Testosterone Therapy for Menopausal Women: Evidence, Benefits, and Safety

Short summary

In this Science Weekly episode from The Guardian, Madeleine Finlay investigates the role of testosterone in peri and postmenopausal women, exploring what the evidence says about libido, mood, and cognition, how testosterone is measured in women, and the safety considerations and access barriers that shape real-world use. The piece highlights the gaps in women’s healthcare and the ongoing research into appropriate dosing, formulations, and monitoring to ensure safe, effective use.

Introduction

This Science Weekly episode from The Guardian opens by shifting the common perception of testosterone as predominantly a male hormone. It explains that women also produce testosterone, which contributes to the synthesis of oestrogen and to various body functions. The discussion situates testosterone within the broader context of peri and postmenopausal symptoms, where low sexual desire and other symptoms can occur, and where some women seek testosterone therapy as an adjunct to estrogen-based HRT. The episode frames the central questions: What does the evidence actually say about testosterone’s benefits for menopausal women, what are the risks, and why is access to treatment so variable?

The hormonal story and the evidence base

The episode reviews evidence from trials and guidelines, emphasizing that there is good, consistent evidence that in postmenopausal women with low libido, testosterone can improve sexual desire. It also notes that there is no robust evidence that testosterone helps with most menopausal symptoms such as mood swings or brain fog. The NICE guidelines are cited as allowing consideration of testosterone for menopausal women with low sexual desire if standard HRT does not help, after appropriate dose adjustments. The host and researchers discuss how testosterone levels decline with age but there is no proof that menopause itself triggers a drop in testosterone that drives menopausal symptoms. "There are no symptoms in women that have been shown to be associated with low testosterone in any reliable study." - Professor Susan Davis

Measuring testosterone in women

A key theme is the difficulty of accurately measuring testosterone in women. Testosterone levels in women are very low, and most measurement platforms struggle to distinguish normal from low or very low values. The episode quotes Professor Susan Davis on the measurement challenges, including the idea that blood levels may not reflect cellular testosterone activity, which can vary between individuals. "Measurement of testosterone is very complicated for several reasons." - Professor Susan Davis

Personal experiences and patient pathways

The narrative includes Linda Geddes, The Guardian science journalist, who describes her personal journey with perimenopause and ultimately testosterone therapy as part of her treatment alongside HRT. Linda shares that testosterone helped with libido for her, though she cautions that expectations about mood and brain fog should be tempered. She also discusses the practicalities of accessing testosterone on the NHS, including referral to specialist clinics and the waiting times that can complicate timely treatment. "I've been taking it for just over a year now, and I do think it's made a bit of a difference." - Linda Geddes

Safety, regulation, and what comes next

The episode emphasizes that there is little long-term safety data for testosterone use in women beyond the pre-menopausal range, and that potential risks at higher doses remain uncertain. It discusses side effects observed in high-dose cases and the lack of female-specific formulations in the UK, though a MHRA-approved product for women may become available. The conversation also notes the risk that high demand and access barriers push some women toward private care or unregulated sources. "Based on my experience, if you're expecting testosterone to have a big impact on your mood, on your brain fog, you're gonna be disappointed." - Linda Geddes

Takeaways and future directions

The final segment highlights that testosterone is not a magic elixir for all menopausal symptoms, but it can help a subset of women with low libido. It stresses the need for better understanding of female-appropriate dosing, mechanisms of action at the cellular level, and more comprehensive safety data. The episode ends with a commitment to ongoing trials and careful, evidence-informed use of testosterone in women, acknowledging both the potential benefits and the important remaining questions about risks and best practices.