The use of testosterone therapy among menopausal women, popularized by celebrity endorsements, is facing increased scrutiny due to concerns about potential links to heart disease and other side effects, according to medical experts. Demand for testosterone treatments among women experiencing menopause has risen significantly, with one study indicating a 15-fold increase in England over the past decade.
Advocates, including figures like Davina McCall and Kate Winslet, have spoken out about testosterone gel as a solution for symptoms such as low mood, brain fog, and decreased libido. However, Dr. Channa Jayasena, a medical expert, warns that these testimonials often omit crucial details about the risks involved. At best, the hormone may be ineffective, and at worst, it can lead to side effects like hair loss, acne, and voice changes.
Recent findings presented by U.S. researchers suggest that women taking testosterone are approximately eight times more likely to suffer from heart disease compared to those on traditional hormone replacement therapy (HRT), which typically combines estrogen and progesterone. This increased risk was observed even with relatively low doses, a point of concern given that cardiovascular disease is the leading cause of death for women.
While testosterone plays a role in women's sexual desire, its efficacy for broader menopausal symptoms like brain fog, low mood, or fatigue is not well-supported by clinical trials. Studies have shown 'insufficient' evidence for its benefit in treating brain fog, with only about one in ten women reporting symptom relief in trials. Current UK guidelines recommend testosterone for low sexual desire that significantly impacts quality of life, and only after standard HRT has been attempted. It is not considered a first-line treatment for other menopause symptoms.
Experts are worried about the long-term cardiovascular effects, as testosterone could potentially raise levels of 'bad' cholesterol and blood pressure, both significant risk factors for heart attack and stroke. While testosterone is known to increase these risks in men, the concern is that women using it unnecessarily or at higher doses could face similar dangers.
The availability of testosterone products specifically licensed for women in the UK is limited. Consequently, women are often prescribed smaller doses of male-formulated products, which can make accurate dosing challenging and increase the risk of unintended higher intake. This poses a particular danger for women with conditions like polycystic ovary syndrome (PCOS), who may already have elevated testosterone levels.
Potential side effects from excessive testosterone can include hair thinning, acne, and vocal cord thickening, which can result in a permanent deepening of the voice. Dr. Jayasena suggests that some private clinics may be overprescribing the hormone, often without adhering to established guidelines that prioritize trying HRT first. He emphasizes that for most women, traditional HRT is sufficient to alleviate menopause symptoms, and lifestyle changes such as adequate sleep, regular exercise, and avoiding caffeine and alcohol can also help naturally boost testosterone levels and improve libido. The effects of testosterone are generally reversible upon discontinuation, offering a safe exit for those who wish to stop treatment.