commonplace HRT to revive a lady’s joie de vivre in center age.
Fb and Instagram accounts of self-styled menopause specialists with 1000’s of followers are crammed with comparable claims.
Topping up testosterone ranges can rework a lady’s flagging libido, they are saying, banish mind fog, and enhance vitality and temper. In the long term, advocates add, it may even stave off dementia, enhance bone power and keep muscle mass. Such statements have thrust testosterone into the highlight as one other hormone which – like oestrogen and progesterone – ought to be changed as ranges decline with age.
Medication containing testosterone have been championed by each non-public clinics and campaigners akin to TV presenter Davina McCall (pictured)
Final week, figures revealed how highly effective the so-called ‘Davina impact’ has been. NHS prescriptions for testosterone gels have rocketed ten-fold within the final seven years, with a major uptick following the airing of Davina McCall’s documentary on the topic.
The info, from a Freedom of Info request by the Pharmaceutical Journal, revealed 4,675 ladies over 50 have been prescribed testosterone in November 2022 alone – up from 429 in November 2015. The identical sample was true for girls aged 49 and below.
However specialists have identified these figures are solely the tip of an iceberg. GPs stay cautious about prescribing the hormone – partly as a result of there isn’t a licensed testosterone drug particularly for girls within the UK.
Much more sufferers are thought to get it privately, at a major private price, from non-public docs: the identical docs who’re extolling its advantages the loudest. It means the true variety of ladies taking it stays unknown, nevertheless it may run to greater than 100,000.
Talking to The Mail on Sunday, docs and scientists say there isn’t a proof to justify a lot of the claims relating to testosterone.
Ladies are being exploited, they argue, by those that say the hormone gels are ‘the reply’ to their menopause issues.
They warn that, with out applicable supervision, sufferers may find yourself taking the hormone once they do not want it, or taking an excessive amount of – risking a variety of unwanted side effects together with pimples, extra hair development, greasy pores and skin and even voice adjustments. Additionally they warn of a situation referred to as clitoromegaly, which causes the clitoris to change into completely enlarged.
Hormone specialist Dr Annice Mukherjee mentioned: ‘Ladies are being hood winked to some extent. Testosterone is a development, pushed by social media, which guarantees a one-size-fits-all method to the menopause which is solely not the truth. When the fitting ladies get it, it is transformational. When the mistaken ladies get it, it will possibly trigger hurt.
‘Some are struggling to feed their households throughout a cost-of-living disaster, and are being rightly instructed by their GP they do not want testosterone. But they really feel they’re being deceived due to what they’ve heard on-line. Many pay a whole lot of kilos a 12 months privately for it.
‘I’ve by no means seen a lot confusion and misery amongst ladies as a result of they really feel they can not pay money for what they assume they want. It’s so mistaken.’
It has been two years since The Mail on Sunday grew to become one of many first newspapers to query whether or not extra ladies ought to be given testosterone throughout menopause.
Then, campaigners, docs and girls spoke concerning the profound advantages of taking the hormone, notably if – after beginning commonplace HRT – they have been left with signs together with low libido, low temper and mind fog.
One was Haitham Hamoda, then-chair of the British Menopause Society, who referred to as for extra ladies to be given entry to the hormone. However Dr Mukherjee says the pendulum ‘has now swung too far in the wrong way’ – and too many ladies are being led to imagine they want the treatment however are unlikely to profit.
‘Some non-public clinics appear to be giving it to each affected person,’ she says. ‘That is a priority.’
In males, testosterone is concerned in muscle and bone development at puberty, and, in maturity, for the event of secondary sexual traits akin to physique and facial hair and sperm manufacturing.
As ladies do not produce as a lot, they do not develop these ‘male’ traits. Nonetheless, the hormone additionally will increase ranges of dopamine within the physique, a chemical messenger essential to mind well being and which performs a job in pleasure, focus and decision-making.
INFLUENCER: Davina McCall exhibits her 1.6million Instagram followers how she makes use of testosterone cream
Testosterone ranges in ladies change all through life, through the menstrual cycle, and even fluctuate all through the day – however are thought to say no across the time of the menopause.
