Further advice and support Menopause & PMS www.the-bms.org (British Menopause Society) This leaflet has been written by staff working in the www.menopausematters.co.uk Menopause & PMS service at Chelsea and Westminster www.womens-health-concern.org/
Hospital for clinics at Chelsea and Westminster Hospital and West Middlesex Hospital.
Take home messages Patient Advice & Liaison Service (PALS) • Testosterone is prescribed as part of hormone replacement therapy (HRT) If you require information, support or advice about our • Indications for replacement include low libido, low services, you can contact the PALS office on the Ground Testosterone energy and tiredness Floor of the hospital just behind the main reception. • Testosterone should be prescribed with HRT after a Alternatively, you can feedback your comments or replacement for surgically induced menopause suggestions on one of our comment cards, available at • Not all women respond to testosterone the PALS office, or on a feedback form on our website replacement; other factors should then be www.chelwest.nhs.uk/pals. We value your opinion and female androgen investigated invite you to provide us with feedback. • Excess testosterone replacement may cause acne, hirsutism, alopecia, voice changes T: 020 3315 6727 deficiency • Testosterone side-effects are dose dependent and E: [email protected] minimised by reducing the dose • Testosterone gel is used off-label in women Chelsea and Westminster Hospital syndrome • Testosterone implants are available but are 369 Fulham Road unlicensed London SW10 9NH
T: 020 3315 8000 Total Testosterone: Information for patients W: www.chelwest.nhs.uk SHBG: September 2017
FAI
Date:
Reference range for FAI 1-6 FAI=(TT/SHBG)x100
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is still valid and off-label used of other licensed products Will my libido improve? Testosterone and Female Androgen Deficiency are frequently used. The loss of libido can be very distressing for some women. Other factors may also have a significant What does testosterone do in women? What is testosterone gel affect including psychological, emotional and other Testosterone is one member of a group of hormones Testosterone gels are used to help improve sexual libido health problems. It may be useful to see a called androgens. Although it is commonly thought of as and energy levels. Three products are used: psychosexual counsellor who can give practical and a male hormone, testosterone is also very important in emotional support. women. It has a role in sexual function, energy levels, • Testim Gel 50mg/5mls with a screw cap. The cognition, bone health and vaginal health. Around 50% of preferred product due to ease of use and storage. What are the side-effects of testosterone? testosterone is produced by the ovaries and 50% by the • Testogel 50mg/5mls in foil sachet. Second line Side-effects are related to menopause status, use of adrenal glands. Testosterone can act directly on tissues, choice if Testim unavailable. It should be sealed and hormone replacement and personal genetics. but some of effects may be because it is converted into stored in the fridge once opened. Therefore, testosterone is usually only prescribed to oestrogen, which occurs mainly in fatty tissue. These two gels are used similarly. Each tube or sachet women who are already on some form of hormone used sparingly over 7-14 days and applied variously to replacement therapy. What is Female Androgen Deficiency syndrome (FAD)? the thighs, lower abdominal/pubic area or wrists. The In women, the production of testosterone declines from dose is titrated according to benefits and side effects. Individual response to testosterone is widely the mid-thirties onwards. A natural menopause is not variable. Side-effects are dose dependent and associated with a sudden drop in testosterone, however, • Tostran 2% in a metered canister. Third line choice include: when ovaries are surgically removed (surgical as it is twice the strength of other gels and has • Hirsutism, increased facial or body hair menopause), a woman may experience rapid and increased risk of side effects. Usually used where (common) significant androgen deficiency symptoms. other modalities have failed. • Alopecia, male patter hair loss (less common) One metered dose twice weekly. Maximal dose is three • Acne and greasy skin (less common) Lack of testosterone may result in low libido, lack of times per week. The dose is titrated according to benefits • Deepening of voice (rare) energy, increased tiredness, difficulty concentrating or and side effects. Applied as for testim gel above. • Enlarged clitoris (rare) headaches. How do I use testosterone gel? When should you not use testosterone gel A diagnosis can be made on personal history alone. A • Apply to clean dry skin and allow to dry before • If you are pregnant or breastfeeding blood test is generally not required but may be useful getting dressed • If you have a history of hormone sensitive breast where there is diagnostic uncertainty. • Do not allow skin contact with partners or children cancer • Wash hands immediately after applying to your body • If you are a competitive athlete and anabolic What other effects does testosterone have after the • Do not wash the area for 2-3 hours after application steroids are banned menopause? • Keep medication out of reach of children After the menopause oestrogen levels fall to Are there any alternatives to testosterone gel? undetectable levels. Consequently, the small amount of Is blood test monitoring required? Testosterone implants may be indicated for some remaining testosterone may also cause male type Blood tests for testosterone is not essential but can be women when other products have not provided symptoms, especially increased facial hair growth and useful. The test is not very sensitive in women and there benefit. male pattern baldness. However, personal genetics have is no consensus on the normal female range. The relief of a significant influence upon this and not everyone symptoms and lack of side-effects is a more sensitive experiences these effects. assessment than blood tests monitoring.
Is testosterone replacement licensed in women? GPs are generally only able to measure total All previous licensed testosterone products for women testosterone. Measuring the free testosterone or free have been removed from the market. This was for androgen index (FAI), is more useful assessment and may commercial not safety reasons. However, the safety data have to be requested by the specialist.