For Michelle Burgess, life had become intolerable. The monthly hormonal migraines she had long suffered were lingering far longer than normal. Her libido had all but vanished. And her mood was so flat that she no longer had enthusiasm for anything. Then there was the brain fog, which was ‘debilitating’.
The 53-year-old businesswoman from Whitstable, Kent, says: ‘If I could have stayed in bed all day, every day, I would have. I felt like I didn’t know myself any more – I was completely lost in my anxiety.’
Last October, a visit to her private doctor confirmed what she had suspected: like many women her age, she was in the throes of menopause.
Michelle, who runs pet gift shop called Scruffy Little Terrier, was promptly prescribed standard hormone-replacement therapy (HRT), which tops up dwindling levels of the female sex hormones oestrogen and progesterone, helping alleviate menopause symptoms.
But her doctor also gave her another treatment that few women in the UK can currently access on the NHS – a cream containing testosterone. Often assumed to be an exclusively male sex hormone, testosterone is also produced by women – at far lower levels, which decline with age.
Michelle Burgess, 53, from Whitstable, Kent, who runs Scruffy Little Terrier, started on testosterone cream in October and no longer has low libido, brain fog or anxiety
Experts agree that topping up testosterone at the same time as giving standard HRT can prove ‘transformative’ for some women, particularly those who suffer from a reduced sex drive and low mood.
Support groups online are brimming with stories from women who are evangelical about the treatment, crediting it with giving them back their ‘va va voom’.
Michelle is now one of them. She began to notice the effects after a month. She says: ‘My brain fog has lifted, I have more energy and just more enthusiasm for doing things.
Your amazing body
Have you ever noticed that it is difficult to swallow twice in a row?
When we swallow food or liquid, the presence of these substances in the back of the mouth stimulates nerves in throat and the oesophagus, the tube which connects the throat to the stomach.
Muscles in the throat and oesophagus contract in waves, moving whatever you have consumed into the stomach in a process called peristalsis.
When you force yourself to swallow with no food or liquid in your mouth, you swallow saliva.
By your second swallow you will have less saliva in your mouth, so the nerves that normally trigger peristalsis aren’t stimulated, making it harder for the contraction to happen.
‘There’s been an improvement in my libido too – the spark has been reignited. My husband has noticed that I’m joking and dancing around again, back to my old self.’
Yet experts say thousands of women who could benefit from testosterone are not – and most are even unaware it could help.
The problem is that there is no testosterone-containing medicine specifically licensed for women in the UK, only for men. And because of this, most GPs don’t prescribe it.
This is despite it being recommended by prescribing watchdogs the National Institute for Health and Care Excellence (NICE) in 2015, and an international group of leading medical bodies agreeing it was safe and effective for women during menopause after a review of the evidence two years ago.
Experts are today calling for this situation to change. Several leading specialists in menopause care have told The Mail on Sunday that using testosterone is a ‘no-brainer’ and that GPs should consider all women suffering menopausal symptoms for the treatment.
Haitham Hamoda, chair of the British Menopause Society, said: ‘There’s a wealth of data that this works really well, going well over two decades. There’s no argument about that. It improves sexual desire, and also energy and low mood too. Women say they experience this lift in their energy, this renewed sense of get up and go.
‘But while access is improving, it doesn’t go far enough. Not all GPs are aware of the NICE guidelines, or that it can be used for women.’
Natural testosterone levels peak during a woman’s 20s and 30s, when the body produces up to four times as much of the hormone as it does oestrogen. Testosterone increases levels of dopamine in the body – a chemical messenger crucial to brain health that plays a role in thinking, decision-making and pleasure. Levels start to reduce years before the menopause begins.
If, after starting on standard HRT treatment, women are still left with specific symptoms such as low libido, headaches, insomnia and low mood, then extra testosterone may be the answer, say experts.
Research in this area has focused largely on how the treatment improves sex drive.
Privately, testosterone cream or gel costs about £50 for a one-month supply
The products are safe, with the main side effects being acne and extra hair growth – and both problems disappear when the treatment is stopped. It can be particularly beneficial to women who go through an early menopause before they reach 40, and those who have their ovaries surgically removed, according to Michael Savvas, consultant gynaecologist at King’s College London.
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While testosterone was historically linked to an increased risk of heart disease, recent studies have found that, in fact, men and women with low testosterone are more likely to have heart problems. ‘Testosterone may protect the heart,’ Mr Savvas says.
‘It also probably helps maintain muscle mass, and we think it also helps women avoid [the bone disease] osteoporosis.’
So why aren’t more women being given it? Katie Taylor, founder of The Latte Lounge, an advice site for women over 40, has received ‘thousands’ of emails from women, some of whom have classic symptoms of testosterone deficiency. ‘None of them know about testosterone as a treatment,’ she says.
‘When I tell them they say they don’t want to be a man and develop muscles and grow body hair. Even when I send them information about it to take to the GP, they say doctors won’t prescribe it because it isn’t licensed.’
Privately, testosterone cream or gel costs about £50 for a one-month supply. Katie, 51, has benefited ‘hugely’ from the cream, although she said a pharmacist was initially reluctant to give it to her. ‘I had to explain the NICE guidelines to them,’ she said.
Part of the problem is that a simple test to detect testosterone levels is not helpful on its own.
‘One woman with symptoms of testosterone deficiency could have the same levels as another woman with no symptoms at all,’ Mr Savva says.
‘Symptoms are what a doctor should go on. And sometimes these – sex not being what it was, a lack of energy – can easily be put down to a busy life or a long-term relationship.’
Administering testosterone is not always easy. Some creams come in pre-packaged sachets. While men prescribed testosterone use one sachet a day, women need just one tenth of one, Mr Hamoda says.
It’s a fact
Australia is the only country in the world to license the use of testosterone cream for postmenopausal women experiencing low sexual desire and other menopausal symptoms.
Testosterone treatment also requires regular monitoring by GPs. ‘What you prescribe first is just the starting point,’ Mr Hamoda says. ‘The next question is, how much of it are you absorbing? And, then, how much do you need? There’s a lot of tweaking.’
The situation could be set to change. One product designed for women, AndroFeme, was given an Australian licence at the end of 2020.
It is understood the company behind it plans to submit an application for a UK licence later this year.
‘From a practical point of view, this could be really important for patients and GPs,’ Mr Hamoda said.
‘The tube is pink. The leaflet will talk about a female-licensed product. Those who don’t feel comfortable with the male products could see this differently.’
Women who think they could benefit from testosterone should contact their GP and ask to be referred to a menopause specialist.