The perfect proof on the position the hormone performs in menopause comes from medical trials into testosterone medication, which have proven the treatment can enhance intercourse drive.
That is why pointers from NHS watchdog the Nationwide Institute for Well being and Care Excellence (NICE) advocate that if ladies nonetheless have a low libido after beginning HRT they could profit from a testosterone gel.
No product particularly for girls is licensed within the UK, however Androfeme – an Australian product designed for girls – is offered privately. Medical doctors also can prescribe smaller doses of male merchandise akin to Testogel or Tostran.
Former president of the Worldwide Menopause Society Susan Davis, professor of girls’s well being at Monash College in Melbourne, carried out a overview of the very best high quality trials which was printed in The Lancet in 2019.
‘The proof that testosterone might enhance sexual curiosity and scale back any misery related to that, is irrefutable,’ she says.
However the overview additionally discovered there was not sufficient proof to advocate testosterone for another motive. Research have checked out whether or not it will possibly enhance cognition and bone well being, scale back muscle wastage and enhance temper, with a number of printed since 2019.
‘In all circumstances – other than libido – the info is unreliable and exhibits no profit,’ says Prof Davis.
‘There’s sufficient information on normal wellbeing to say there isn’t any profit to temper. A trial taking a look at ladies with main melancholy discovered no proof of advantages.’
She provides: ‘For cognitive operate, bone and muscle, which we’re notably eager about, the obtainable information persistently exhibits no proof of profit from medical trials or from observational research.
‘For the time being, on this proof base, you would be prescribing [for these reasons] on a whim. It is deceptive to counsel there are different advantages. We don’t know.’
But Dr Paula Briggs, chair of the British Menopause Society, and sexual and reproductive well being guide, says ’round half’ of the ladies coming to her NHS clinics accomplish that as a result of they need testosterone.
Many have been ‘coached’ in what to say to get a prescription.
Dr Briggs says: ‘If a lady does not say her libido is poor, then going by the NICE pointers I am unable to prescribe. Ladies are sharing info that testosterone helps with every kind of issues, and training one another to say they’ve low libido, even when they do not, as a way to get the treatment. That is not truthful for sufferers who might not see the advantages they’re promised.’
One menopause campaigner illustrated this completely when she posted on Twitter final week: ‘Ladies solely say they need testosterone for libido as a result of they know their GPs will not give it to them if they are saying it is for menopause lethargy. We’re not silly.’
Greatest follow means docs ought to first rule out different potential causes of low libido akin to melancholy or relationship issues. Ladies ought to then have a blood take a look at to measure their testosterone ranges. This isn’t to see if they’re low, however to verify they don’t seem to be already excessive earlier than the hormone remedy is began, as topping up excessive ranges can result in unwanted side effects.
‘ ranges normally does not all the time correlate with signs,’ Dr Briggs explains. ‘You possibly can line up ten ladies, with ten totally different outcomes, and those with the bottom testosterone may need the most effective intercourse drive.
‘It is sophisticated. The primary factor is you do not wish to give them an excessive amount of.’
She’s going to give sufferers a low dose in the event that they meet the factors. ‘It’d make issues higher,’ she says. ‘We do one other blood take a look at at six weeks once I’d anticipate testosterone to shift to the higher finish of the conventional vary. After six months, if there isn’t any profit, it ought to cease.’
A number of docs who spoke to the MoS mentioned they knew GPs who had been ‘threatened’ by sufferers in the event that they refused to prescribe testosterone. Dr Mukherjee mentioned: ‘Some sufferers are telling GPs they will sue if they will not prescribe. Some come to my clinic and complain their GPs are ineffective. I inform them to query social media, not their physician.’
On Fb boards, dozens of girls declare their temper improved ‘inside days’ of beginning testosterone. However Prof Davis argues that is largely a placebo impact.
‘Within the trials, the results of libido begin to kick in at round 4 weeks, and peak at three months,’ she says.
‘It stopped me feeling as if I used to be fading away’
Mail on Sunday Journey Editor Sarah Hartley
Sarah Hartley, 51, is The Mail on Sunday’s Journey Editor. She lives in Kent together with her associate and eight-year-old daughter. Sarah says:
I started on testosterone final 12 months, and it has been a revelation.
I used to be already on commonplace HRT, which had efficiently tackled most of my signs – the aches, pains and sizzling surges (which I really fairly preferred, as somebody who’s all the time chilly).
Throughout a medicine overview I instructed my gynaecologist how properly I used to be getting on, however that I nonetheless felt a bit flat.
We mentioned testosterone. I might learn it may have all kinds of advantages, when taken alongside oestrogen and progesterone HRT. He requested if I had misplaced my ‘joie de vivre’ – by which he meant libido.
The reply was no. However I felt as if my colors have been fading – passive, muted one way or the other, and as if I used to be receding into the wallpaper of life.
And, worse, I nearly did not thoughts. I began to know the faces searching at me from previous household pictures; feminine kin of the identical age whose smiles weren’t as vivid as earlier than, their laughter not as heartfelt.
Testosterone gel was prescribed and now I would not be with out it. Davina is true – it does not make you develop a penis, however for me it does contribute to slight hair development the place it is utilized three days every week on my stomach, simply eliminated throughout my common salon appointments.
The outcomes of testosterone have been refined however profound. The world seems to be a brighter color and my considering is sharp so I really feel I am again within the race and – in life and dwelling properly.
Is it a placebo?
I’d argue strenuously not – the dose and the outcomes work for me.
‘Something earlier goes to be placebo. If you happen to’ve bought charismatic non-public docs telling ladies testosterone goes to make them really feel higher, initially they may. And so they’re paying some huge cash to really feel higher.’
Dr Mukherjee agrees: ‘Ladies will instantly really feel a profit as they really feel empowered after getting the remedy. That could be a highly effective enhance to your psychological well being.’
The opposite large concern is that sufferers might take an excessive amount of. Public well being specialist Dr Ash Paul warns ladies are sometimes not correctly supervised after getting their prescription, and should enhance their dose if they do not see an impact. Dr Briggs recalled one affected person who confessed she’d been taking almost every week’s value every single day.
Additionally on the boards, ladies talk about experimenting with their dosage. One described how she had became a ‘sexy teenager’ after bumping up the prescribed quantity when she didn’t see a profit after only a few days.
One other complained her GP wished her to cease taking testosterone as a result of her ranges have been too excessive – whereas a non-public physician instructed her it was ‘nice’ to proceed if she wasn’t experiencing unwanted side effects.
Specialists say so long as testosterone stays inside the regular vary – equal to a standard degree pre-menopause – there’s nothing to fret about. However identified unwanted side effects of an excessive amount of embrace pimples, greasy pores and skin, complications, adjustments in temper and extra hair.
In trials, ladies experiencing these points didn’t usually drop out, says Prof Davis, suggesting they weren’t extreme. Extra severe points embrace male sample baldness: dropping hair from the top, however gaining it elsewhere. It could possibly additionally trigger the voice to change into deeper and extra masculine.
Dr Mukherjee describes seeing one affected person – an expert singer – whose profession was in jeopardy when her voice ‘grew to become croaky’ after being prescribed testosterone by a non-public physician.
‘Nobody was monitoring her ranges, regardless that it was famous as excessive the earlier 12 months,’ she provides.
There are additionally questions over the impact of testosterone on the guts. It’s identified that males who take anabolic steroids – which embrace testosterone – to extend muscle mass usually tend to undergo coronary heart illness and strokes.
Dr Briggs says: ‘If you happen to use an excessive amount of [testosterone] it is identical to taking an anabolic steroid.’
Specialists agree extra analysis is required. Prof Davis is ready to begin a number of large research investigating if giving testosterone in menopause can have an effect on muscle wastage, bone power and cognitive operate.
However within the meantime, specialists say there additionally must be extra oversight of an business which has spiralled uncontrolled.
‘We now have to place the brakes on,’ says Dr Briggs. ‘I’ve heard that testosterone is the lacking piece of the jigsaw. But it surely’s not.’